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Thread: Please any help with this....

  1. #1

    Exclamation Please any help with this....

    Dear friends and SCI Nurses, I`m from Peru, I found this website in 2002, since my uncle had an accident. Since that time, my uncle these last 2 years have had problems with a wound he had in the left buttock , and two months ago , after two surgeries he had recovered from that..., but some weeks ago he presented in the right buttock some reddening, then a part of it turned brown and black..., but without wounds! some doctors said it was not important..., but two days ago he presented some fever, and now he is hospitalizaded..., doctor said he has some blood vessel inside, and maybe an infection too because that part inflated and doctors suctioned kind of water they found there, and on friday doctors will see inside after a surgery.., and they say that is caused because he hasn´t muscle on that area... (my uncle don´t stand up since more than 1.5 years because of the wounds and the iron supports, that don´t allow it) , and I´m so concerned and sad about this. I think it is too much , the accident was too much, and now these other problems that we dont understand why happens..., I would be grateful if somebody would tell me what to do with this problem , since maybe the doctors here don´t know very well about these problems..., what can we do to avoid the same will happen again.., and what suggestions will give me to obtain my uncle take a good quality of life. He is 54 years old.


    Mari

  2. #2
    Did your uncle have a myocutaneous flap surgery done by a plastic surgeon to close the previous pressure ulcer, or did a general surgeon just sew the edges together?

    Brown or black tissue is very bad. This is either a deep tissue injury (DTI) pressure ulcer or an open wound that is covered with black leathering material called eschar (sort of a type of scab). Either way, it indicates extensive tissue damage. It is likely that he has an abscess under this which is infected and causing his high fever. He may have bone infection (osteomyelitis) too.

    He really needs a physician who is an expert in pressure ulcer surgical treatment and recovery. This is usually a plastic surgeon. He may need to go to a large teaching/university hospital to find one who knows what they are doing with a SCI pressure ulcer. It may be that he will have to have a myocutaneous flap done. This is a very complex surgery that requires very specialized post-operative care, with a special bed for 5-6 weeks of total bedrest with no movement of the involved hip or knee allowed at all. Proper nutrition is also critical, and should be optimized PRIOR to such a surgery as well. A specialized progressive sitting program after 6 weeks (if all goes well) is also critical.

    It is critical that your uncle take actions to prevent pressure ulcers in the future. This booklet is the best resource that I can share with you now. Print it out and share it with him (be sure to print the Spanish language version): http://www.pva.org/site/News2?page=NewsArticle&id=8097

    If it is possible to get good quality digital photos of his wounds I would be glad to look at them for you. Send me a PM and I can tell you how to get them to me privately.

    (KLD)

  3. #3
    Dear SCI Nurse, at first thank you very much for answering my post.

    My uncle had a general surgeon, not a myocutaneous flap surgery.

    My doubt is: that surgery seems to be ok now, although it had to be practiced two times..., (first time everything was ok we think but after myuncle used the supports to start their exercises again his buttock turned again brown and had to be operated again)

    The problem now is the other buttock that never had a wound there, only it started red, then brown ...and black, and then inflating, but without wound and is rare because he was not sitting too much time because he is still recovering after the surgery of the other buttock that was made on March first week.

    Some kind of infection could have passed from the recently operated buttock to the sane buttock ? which now has the problem....

    Could you recommend me any kind of diet to make he recover or gain some weight?

    Thank you so much again....

    He is going to be operated today, and I won´t could take the photo now, but I will maintain in touch, I will appreciate your answers...

  4. #4
    Dear SCI Nurse, after my last posting I traduced a word I didn´t know, and understood better about flap, which I have heard to the doctors who made the last surgery, but I think they are not plastic surgeon..., I will confirm it....

    But that las surgery was going well..., I dont know what happened with the other buttock that never had an ulcer, and there wasn´t cause to produce that...because he was in bed almost all the time...

  5. #5
    Is there any way you can send me a digital photo? I am not able to tell much by just a verbal description of this wound.

    (KLD)

  6. #6
    Senior Member lynnifer's Avatar
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    How is your uncle's diet and what does he sit on?

    Could he take a multi-vitamin at the very least?
    Roses are red. Tacos are enjoyable. Don't blame immigrants, because you're unemployable.

    T-11 Flaccid Paraplegic due to TM July 1985 @ age 12

  7. #7
    Hello SCI Nurse, I'm again here, cause I need urgent help with the same problem. Can you believe my uncle continued with the problem with the ulcer that after every surgery , when he starts sitting, that zone turns hot, then red, and when doctors examine that , they see some liquid in the ecography, and programme another surgery. This is the fifth surgery I think, in 3 years. I need to know what should we do, because doctors here in Peru dont know what more to do.

    Thank for any help

    Mar*a

  8. #8
    Maria -
    It is a shame that this problem has continued. I have some suggestions; please forgive me if I say what you already know -

    • If he has not yet been treated by a surgeon who is an expert in pressure ulcers due to SCI, try again to find one.
    • He may be sitting on the fragile area too soon after the surgeries - the area may look fine on the surface, but it has not healed completely yet.
    • If any red is seen, he should stop sitting immediately.
    • That area will always be more fragile after once being damaged, even after it is completely healed, so he will always have to be extra careful.
    • When he is ready to sit again, he may need to use a better cushion that distributes the pressure over a larger area (such as a Roho cushion).
    • If you have not downloaded the booklet about pressure sores that nurse KLD gave you a link to (above), please do so. He should read it, and so should you and those others that help care for him. PVA also have excellent publications on other subjects related to SCI - see http://www.pva.org/site/PageServer?pagename=pubs_main.
    • Take every advantage of the help that KLD offers. It is a wonderful opportunity to get help from her.

    Best wishes
    - Richard

  9. #9
    Maria, I have no better advice to give than what Richard has already given, but wanted to wish your uncle well and hope he finds the help he needs.

    These pressure sores are not to be taken lightly, and once you have one, you must take extra care that they don't return. Don't let time go by before seeking help if you think you've found a hot spot.

    Good luck.

  10. #10
    Thank you very much for your answers, at first I will ask very well what kind of procedure doctors made and if they are reconstructive surgeons, if not I hope to find any qualified here in my country.
    I will continue posting the news to get help from this excellent forum.

    Mari

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