Wednesday, December 21, 2011

What is PERCS and why does he need it..

Since so many have been asking me what the surgery James will be having is and why, I figured I would answer all that here and everyone can read at your leisure. I'm nice like that :-) 

Ok so here is the Medical mumbo jumbo. Tendon release is a surgical procedure to cut through or disconnect a tendon  The procedure normally involves cutting the tendon and allowing it to retract towards the junction of the muscle and tendon.  The purpose of tendon release is to identify and surgically remove (resect) the area producing symptoms while protecting the normal surrounding tissues and their attachments. Tendon release may also involve removal of unhealthy surrounding soft tissues or bone to promote an improved healing. Tendon release is commonly done to relieve tightened or shortened muscles or decrease friction irritation. Sometimes the tendon is re-routed (transposed) to maintain muscle function. 

It is common for kids that have had selective dorsal rhizotomy surgery to need this additional surgical procedure  to relieve limited motion in their joints. At James' 1 year sdr follow Dr. Park told us that he believed James would need this surgery, but we all agreed to try and see if a year of stretching and PT would allow us to avoid it. It was a long shot but we tried it anyway.  Dr Dobb's, pediatric orthopedic surgeon, uses a minimally invasive procedure to lengthen the tendons called PERC. This allows the muscle to return to its normal length and enables the joint to straighten. The most common tendons that need lengthening are the hamstring and/or heel cords. They will be also looking at James calf muscle and it is possible that it will be released as well.

The lengthening is done in the operating room through small incisions where a controlled lengthening is performed. No casting is required, which is awesome news. The older version of tendon release require long term casting. Now it is still possible that they will not be able to release what they need to just with the PERC procedure and they might have to do a tradition release as well. That wont be known until we get to St. Louis and see Dr. Dobs. Most kids begin physical therapy the day after surgery. Post-operative bracing is used for standing and advancing with walking. The size of the brace decreases as James get stronger. 

Now the everyday reasons that James needs this surgery. James' stroke caused his CP, and because he could not move and develop normally his hamstrings and tendons weren't stretched like other kids would have been in normal everyday movement. After his SDR his muscles were able to moved but his tendons were shorter than they should be and limited his movement. We have stretched and stretched but just cant make up the gap that is needed for a more normal walking pattern. Yes, there are some con's to the surgery. James will be set back a little but in his rehab but we believe that will be temporary and short-lived. We have gotten the opinions from several different physical therapist and they don't all agree but we have decided that this is what is best for James and our family.

Our local ortho does releases, but we feel that he is not experienced enough for children that have also had the SDR. I trust St. Louis and the extensive experience and research they have with kids like James. Especially Dr. Park. Lets just say that if Dr. Park asked me to stand on my head and spin and sing Dixie, I would be clear my throat  and start spinning! That might sound really extreme to most of you but if you had seen your child's life change by God's guidance and Dr. Park's hands you would understand. so if he put his trust in Dr. Dobb's so do I. That certainly doesn't relieve my worry and anxiety over my son having another surgery. Cause I could right a book on that right now but I am trying to keep all that under control until after Christmas. So there ya go. We are headed up to St. Louis on the 1st but his surgery isn't until the 5th.

*UPDATED 12/22/11* There are specific prayer requests that I would like to ask of my prayer warriors out there. 
1. Our hotel / Ronald McDonald housing 
2. Good Pain management post op
3. James to be calm and fear free during his hospital stay
4. Safe Travels to and from St. Louis


Denise :)

Will be praying for you all as the surgery date approaches. Do you have specific prayer requests (housing, finances, whatever) or concerns I can lift? Love you! :)


This sweet little boy will be in my prayers and I will remember your specific requests. May God be with all of you during this time. Blessings

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