25 replies to this topic

[McRobb]

OK - last week I posted a question about a second flap surgery to add muscle/skin to a pressure sore that heals and then breakes open when we get to 2 hours in the chair. I had lots of reads but no replies so it seems that no one has ever done that on here.

I went to doctor on Friday and he wants to see surgical notes from first surgery 2 years ago (that broke open after 10 days)and do some research on possibiity. Go back next week.

Wondering though, how do you deal with a pressure sore that does not heal and continues to break open when you get up on it? Do you just say this is going to be my life and stay in bed or do you get up knowing that being on it is going to break it back open?

Three times we have had this totally closed and when I reach 2 hours in the chair, no matter how much pressure relief that I do, we get a small opening. Currently I am doing 5 minutes of pressure relief (by leaning back my reclining/tilt chair all the way) every 20 minutes. I thought this was going to be the key as before I was waiting 45 minutes and then doing 15 minutes of pressure relief when this reopened. But once I hit the 2 hour mark, the wound reopened.

Even though it is open in a small area, it heals back if I get off it and go back to shorter time in chair. No infection, very clean but still open.

So do you get up and know that it is going to open and try to live a life? Or do you do the minimum time that keeps it closed and spend your life in bed? If you do get up and let it reopen, is it a case of just waiting for an infection to set in or the wound to get worse and worse?

I guess I had it easy before this sore came along - up all day and driving and doing whatever I could do for a 16 hour day. Since all this, my life is lived in bed and I am not sure that I can keep doing that forever.

Would appreciate hearing your experience and how you handled it. Thanks everyone.

[mellowgator]

mcrobb,

i'm sorry you are suffering so. man i feel for you.

have you tried using a roho? you can let the air out of the cell underneth your sore can get zero pressure? that way you can get up and not disturb the sore.

just a suggestion. good luck to you.

mellowgator

[Zack]

Question?
When these Doctors do the Flap, are they doing anything like inserting a temporary balloon under the skin, so after its closed the skin is Not pulled taunt / tight when your in the sitting position?
Just like you need excess muscle to bend your leg, you need excess skin. If the skin is pulled too tight just like a balloon with too much air it will burst easier!

[paraman]

Where exactly is this sore? I am using a Roho Quadtro Select air cushion which allows me to sit for even 4-5 hours at a stretch. Though I take care not to overdo it. What cushion are you using now?

[Zack]

I've been sitting on a 4 inch Roho for 20+ years, 4 to 9 hours a day. It's never even given me Red skin.
With the Roho cushion the trick is to keep checking that you have enough air in it, without having too much, making it too firm!

[qbounce]

I have a question too. After surgery, how long did you wait before finally getting up in your chair?

I was in a clinitron bed laying supine (flat on my back) for 5 weeks before even beginning a sitting routine.

In fact, my flap site wasn't totally healed at first, so they had me use a tens until around the muscle area to better help the blood circulate, and in turn heal the open area that much faster.

Anyway, you need at least one month to heal your flap surgery before you apply any pressure on it.

[allis53ca]

robb, after 18 months w/my wound...ive decided to just go nutty

[kiwiquad]

Don't tilt/recline your chair, sheering will open the sore.

[McRobb]

Zack, on 11 December 2011 - 01:00 AM, said:

Question?
When these Doctors do the Flap, are they doing anything like inserting a temporary balloon under the skin, so after its closed the skin is Not pulled taunt / tight when your in the sitting position?
Just like you need excess muscle to bend your leg, you need excess skin. If the skin is pulled too tight just like a balloon with too much air it will burst easier!

As far as I know, there was nothing inserted under the skin to keep it loose but that is a good and interesting question. I am going to add that to my list of questions for this current surgeon that I am seeing again next Friday. Thanks.

[McRobb]

McRobb, on 12 December 2011 - 03:21 AM, said:

Zack, on 11 December 2011 - 01:00 AM, said:

Question?
When these Doctors do the Flap, are they doing anything like inserting a temporary balloon under the skin, so after its closed the skin is Not pulled taunt / tight when your in the sitting position?
Just like you need excess muscle to bend your leg, you need excess skin. If the skin is pulled too tight just like a balloon with too much air it will burst easier!

As far as I know, there was nothing inserted under the skin to keep it loose but that is a good and interesting question. I am going to add that to my list of questions for this current surgeon that I am seeing again next Friday. Thanks.

Thanks for all your replies. Let me answer a couple of your questions here: My sore is an ischeal tubroscopy sore - in other words, your sitter bones of your butt. My sore was to the bone and part of the bone had died and had to be shaved to "live" bone during the first flap surgery. I have a 4" Roho cushion now and that was what I have used since my accident in 04 (I have also had an alternating pressure air bed since that time). The first cushion served me well for 5 years and then developed a leak (actually, the whole backing came away from the front molded cushion)that I was not aware of. The cushion went flat while I was in the chair and that is why the pressure sore happened in the first place. I did not know then that the cushion should be replaced every three years at that time. I have made numerous inquiries about different/better cushions but everyone that I have talked to agree that the Roho is the best. We have not tried collapsing the fingers of the cushion under the wound as some have suggested although I have talked to a couple of therapists about doing this and none have advised doing so. And we do keep a check on whether it is inflated properly and it is. I do not move or slide in the seat when the chair is reclined so "shearing" of the area should not be the problem.
After my first flap surgery in Feb of '10, I was in bed lying flat for almost 10 months. 10 days after the surgery, the surgical site broke open completely down to the bone. A wound vac was applied and I had it on for 14 months. I did not even attempt to get into my chair until 8 months after the surgery and then for only a few minutes a day. After a couple of months of that, the wound ceased to heal even though it was quite small by then - maybe 2 X 3 centimeters and only 2 cm deep. So, January of '11, I went back to bed totally - again. Did not get up until the wound was closed totally in June. As I said, we have had the wound open and closed 3 times since then. I am back to staying up for 1 1/2 hours per day now and wound is making progress toward closing again.
I did meet with a surgeon and wound specialist last Friday and he wanted to review surgical notes from the first surgery and do some research before he made any decisions. That is what I expected so was not disappointed in his answer.
As far as going nuts with this thing - I am about there already! Will try to update with what doctor comes up with to let people know what is going on. Merry Christmas, Everyone.

[goose]

I can't offer any advice but I can say MERRY CHRISTMAS. Hope the best for you and an extra dose of sanity is being sent your way.

[willowt]

What is a tens?

qbounce, on 11 December 2011 - 10:02 AM, said:

I have a question too. After surgery, how long did you wait before finally getting up in your chair?

I was in a clinitron bed laying supine (flat on my back) for 5 weeks before even beginning a sitting routine.

In fact, my flap site wasn't totally healed at first, so they had me use a tens until around the muscle area to better help the blood circulate, and in turn heal the open area that much faster.

Anyway, you need at least one month to heal your flap surgery before you apply any pressure on it.

[willowt]

Wish I had advise but I come with only questions:( My BF is also trying to heal a sore (for about 2 years). He gets up bout twice a week and I think that keeps him set back. Anyway, I wondered what you were using in bed to stay off it. We use those neck pillows. They work ok but I wondered if there was an alternative.

I wish you luck with yours

McRobb, on 11 December 2011 - 12:29 AM, said:

OK - last week I posted a question about a second flap surgery to add muscle/skin to a pressure sore that heals and then breakes open when we get to 2 hours in the chair. I had lots of reads but no replies so it seems that no one has ever done that on here.

I went to doctor on Friday and he wants to see surgical notes from first surgery 2 years ago (that broke open after 10 days)and do some research on possibiity. Go back next week.

Wondering though, how do you deal with a pressure sore that does not heal and continues to break open when you get up on it? Do you just say this is going to be my life and stay in bed or do you get up knowing that being on it is going to break it back open?

Three times we have had this totally closed and when I reach 2 hours in the chair, no matter how much pressure relief that I do, we get a small opening. Currently I am doing 5 minutes of pressure relief (by leaning back my reclining/tilt chair all the way) every 20 minutes. I thought this was going to be the key as before I was waiting 45 minutes and then doing 15 minutes of pressure relief when this reopened. But once I hit the 2 hour mark, the wound reopened.

Even though it is open in a small area, it heals back if I get off it and go back to shorter time in chair. No infection, very clean but still open.

So do you get up and know that it is going to open and try to live a life? Or do you do the minimum time that keeps it closed and spend your life in bed? If you do get up and let it reopen, is it a case of just waiting for an infection to set in or the wound to get worse and worse?

I guess I had it easy before this sore came along - up all day and driving and doing whatever I could do for a 16 hour day. Since all this, my life is lived in bed and I am not sure that I can keep doing that forever.

Would appreciate hearing your experience and how you handled it. Thanks everyone.

[nomis]

willowt, on 15 December 2011 - 08:15 PM, said:

What is a tens?

Transcutaneous electrical nerve stimulation which is a simple machine that emits little electrical charges that triggers muscles to contract.

[Wheels08]

I have heard that if you can get a dr to put a wound vac on it just for a while, it can help as you are trying to get it to heal. Besides pulling fresh blood to the site, it also stops pulling or sheering or putting tension on the fragile skin around the wound. I think that would help a lot.

[Salih]

kiwiquad, on 11 December 2011 - 09:03 PM, said:

Don't tilt/recline your chair, sheering will open the sore.

Does that really help bc my dr/nurses always advise tilting+reclining, but it puzzles me bc they say shearing causes breakdown?

[edlee]

Wheels08, on 16 December 2011 - 07:23 PM, said:

I have heard that if you can get a dr to put a wound vac on it just for a while, it can help as you are trying to get it to heal. Besides pulling fresh blood to the site, it also stops pulling or sheering or putting tension on the fragile skin around the wound. I think that would help a lot.

Couldn't agree more. I wore mine for over a year. NEVER stayed in bed, Taped down the fingers on the Roho, under the sore,, but, really,, with that dressing on,, it probably wasn't necessary to do that. I had no flap surgery and although it is scarred pretty badly,, it's never broken open or reaccurred in that place,, so I am a firm believer in WoundVac and moving around.
ed

[S on wheels]

Hello...... I am no wound expert and now I totally respect and fear them. My husband developed a wound at nearly the same site but nothing as serious as yours...... and the doctors and nurses were perplexed about the location as it was not a pressure point it was about one inch below the start of the crack of his bottom. It took weeks to heal even after a lot of care and restricted sitting time. What I believed helped heal the area faster was electrical stim to the area.
I am now a firm believer in Mepilex Border plasters....Expensive but it works.
Since then my husband developed a heel sore and that is now healing after 9 mths. Then two new sores from overnight spasm in bed... Right ankle positionsed itself neatly under left calf........ Volia.... blister and then sore. The minute I see any sort of redness anywhere on his skin, even at the old butt wound site ...... the brigades come out..... Or we end up paying for it..... like his very expensive heel sore.

How come you don't lie on your side in bed? We all know that once a wound site has healed that site, forever, is a weakened area and always needs to be handeled delicately. Have you increased your protein intake? I find that Juven also helps build tissue. I am sorry I cannot get it here in Germany ..... would love to have some.

My advice..... continue to treat the area, restrict sitting time, have the area stimmed for just blood flow, change diet with added protein and of course daily allowance of zinc and potassium, get some Juven. Every little bit counts. Always treat that area as an open sore area even after it heals..........Do your weight shifts....( It annoys my husband when I say that, cuz he is as bad as you are...lol)

You are obviously very strong person to stay in bed for such a long time..... Blessings.

SOW

[richo]

Zack, on 11 December 2011 - 06:57 AM, said:

I've been sitting on a 4 inch Roho for 20+ years, 4 to 9 hours a day. It's never even given me Red skin.
With the Roho cushion the trick is to keep checking that you have enough air in it, without having too much, making it too firm!

j you must be blest with a good arss

[dee342]

I'm really sorry to hear about your pressure mark.

My fiance is currently using a new sall wound vac which is about the size of a ipod nano and the results have been great. Its called PICO and has only been recently inrtoduced to Stanmore hospital, UK. I'm not sure if it would help you but its allowing John to get up and still heal.

Wishing you all the best

[allis53ca]

dee...link to pico ?

[greybeard]

allis53ca, on 05 January 2012 - 10:56 PM, said:

dee...link to pico ?

Here you go. http://possiblewithp...om/introduction

[allis53ca]

thx bro

[Terrible Texan]

i know your pain, i'm going through the same thing know. My 3rd pressure sore that i had flap surgery's on, opened up again thur. had a blood clot tunneled 2 " under the skin. as of now, plastic surgeon said just come in & see him on tuesday unless it gets worse. i've only been geetin' up for about 6 weeks now from being in bed 5 months, untill about 4pm daily. dr says i need to lean side to side also, instead of just back & forth. the other 2 sores i had the surgeries over, hopefully not w/ this one

[Rabih]

does a pressure sore increase the neuropathic pain?

[jamiechesman]

What is Juven?