Robert Blum Website

Robert L. Blum, MD, PhD

Sean's Accident

My son, Sean, broke his left (dominant) forearm at the end of April 2008.

He was playing basketball with his college buddies and smashed into the bleachers.

Both the radius and ulna were broken proximally, and his forearm was bent upward at

right angles.

He was ambulanced to Kaiser and was in the hospital for a week.
During that time his arm was opened in the OR and metal plates and screws were placed
to align and hold the fractures. Because of an impending compartment syndrome
- greatly increased pressure inside the forearm - the surgeon had to leave
the radial incision open.

Bouldering in 2007

The picture above shows Sean before the accident. He is doing some bouldering
in Tuolumne Meadows in the Sierras. Note the black dot on his lower abdomen –

a radio transmitter that sends his blood glucose to a receiver every 5 minutes.

In the picture below Sean has just been released from the hospital.
(The wound is 14 by 8 cm.) I was adamant about flying him home from college,
but he wanted to stay and finish the month remaining in the quarter.
Stay in the dorm with a large open wound and diabetes? Impossible!
But he did it!

Kaiser sent out home health care nurses (thank you, Mary Beth and Neil)
to his college dorm and supplied a portable Wound-Vac suction apparatus.
The Kaiser system was at its best, and all of us are immensely grateful.

Early May in the dorm

As an ER doc of many years I was quite pessimistic about this wound closing
without becoming infected. A large open wound with deep devitalized tissue
is a set-up for infection especially in a diabetic.

However, as the weeks went by it seemed we might get lucky.

Because of the atrophy in Sean’s muscles, the resolution of deep inflammation,

and the continual drainage by the Wound-Vac of secretions and edema,

the wound closed to 7 by 3 cm below (after 7 weeks).

Mid June pre-surgery

This picture shows Sean’s One Touch glucometer, the drainage cassette
from the Wound-Vac, and a vinyl periodic table place mat (we were studying organic chemistry).

Now look at the wound. The poles have drawn together and annealed
to form scar tissue. How do the dermal cells know when to start and when to stop?

The wound itself is covered by a grainy mat of new collagen and fibroblasts
– granulation tissue. How is it controlled? Sean, perhaps you can tell me
when you get further along in cell biology.

Finally, a Kaiser plastic surgeon – thank you, Dr. Santoro
- closed the wound completely.(To our relief no skin graft was necessary.)
The photo below shows Sean’s arm two months after the injury.

Early July

ADDENDUM: "After" pictures from March 2009

Sean Arty Guitar

Sean Smiling in Office