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Thread: pressure ulcer and wound vac

  1. #1

    pressure ulcer and wound vac

    Hi, new here. I have been having a really terrible time with a pressure ulcer on my ischial area. The worst place, I swear. I haven't had any trouble at all with pressure sores in 20 plus years, and this past year, it resurfaced in an area that had healed over tunnels. My skin was always dimpled there, and it felt like surface tunnels were there. Maybe a lot of scar tissue, not sure.
    So I got a 20mm deep and very narrow tunnel that opened up. For months, the wound clinic did dressing changes with bacrtoban and a gauze strip. In several months, it never got shallower.

    Then one of the doctors wanted me to get a flap done. I don't want that, because the tissue is then at best 80% normal. I don't have the care in place to have to stay in bed 100% of the time, that's necessary after surgery. So I got a different doctor to agree to try a wound vac, after debriding it and making a saucer around the tunnel, getting rid of scar tissue. Now it's like an inch deep and half inch wide. Kind of scary. Plus, after a month now, it has not gotten much better with the wound vac. The doctor thought it would take only a month to completely heal. I am really frustrated that this wound refuses to heal.

    I don't understand why this is happening, other than I do cheat with off-loading a little bit. I mean, after a week of bed, for my sanity I need to get out for awhile. I also get up to cook, feed my animals, etc. But I have a roho, and I shift position a lot. I eat extremely healthy, taking vitamin C (powder), and upping my protein. So what's the problem I wonder? I used to heal super fast. Any suggestions on what else I can be doing? It's so depressing to be spending this much time in bed, for so long

  2. #2
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    Have you had a swab done?
    I would stall out when I had a bateria load, which all chronic wounds do.

  3. #3
    Quote Originally Posted by Patonb
    Have you had a swab done?
    I would stall out when I had a bateria load, which all chronic wounds do.
    Wouldn't the VAC take care of any bacteria? Plus the bactroban? I don't think they have, no. The doctor and nurses just scowled and bawled me out. Pushed surgery again. The wound looks really clean, my favorite home nurse tells me, but it's just going slooow. I think it's gotten a tad narrower, but it needs to heal from the bottom up.

  4. #4
    You might want to consider getting pressure mapped on your ROHO. A couple of years ago I started having problems on the ROHO. Tried Stimulite Classic without better results, then an Isch Dish which sits you on firm foam and suspends the coccyx area completely. Had better results on this but went to U of M wheelchair seating clinic where I was pressure mapped and then molded for a Ride Design Custom cushion. Only had this for a few days but redness and sweating in buttocks area has so far disappeared but I need more time to see if this is a permanent solution.

    You probably know that healing would be best accomplished by getting off of it as much as possible but I know this isn't always an option.

  5. #5
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    Oh gawd no...... No dressing c an take care of bacteria and infection... Mine were like yours, and were constantly getting "infected". Total stall, even with VAC. 10 days of whatever, and you could almost watch it close.

    Also with a tunnel, youi're dealing with a whole nother beast. Just whats at the end of it determines whats happening.. Bone, underlying bone spur, etc all cause healing issues.

    I'd bet you if they swabed it trhere'd be a culkture of nasty... Most chronic wounds are if not watched.

  6. #6
    I'm trying to get a Ride Designs cushion. It looks great for me, and just submitted a prescription for it. Though I'm on MediCal only, so it might be a fight. They're part of the problem, too. I was on a Jay cushion that wasn't working anymore, and my DME took ages to get me the cushion a PT eval said to get. They got the one without air, though, and I had that for a month, then two months before they got the air one. Not a roho, but Invacare Max Contour. Not good, either. They said I was stuck with it. Then I bought my own manual chair, since MediCal denied me for two years while the DME just kept submitting over and over. That one doesn't fit me quite right, and the dump puts too much pressure. Ugh.

    I asked to get pressure mapped at the last eval, and they said no, I don't need it. How frustrating. So now I have to wait to get in, and insist. I really need to know, so I can finally get the right fit on everything.

    And yeah, I know, offload

    Quote Originally Posted by ancientgimp
    You might want to consider getting pressure mapped on your ROHO. A couple of years ago I started having problems on the ROHO. Tried Stimulite Classic without better results, then an Isch Dish which sits you on firm foam and suspends the coccyx area completely. Had better results on this but went to U of M wheelchair seating clinic where I was pressure mapped and then molded for a Ride Design Custom cushion. Only had this for a few days but redness and sweating in buttocks area has so far disappeared but I need more time to see if this is a permanent solution.

    You probably know that healing would be best accomplished by getting off of it as much as possible but I know this isn't always an option.

  7. #7
    The VAC is not magic. If you are sitting, it is very unlikely to heal. We only use the VAC if the patient is willing to stay on total bedrest while using it. The sponge actually creates MORE pressure when you are sitting.

    Surgery is nearly always needed to heal a stage III or IV pressure ulcer like this if you will be able to sit in the future. Healing by secondary intention may close the wound eventually after many months with the VAC and bedrest, but because it will fill in with scar tissue, not muscle, fat, etc. if you try to sit it is very likely then to break down again.

    Have you had a bone biopsy to see if you have osteomyelitis? This is very common with a stage III or IV ischial pressure ulcer, and only a bone biopsy combined with MRI can determine how bad it is and how to treat it. Surgery and IV antibiotics are then needed BEFORE a flap, which would require at least 6 weeks of total bedrest for good healing.

    (KLD)

  8. #8
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    Quote Originally Posted by SCI-Nurse
    Surgery is nearly always needed to heal a stage III or IV pressure ulcer like this if you will be able to sit in the future. Healing by secondary intention may close the wound eventually after many months with the VAC and bedrest, but because it will fill in with scar tissue, not muscle, fat, etc. if you try to sit it is very likely then to break down again.
    (KLD)
    Hmm, I was alway told it was the other way round.

  9. #9
    The rule is that Stage III or IV are unlikely to heal conservatively and if they do, they are full of scar tissue, which is more likely to break down.
    I can only imagine how difficult it is to stay in bed, off of it, but if you want to try the conservative route, that is the way to go. Otherwise, surgery is usually a better method.

    Is there anyway that you can get some help to decrease the amount of time that you are up even more? What about your diet? Are you eating enough protein and drinking enough? Are you on any supplements? These things MIGHT help a little bit.
    CKF

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