Brave Little Angel
November 25, 2008 7:30 AM

Sorry, no pictures yet. Juliana has a "surgical dressing" sutured around the left side of her mouth, which is black and looks like a handlebar mustache. It's temporary and will be removed today, as she goes back to Miami for another skin graft.

When I first saw it, before I realized what it was, I was shocked. I thought it was necrotic tissue, and that the skin flap had failed. But thankfully, that's not the case at all. The skin flap "took" very well, and her suture lines are healing. The area is sensitive and she doesn't allow much touching or cleansing of it, so a lot of that is done while she's asleep, but she's in a lot less discomfort than we were anticipating.

The main challenge has been securing her trach. Usually it's secured by a velcro tie around her neck, but because of the skin flap and sutures, we couldn't put anything around her neck that would constrict that area. The flanges of the trach were being taped—held down with duoderm and waterproof tape. Because of increased oral secretions and drooling, the tape often became loose.

Juliana needed constant supervision to make sure she didn't cough out her trach! Also, changing the loose tape was an ordeal, because her neck was becoming iritated. Finally her sutures had healed enough that we decided to try loosely applying a trach tie, just enough to secure the trach without putting pressure on the skin flap. Thank God, it works! Anyone who's had a dressing removed knows it pulls the little hairs on the skin and it hurts.

Juliana was breaking my heart: trying to be so good and let us remove the tape from her sensitive neck area, but unable to resist trying to get us to stop. I'm so glad we don't have to do that anymore. Next, when she returns from Miami, I'll let you know what's different.

—Jeanne ("Party")