[Resolved for now] Extremely slow recovery after Apex Flex install

[SteffanDonal]

I had my Apex Flex installed on Nov 30th last year.
The installation was not very smooth, but we got it in there.

Today, nearly three months later, it still looks like this:

Bruising

Context

• I’m in the UK; this was my fourth implant install. I had the xNT, xG3 and flexNeXT installed before this.

• Healing times for the xNT & xG3 were roughly a month until entirely “normal”.

• The flexNext took much longer but healed fine. As there was significant pooling, I kept my hand raised essentially for three weeks straight. I attempted to play VR once it looked good, but unfortunately, it swelled again. After that, I kept it elevated until I was sure it was healed. Sadly, the NFC & LEDs have since stopped functioning; otherwise, it’s all good.
  The scar & skin above the implant often shows pink/purple colouration when my hands are cold.

• I booked with an installer from the DT map, but on the install day, I found out that he had stopped taking installs for the Apex form factor as they often take a long time and are riskier than the usual injectables. He graciously decided to do it as he concluded my skin was soft/flexible enough to make it easier. I tipped a fair bit; it was very cheap in the first place.

• He initially didn’t make a long enough pocket. He removed the chip, re-inserted the needle, and pierced the opposite end of the pocket very slightly. This was still insufficient, so he used the needle’s point as a makeshift scalpel to cut a slight pocket under the entry incision.
  Talk about agony, holy shit. Chunters about UK surgery law.

• This worked, and I was advised to avoid bending my wrist for at least a week and to very gently change steristrips/plaster when needed. I followed this advice very carefully; no issues or accidents to speak of. Very little pain after day one.

• Since then, it’s been stable. I’ve been using it regularly. Same colouration day-to-day. Gets more purple in cold weather. Absolutely zero noticeable pain. The only thing remarkable is how long it’s been this way, and a small “ball” of scar tissue at the far end of the implant, where the needle punctured the skin from the inside.

Is this taking an abnormally long time to clear up? Does it indicate any problems?
Is this as good as it gets, or can I expect this to heal fully eventually?

If this had been my first implant, I probably wouldn’t think much of it; but my other three have healed amazingly. I can’t help but wonder if the… less than smooth installation is to blame.

[Coma]

First things first - I’m not a doctor, so take everything I say with the usual grain of salt

@SteffanDonal

The scar & skin above the implant often shows pink/purple colouration when my hands are cold.

I had a FlexNExT, too, and even though it’s been removed over a year ago, this still happens to me as well. I have no clue why this happens, but my hands tend to be slightly blueish anyways when they get cold, so I didn’t think about it much.

@SteffanDonal

He initially didn’t make a long enough pocket. He removed the chip, re-inserted the needle, and pierced the opposite end of the pocket very slightly. This was still insufficient, so he used the needle’s point as a makeshift scalpel to cut a slight pocket under the entry incision.

This all sounds not really optimal… when I first saw your picture, I thought about a scalpel install with sutures, and was immediately like “naaah, sutures, three months later, totally normal”
But for a needle install… well. It looks like it was a pretty rough install.

@SteffanDonal

Does it indicate any problems?

Hard to say, but not neccessarily…
I’d check some other, typical things first - like, is it warm or hot, is it painful (you write it’s not, so that’s a good one), is it swollen (doesn’t look like it is, so another good one), do you have any limited mobility?
If it’s a “no” to all those points, I’d carefully assume it’s “just” a cosmetic problem, just like the purple patches above your other flexy.
If it is painful when you do certain movements with your hand or such, it might be that the pocket is not straight or not “levelled” (because he pierced the end of the pocket, so the needle was supposedly angled) and the implant is trying to adapt to that… this could be a problem.

@SteffanDonal

Is this as good as it gets, or can I expect this to heal fully eventually?

Just speaking from my personal experience with scars and wounds here, they usually get brighter over time, but it can take a lot of time.

And, my usual question - did you talk to your installer about it? To be honest, after your description of the procedure itself, I don’t think he’s very routined in implants, but he might have some interesting ideas about it

[SteffanDonal]

Appreciate the reply, cheers!

@Coma

my hands tend to be slightly blueish anyways when they get cold, so I didn’t think about it much.

Exactly my thought. Not really bothered by it.

@Coma

But for a needle install… well. It looks like it was a pretty rough install.
[…]
did you talk to your installer about it?

It wasn’t great, no
I haven’t reached out to talk to the guy since/yet. Not trying to be rude or anything, but I wasn’t given any easy way to contact him directly, nor was I encouraged to. I got the impression that he took these jobs on as an extension of the typical injectables and then ran into repeated complications. I made it clear I’d be happy to walk away, and there’d be no hard feelings. He talked himself into it. He was obviously happier doing the typical in-and-out injectables…

@Coma

If it’s a “no” to all those points, I’d carefully assume it’s “just” a cosmetic problem, just like the purple patches above your other flexy.
[…]
If it is painful when you do certain movements with your hand or such

Literally zero pain. I can press on it without protest, no movements feel uncomfortable - it looks pretty flat when viewed from the side.

/shrug
I guess I just keep an eye on it. It’s just a bit ugly and I’d like for it to fade at least a little more

[enginerd]

@SteffanDonal

He initially didn’t make a long enough pocket. He removed the chip, re-inserted the needle, and pierced the opposite end of the pocket very slightly. This was still insufficient, so he used the needle’s point as a makeshift scalpel to cut a slight pocket under the entry incision.
Talk about agony, holy shit.

Thick needles are hard to get under the skin but things should go smoothly once the needle is in the fascia. If it was extremely hard to push all the way in, there’s a possibility that the needle never got under the skin.

Can you move the skin over the implant or does the Apex appear to be attached to the skin? And can you still feel with the skin that’s over the implant, or is that area numb?

[Pilgrimsmaster]

is the circled bit the edge of the Apex Flex?
As in can you feel the edge?

To me it looks like it is trying to push its way out.

I dont think the pocket was long enough and it looks like it will continue to be problematic.

My opinion is, I think you should remove it, and relocate it.

Use a custom needle to make the pocket (You could go up to to the black line, which is longer than you need on the newer PCB Flexs)

[SteffanDonal]

@enginerd

things should go smoothly once the needle is in the fascia. If it was extremely hard to push all the way in, there’s a possibility that the needle never got under the skin

Hard to say if it was hard the entire time, I honestly don’t remember. It wasn’t painful much other than the initial entry. It certainly was difficult towards the end of the implant pocket though, not painful. The real pain was him digging to make the little extra pocket.

@enginerd

Can you move the skin over the implant or does the Apex appear to be attached to the skin? And can you still feel with the skin that’s over the implant, or is that area numb?

Testing using a bit of metal I have on my desk, compared with the back of my flexNeXT, it’s significantly less sensitive, very close to “completely numb”. That said, my flexNeXT left me numb for quite a while. I am not able to make the skin bunch up at all on the Apex Flex, whereas I can, just about, on the flexNeXT.

NGL now I’ve made that test I’m left worried that yes, that’s actually what’s happened here.

@Pilgrimsmaster

is the circled bit the edge of the Apex Flex?

It is, yes. That little dot you see appears to be a tiny bit of scar tissue from where the needle punctured the end of the pocket.

[Pilgrimsmaster]

@SteffanDonal

That little dot you see appears to be a tiny bit of scar tissue from where the needle punctured the end of the pocket.

Ah, Not quite as bad as I thought, I was worried it was the “cutting” edge of the implant (Although a through and through is still not great when it comes to implants, but also not the end of the world)

[enginerd]

@SteffanDonal

It certainly was difficult towards the end of the implant pocket though

@SteffanDonal

I am not able to make the skin bunch up at all on the Apex Flex, whereas I can, just about, on the flexNeXT.

NGL now I’ve made that test I’m left worried that yes, that’s actually what’s happened here.

I suspect that it’s in your skin, not under it. And to be fair, I don’t know what to do here? I don’t know for sure if it’ll stay in place, grow out of the skin, or grow into the fascia?

I had a similar problem with a 3mm glassie and decided to get it removed and reinstalled but that was based on my limited knowledge, and x series chips can be autoclaved so it wasn’t a big deal.

As you probably know, cleaning a flex is not as easy but you can always soak it in chlorhexidine for three days or send it to Amal for proper sterilization.

[SteffanDonal]

@enginerd

I suspect that it’s in your skin, not under it. And to be fair, I don’t know what to do here? I don’t know for sure if it’ll stay in place, grow out of the skin, or grow into the fascia?
[…]
As you probably know, cleaning a flex is not as easy but you can always soak it in chlorhexidine for three days or send it to Amal for proper sterilization.

Very much the same here… Right now, it’s not causing any trouble. It’s just purple™️. I assume this is a strictly temporary situation that could get messy…?

@amal: Apologies for the ping; what do you think? Should I CTRL+Z this thing ASAP?
Honestly, I don’t even know where I’d get it done in this country. Finding someone here who’s allowed to scalpel me up is something I don’t have the faintest on where to begin. I’ll take any suggestion

Its current location is quite convenient and I’d probably have to wait a long-ass time for my hand to heal to try the same spot… Bleh.

[Pilgrimsmaster]

@SteffanDonal

Finding someone here who’s allowed to scalpel me up is something I don’t have the faintest on where to begin.

@KaiCastledine @greydoc

[greydoc]

Hi there, someone rang?

Anyway, to business. Sounds like a less than ideal install and I agree with one of the earlier posts that this is probably sitting too shallow, somewhere in the dermis. The discolouration, sensation changes and response to cold is likely because you have interrupted the natural maturation and progression of skin cells from deep to shallow as well as some cutaneous nerves.

Will it get better, maybe, could it get worse or be expelled, maybe too but probably not.

It doesn’t look infected and as long as you have full range of motion with no catching or impingement in the surrounding digits as well as them all being neuro-vascularly intact then nothing urgent needs doing.

I am unfortunately out of the country for work and will be for most of the year.

If you are looking for a legitimate option then a private hand surgeon will take it out for you but it will cost a bit.

[Coma]

@SteffanDonal

Finding someone here who’s allowed to scalpel me up is something I don’t have the faintest on where to begin. I’ll take any suggestion

I don’t know anything about public healthcare in the UK, but if something makes trouble, it should be possible to visit an “official” doctor to get stuff sorted out… my flexy was taken out in a hospital

[enginerd]

@SteffanDonal

Finding someone here who’s allowed to scalpel me up is something I don’t have the faintest on where to begin

If you must get it done with a needle, make sure that your installer tents your skin like there’s no tomorrow. And the resistance should decrease once the tip is fully under the skin.

[Naus3a]

I agree with the people suggesting the placement might be too superficial: possibly it’s just slowly rejecting.

I might consider removal and reinstallation, mate.
And I know it’s tricky to find somebody in the UK; sorry about that.

[SteffanDonal]

I appreciate your response greydoc; it makes me feel a fair bit better
Given you’re off travelling, have you got any advice for me finding a private surgeon? I’ll start throwing search terms at the wall in the meantime.

@Coma

if something makes trouble, it should be possible to visit an “official” doctor to get stuff sorted out

Oh boy, yes, I sure am looking forward to putting just a little bit more strain on an already stretched resource (In all seriousness, I would do it in a heartbeat if I think I needed it, thanks for the reminder)

@Naus3a

I might consider removal and reinstallation, mate.
And I know it’s tricky to find somebody in the UK; sorry about that.

Yeah. I will have to bite the bullet and get on with it. I’ll probably be attempting to get it installed in the same spot again; I’m assuming I have to wait 'till it looks healed, then I’m clear?

I have until today been “comfortable but feeling impatient”. Glad to see people are on the same page about it not being installed correctly.

[enginerd]

@SteffanDonal

I’m assuming I have to wait 'till it looks healed, then I’m clear?

Since it appears to be in the skin and it’s going to be reinstalled in the fascia, I do think that you should be able to get it done shortly after the removal.

It might be possible to do it all in one procedure but doing so could slow down the skin healing process. Although a lot of care must be taken to avoid scratching the device.

[amal]

@SteffanDonal

@amal: Apologies for the ping; what do you think? Should I CTRL+Z this thing ASAP?

I’m glad for @greydoc opinion on this… definitely more qualified than mine.

@enginerd

Since it appears to be in the skin and it’s going to be reinstalled in the fascia, I do think that you should be able to get it done shortly after the removal.

I wouldn’t put it in the same place though… that skin is already stressed enough and healing has been abnormal. If you need it removed they will probably want to use forceps to grip it and pull it out which could cause damage.

Given @greydoc opinion on the matter it might be best to leave it and see how it heals up over time… but if you do want to remove it I can inspect it for damage and resterilize. Installation should be done in a new location though.

[greydoc]

No problem, if you go down the NHS route this would take a while and the referral may not be accepted.

Through the private route you can literally just Google local hand surgeons and you can normally book an appointment.

The only thing to bear in mind is if the skin changes continue to evolve then this may be the start of a process called keloid scaring. A keloid scar is when a scar keeps growing and becomes bigger than the original wound. It can happen if you have too much collagen in your skin. It normally happens following trauma but can with surgery. Unlikely but something to keep in mind.

I agree with others including @amal, if you have it removed I would wait a while before implantation or implant in a different location. I’m also not 100% convinced regarding the safety of re-sanitising an implant following removal due to the likelihood of damage to the surrounding capsule. @amal might have more info on that though.

[SteffanDonal]

Alright, so resolving this thread:

1. I’m gonna sit tight for now and monitor the situation. I’ll report back if anything changes.

2. If I notice that the scar tissue continues to grow, I’ll find a private hand surgeon and get the thing removed ASAP.

3. If I remove it, I’ll get Amal to inspect/resterilize and implant it elsewhere.

Cheers for the help folks, appreciate it

[SteffanDonal]

Hello! I’m back, sadly.

Since my original post, it’s been almost entirely stable; nothing to remark on, and everything is working fine.

Today, I’ve noticed changes.
There’s slight discomfort whenever I move my hand (very slight but noticeable). When I wash my hands, there’s a slight stinging/painful sensation over the implant. The skin appears much more red than usual and glossy over one area. Gently feeling it with my finger, there’s a noticeable “ridge” somewhat toward the center of the implant’s location. I cannot tell with my fingertips, but using my lip, the area is warmer than the rest of the hand. It hasn’t gone away even after several hours.

Here’s a video showing what it looks like, particularly the sheen:

Expand for video

I’ve not done anything recently out of my usual activities, no impacts/squeezes/crushes, other than perhaps lots of walking yesterday.

I’ll keep the thread posted… Not sure what to make of this at the moment.
Pinging @amal & @greydoc