10 weeks post-surgery from RFF phalloplasty with the New Victoria Team (Mr Rubin). NVH Team like to do a full-thickness graft harvested from the buttocks - makes recovery a little rough (I had some crazy complications I'll share once they're resolved) but I'd choose it again every time.
I went non-dominant arm - shoutout to anyone who goes dominant I can't imagine how much harder that makes recovery.
Arm is coming along gorgeously despite healing some other issues at the same time. I haven't documented it as well as the other parts but I still have some stuff to share.
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Week 0 (Admission)
Had a wound vac on for the first 5 days of my admission, woke up in recovery feeling like my arm was gonna explode, but did a party trick where I told myself "Hey it's not painful, it's just a strange sensation you've never experienced before. It's intense but it doesn't hurt.". Didn't hurt at all after that, and actually started to lowkey enjoy the vac sensation. Arm was in a vertical sling for the whole duration of the admission.
Did have some numbness/pins and needles in the back of my hand, but think it was because of how tight the bandage was. Resolved as soon as I got a dressing change. But otherwise retained full sensation and the range of motion I was allowed to do (moving fingers at the MCP joints only). Also not much hand swelling at this point.
Picture 4 is the day I got the vac off.
Week 1
Had a homemade vertical sling which came clutch for sleeping this week. During the day also mainly kept arm vertical w a pillow for support.
Pain was non-existent for the most part - did have one night (day 12 I want to say) where I slightly awkwardly twisted my wrist so had some crazy shooting pains for a few hours. But popped a codeine and it was gone by morning. Did find even gently moving my fingers side to side this week caused some gentle shooting pains.
Allowed to start elbow flexion - was roughhhh at first, got to maybe 60% straight but got worried about tingles under the bandage.
Try and moisturise your hand! The dry skin where the bandage rubbed was the main pain I had.
Hand swelling popped up a bit but never got bad enough to need compression. Did some drainage massages to settle things down.
Dressings were changed weekly by my beloved NVH CNS's (I live close enough to be managed by my surgical team). These changes were super light with a quick rinse down but no de-roofing of blisters or anything fancy.
Picture 5 is from the dressing change this week.
Week 2
Minimal pain again, stopped using the sling as the arm was feeling less fragile and I heard a horror story about someone who vertical slinged too much and it caused issues. My shoulder also started getting a little grumpy but made more of an active effort to keep my shoulders level and it settled.
Elbow flexion was at c.85%, wrist flexion started and only had about 20% forwards and 40% backwards motion.
Hand swelling popped up a bit more this week, led to some discomfort but wasn't bad enough to need compression.
Dressing changes still weekly by NVH, but got less bulky.
No pictures from this week :(
Week 3-5
Range of motion carried on improving, it's a marathon not a sprint - I found I was getting back a few degrees of motion a day with careful repetition of exercises. Worst part was after waking up as my arm would have been pretty still all night so everything felt stiff and tight but gentle stretching did the trick to get him back to normal. Also now allowed to play video games as hand rehab so that was a huge W.
Big dressing ended and daily salt baths started - soak that kiddo in warm water and a handful of salt for 10-15 minutes then redress. Don't touch any of the graft that doesn't look like healed skin - rule of the road is less is more. Best purchase was a plastering trough that was the perfect size for bathing him.
Any areas that do look healed can be massaged with unscented moisturiser, but I found once again less is more - the graft at this stage didn't absorb like normal skin so I had to be careful to not use to much and leave some surface grease on him. Also made to sure to moisturise the surrounding skin including the hand as the salt bath did a number on me.
Dressings now done at home, some Atrauman to keep him moist and protected, then a layer of gauze and a dressing pad for protection all held in with a tubigrip - pretty lowkey. Once problem areas sprang up I learned through honey and alginate all things are possible, carry on dressing it as I was with a little bit of honey and alginate over any open areas.
Picture 6 was after his first homebath, Picture 7 was a few days later. He starts to look crazier before he gets better but weeks 3-5 were pretty much just a slow evolution of salt baths and surface scabs coming off.
Picture 8 / Picture 9 were at the back end of week 5 and the day he got a fair amount of love from the CNS - stitches removed and he starts to look like a real arm. Picture 9 that white spot in the middle is a little bit of graft failure leaving the tendon exposed but it's infilled amazingly and if anything it's just kinda cool 😅
Week 6-9
90% of the graft was perfect, but the gap between the grafts and at one edge started to separate / form an eschar.
Picture 10 highlights it pretty well, the white slimy looking bit is the separation between the grafts whilst the big ole scab to the bottom right of it similarly was an eschar forming over some more separation.
Panicked a little at the time but was told it'll just slowly infill itself and if anything the separation in the middle is good as it'll give a bit more range of motion and less scar tightness (can confirm is has done).
Carried on getting more range of motion and strength back, consistency is key. Massage and moisture was also super good - giving more love to any problem areas - corners of the graft/the wrist suture line are my main problem children.
Week 10
Big timeskip but nothing happened for weeks, carried on with honey and alginate and he carried on infilling with no issues.
Mobility is pretty much 100% - I get some tightness at the edges of my range of motion but it seems to get better every week.
Still diligently moisturising and massaging the scars at least every day, with more love to the tiny hotspots at the corners that like to get a little dry.
Pictures 1/2/3 are from this week. As you can see one side of the graft is perfect, even growing back a decent pop of hair. The join between the grafts has filled in gloriously and has lost maybe a tiny bit of depth but worth it for more motion. The edge of the graft is still filling in a little but should be done by this time next week.
In terms of protection and dressing, now just down to a UV sleeve to keep him happy. I have my 3 month follow up (a little early) this Friday so will make a judgement call if I need any silicone treatments, but when I chatted with my CNS last week its seeming like I might not need it as long as I carry on treating it the way I am.
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Any questions feel free to DM me or comment. Like I said I've got a few other posts to make about the recovery of the different surgical sites (arm, butt, phallus) but they'll land as things come to a natural reporting point.