[sheri's mom]

Hi,
I'm taking care of our daughter a T-6 T-7 para, who was diagnosed with a decubitis ulcer a few weeks ago. I was wondering what some of the signs of healing are. She has been using Melaleuca oil in here wound on the days she cleans it out herself. On the days the home health nurse comes out they use dakin. I'm just curious to know the stages of healing if anyone can help me learn.
Thanks,
Sheri's mom

[kewlcatkez]

sheri's mom, on Mar 22 2008, 01:31 AM, said:

Hi,
I'm taking care of our daughter a T-6 T-7 para, who was diagnosed with a decubitis ulcer a few weeks ago. I was wondering what some of the signs of healing are. She has been using Melaleuca oil in here wound on the days she cleans it out herself. On the days the home health nurse comes out they use dakin. I'm just curious to know the stages of healing if anyone can help me learn.
Thanks,
Sheri's mom

Hello Sheri's Mom,

Please see the info which has been provided by Apparelyzed (not a forum page but an info page) HERE

With regards to the Decubitus ulcer, I am not a wound care expert, but although my specialism was cardiology, I was a link Nurse for wound care on our unit a few years back - pre chair dumping disability...I am thinking the basics may be of use...
Good question. The first signs of healing depend on whether or not the ulcer begins to heal from the inside out or the outside in.

The ultimate goal is for the sore to heal completely, from the inside out. This is why large ulcers/wounds are 'packed' with a dressing material. This should enable healing from the inside out and be a good indicator of when healing is occuring. Quite simply the amount needed to pack will decrease. Of course some nurses/people will/try to push more in than others! The aim is to gentle pack the space.

Of course, some long term wounds are so stubborn that they are difficult to heal totally. This can be due to unexplained reasons, just one of those things - which drs will attribute to 'too much time up", "poor circulation" or "poor nutrition". Of course those things are important considerations, but sometimes a wound is just stubborn b/c it has scar tissue within it ( heals slower and with less elasticity). Other times, a wound will not heal because it still has an area INSIDE it which is not healed and the wound has healed from the inside out.

The emphasis is on inside out as if it heals from outside in, it may not be truly healed at all and may be a void with healed skin layers over the top.

You will also notice skin granulation which looks like areas of thickened skin at the edges of the wound which are pink in colour. This is another sign of wound healing. The exudate (stuff ozzing) should lessen. Any re-occurrence should be swabbed to check for infection.

In terms of healing, it is pertinent to look at stuff such as our lifestyles, are sometimes contrary to wound healing. For eg, Smokers tend to heal more slowly due to the components of the ciggies and also due to the reduced oxygenation of the tissues. In smokers, wound edges can 'die off' and break making it difficult for the wound to heal. The same is true of alcohol consumption. The higher the intake the more this factor plays.

People with Diabetes also have the added complication of high blood sugars inhibiting healing and circulatory issues (due to instability of the blood glucose and Neuropathies).
I mention these things as general points, Of course they may or may not be applicable to your daughter.

With regards to what you and she can do to assist directly and prevent further breakdown of this area ( or others within its boundary), it is important to revisit the above points. She also needs to ensure that she doesn't spend too much time up in her chair, that the cushion she uses is sufficient for the sitting she does. Only she and you can work out what is too much time up, based on increasing slowly (from nothing) and cutting back at the first signs of issues.

Nutrition is very important too as I am sure you know already. What I would add is that in times of wound healing, eating higher PROTEIN content is beneficial to help healing occur ( helps cell devision and granulation). If a person does not eat well, or often, they can wind up with your body using the fat and sometimes the muscle stores to fuel its day to day running. ( The tell tale signs of this is Ketones in the urine of a non Diabetic, repeatedly). Vitamin E in the diet and some say to the wound ( CAUTION WITH open cavities). VIT C is essential to synthesise Collagen to promote wound healing. Drinking enough is also essential to ensure that Osmosis takes places and that 'fluid' is flushed away from the tissues. (This fluid may be invisable to the eye) It is caused by interrupted Vasoconstriction which in turn causes pooling of the blood in our lower body ( in paralysis)

The other main thing to remember is that when skin heals, scar tissue forms and scar tissue is actually unable to stretch as the healed wound and its edges are composed differently ( from weaker collagen) which can split off. The cells in the wound actually begin secreting collagen by the second or third day of healing. Therefore the edges of it are less forgiving of movement/twisting. Also, when forces are placed upon it ( such as twisting, sitting on it etc) the healing area is more likely to split open again at a scarred site. If in the middle of a scarred area, the sore/wound will have a tendency to split as opposed to regular skin which will stretch some, accommodating for the changes in pressure and position a little more favourably.

Of course this is a simplistic view, but I am sure it gives you the idea. When a wound is in the muscle it also doesn't have the benefit of calcium to speed the healing ( like bone does for example). So when you think about it, bone with its calcium boost takes a while to heal and therefore it can make sense that muscle will take longer. When the muscle does heal, it is then constructed of different properties than before. It does not merely grow more muscle to join up with the other side of itself, but instead, Collagen heals in the hole/gap. Also muscle fibres tend not to be 'aligned' together when healing so it may also result in weakened area of power/movement/strength if the muscle is in an area of ( residual?) function.

I hope this helps and that your daughter's healing is swift and full from this Decubitus ulcer,

Take care,

K

[linda]

Wonderful! I see you have found your answer. I have a daughter with a C5 incomplete and I do have to say .....I have been fortunate not to have had to deal with break downs. I have however seen first hand how difficult they can be to treat so for that I am thank full not to have had to deal with them.

I hope your daughter will soon be well, free of those pesky sores.

[sheri's mom]

Hi K.

Thank you so much for the great information. It was very helpful. Thank you for taking your time to respond.