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Thread: Flap recovery questions

  1. #1

    Flap recovery questions

    I'm scheduled to have flap surgery done on both of my ischium's at the end of the month. On the right side it will be the second time. I've been told that I'm going to be in pretty much the same position for six weeks with no stretching and that I have to completely get rid of my spasms. What are the steps and the time frames for stretching and getting back up in the chair? I was going to start school this semester but this is going to put it on hold once again. Also, I'm on a Rojo quad chamber high profile but I'm tired of worrying about air in my cushion. This is a second time I've needed flap surgery because a cushion went low without me knowing about it. Can you recommend another good cushion for me? Should I get pressure mapped before the surgery? Is there going to be a significant change postsurgery? Thank you in advance for any answers you can give me.
    C-5/6, 7-9-2000
    Scottsdale, AZ

    Make the best out of today because yesterday is gone and tomorrow may never come. Nobody knows that better than those of us that have almost died from spinal cord injury.

  2. #2
    Senior Member Mona~on~wheels's Avatar
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    I can't answer your questions.
    I wanted to wish you good luck.
    I'll be praying for you.
    May you get them healed & they stay healed.
    God Bless!

  3. #3
    I'm hoping either the nurse (by the way,KLD, what's your name) or Wise or any other physicians or physical therapists will chime in and tell me what to expect. My plastic surgeon kind of told me but I'd like your professional opinion also. I'm going through the Mayo Clinic here in Scottsdale and there isn't a whole lot of spinal cord injury rolling around their.
    C-5/6, 7-9-2000
    Scottsdale, AZ

    Make the best out of today because yesterday is gone and tomorrow may never come. Nobody knows that better than those of us that have almost died from spinal cord injury.

  4. #4
    Different plastic surgeons have different regimens. We would not do both flaps at the same time, but yes, you would need to be totally immobile (except for slight side to side turns without bending your hip or knee) for at least 5 weeks on a Clinitron if using the program we use. Where will you be during this recovery period? They will not allow you to stay in an acute care hospital all that time. Do you have enough help to be at home on total bedrest, and will your insurance cover the Clinitron bed rental?

    http://sci.rutgers.edu/forum/showthr...itting+program

    You must be pressure mapped the first time you sit AFTER the surgery, and then only sit according to the schedule I have linked here. There is no way to tell which cushion would be best for you prior to doing the mapping, so be sure they are prepared to check out several cushions at that time.

    I am assuming they are planning to control your spasticity with an external baclofen pump???

    (KLD)

  5. #5
    I actually have an internal pump but I'm still fighting some spasms and I'm just about topped out on what I can get with the pump. They're planning on putting me in a nursing home after being in the hospital for two weeks. I did that last year when I had a sacrum wound closed and I think I ran out of days at around three weeks so I came home on a Clinitron bed but the rental was $150 a day and I only have a $10,000 durable medical equipment Limit and I don't want to use it all on the bed rental. I've got a power chair I'll be migrating to but I think I need to get tilt put in it. I don't think my side to side weight shifts are going to be adequate anymore. If I can only turn so much, how my supposed to do bowel care? I do have enough support with caregivers to get help for six hours a day, plus I live on my parents property so I'm sure I can get help from my family in between times, which is what I have now and it pretty much works out fine. I just remembered that I needed to be fed because I couldn't sit up enough to do it myself. That's going to suck but I'm sure I'll get used to it. Should I hold off on the surgery if I can't get my spasms under control in time? I just had my pump adjusted yesterday and it's helped out a little bit, but once in a while my whole body still spasms up. I'm worried that it will tear the flaps apart. How come you would not do both flaps at the same time? I'm starting to have concerns about my doctor considering he hasn't brought up anything about pressure mapping.
    C-5/6, 7-9-2000
    Scottsdale, AZ

    Make the best out of today because yesterday is gone and tomorrow may never come. Nobody knows that better than those of us that have almost died from spinal cord injury.

  6. #6
    We would not do both flaps at the same time as this then means you cannot flex either hip or knee, not just one, for at least 6 weeks. It is also technically more difficult to do both in the OR, and the chance of infection going from one to the other is higher. We also always position on the side with the flap side up on the Clinitron for bowel care to avoid contaminating the incision area, and you can't do this with two incisions.

    Can you prone? Years ago we used to do the post-operative time on a low-air-loss bed with the patient laying on their stomach. Some studies show just as good of an outcome as laying on your back on a Clinitron.

    The spasms that would be most problematic would be hip spasms and knee spasms. Recently we used Botox to control excessive hip adduction on one of our patients having a flap and it worked well, but it must be done about 7 days ahead of time to get the effect when it is needed most (the operative day and first few days after surgery).

    (KLD)

  7. #7
    Well this guy is pretty confident about doing both at once. I don't know how this is going to work out. Originally he wanted me to get a colostomy. When I spasm, my body straightens out, I don't know if my hips flex or if my buns are firing (LOL) or if the skin is getting pulled on, but they can be rather violent. I couldn't lay prone for very long because I can't turn my head that far. I never considered that if one gets infected they'll both get infected. Fortunately for bowel care, I haven't required the use of a suppository in a couple of years and everything can be pulled out manually so there would be no draining onto a wound. I am fairly concerned about turning without bending my knees but I think we did that last year when I had the flap done on my sacrum. I wish I could've gone to someone with more recent spinal cord injury experience but my options are very limited. The doctor I'm going to taught the other plastic surgeons in the Mayo Clinic here in Phoenix what they know and is the head of the department so I'm kind of stuck with him and the person I went to for a second opinion told me he would basically do the same thing and I wouldn't be able to get surgery until November (that's through my state insurance) so I hope everything works out fine.
    C-5/6, 7-9-2000
    Scottsdale, AZ

    Make the best out of today because yesterday is gone and tomorrow may never come. Nobody knows that better than those of us that have almost died from spinal cord injury.

  8. #8
    Make sure that the doc knows your concerns and answers your questions. We also don't do both sides generally, but have had success with them so it is not out of the question. Make sure that you eat well, drink enough and get turned VERY carefully.

    Good luck!
    CKF

  9. #9
    Rybread, so sorry to hear that you have had to deal with these sores. I had a flap done about two years ago. I doubt it was as hard for me as it had been for you. One thing I do recall is that the doctor had insisted that if I made sure that my protein intake was high, it would help me to heal faster. I tried it with those supplements that you make into milk shakes. I did have a hard time though since according to my Gastro I need to keep my protein intake low. He has told me that my liver can't take too much of it. Maybe your doctor has not suggested this to you but it would be good if you ask him about it too.

    Another thing, he ordered a bed for me after my surgery that had a net where I laid and some air kept circulating underneath me. The nurses at first had the one that tilts the patient on his sides and the doctor yelled at them because he said that one did not work as well as the one he ordered for me. I don't know the name of the bed but it seemed to help in my case.

    As to the cushion, I use a roho and it seems to help to some point, though I do have to keep checking often to make sure there are no small breaks in my skin. Every time I change my underwear, I make sure there is no small stains of blood and my caregiver checks often too on my skin.

    It took me awhile to be able to sit up but we worked at it little by little, adding time every day. Hope everything goes well for you. Will keep you in my thoughts and prayers.

    Raven

  10. #10
    Thank you for all your advice. The worst part is this will be the second time I've had a flap surgery done, the first time being on my right ischium from a Roho going flat with me sitting on it all day, a graft on my sacrum from I'm not sure what, most likely a faulty bed overlay, and now these two once again caused by a low Roho cushion. To say the least, I'm tired of air filled adjustable seat cushions. I'm very consistent with weight shifts leaning over both foreword and side to side as far as I can. The last time I had a pressure mapping, even the lady doing it said I was nothing but skin and bones how do I fix that? What can I do to put some meat on my bones so this doesn't happen again?
    C-5/6, 7-9-2000
    Scottsdale, AZ

    Make the best out of today because yesterday is gone and tomorrow may never come. Nobody knows that better than those of us that have almost died from spinal cord injury.

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