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Thread: Pressure sore healed, when can I sit again ?

  1. #1

    Question Pressure sore healed, when can I sit again ?

    Hi there,

    I've been dealing with a pressure sore for so long now, it has been healing slowly but surely, It's now closed but I tried to sit again and it ruptured a little bit with some blood coming out, It has closed again and I'm not sure when can I sit on it again.

    Last time I sat it was for about 3 hours only, just to see if its ok. What can I do now to make the skin better, the skin color is kind of pink, should I wait until it gets to normal color like the rest of the area.

    If you guys have any advice please share, and yeah, my sore is on my butt.

    A.J.

  2. #2
    Quote Originally Posted by Neo View Post
    Hi there,

    I've been dealing with a pressure sore for so long now, it has been healing slowly but surely, It's now closed but I tried to sit again and it ruptured a little bit with some blood coming out, It has closed again and I'm not sure when can I sit on it again.

    Last time I sat it was for about 3 hours only, just to see if its ok. What can I do now to make the skin better, the skin color is kind of pink, should I wait until it gets to normal color like the rest of the area.

    If you guys have any advice please share, and yeah, my sore is on my butt.

    A.J.
    Absent a lot of details necessary to offer you truly well-informed advice, I think that considering your report that the sore has "ruptured" with bleeding, I would think that you would be well advised to keep pressure off the area as entirely as possible. It sounds as if it's far too soon to be sitting again.

    Has the sore been examined by a professional? Do you know that it's not infected? There are obvious limitations to the advice you can receive here on CC even from our esteemed SCI_Nurses. It's imperative to have the sore evaluated by someone directly.

    Having said that, there are numerous approaches/strategies/products for dealing with pressure sores because they're not all the same, but what each approach has in common is the need to eliminate pressure from the site, as crushing as that can be to your mental health, especially when the location of the sore is on your butt.

  3. #3
    Well, by ruptured I mean a really small hole in the wound not bigger than 1cm in diameter, with slight bleeding, just a couple of drops on the gauze. Sorry I didn't choose my words wisely.

    Examined by a professional ? hmm, there aren't good doctors where I live, and none of them specialize in SCI or wounds. I have seen quite a few doctors, it's not infected as there wasn't any puss or discharge while it was healing, I have only treated it with a disinfectant and vaseline gauze as I've seen the nurse here recommend. It has taken a lot of time to heal but it's now closed completely, the skin is complete but its pink in color. I'm not sure if that means that it's healed or not.

    I'm familiar with those products as I've read a lot on this subject recently here on CC, We don't have those product in our market, and I've had good success with only vaseline gauze and keeping the wound moist and not wet, I've been off it completely for a couple of months now and that's how it healed.

    I think that my weight is causing this bleeding, I am overweight, or my cushion which is an old invacare something, it's not very comfortable and hard I'm not sure which cushion is best for me, I'd like to stay away from Roho or air filled cushions, as I don't like them.

    If you need more info I'd be glad to provide, I just want to get rid of this sore as fast as possible, Is there anything I can do or apply to my sore to make the skin heal better or faster ?

    Thanks.

  4. #4
    Neo,
    One thing I have found is that new tissue is very delicate and and as easily damaged by rubbing on clothing or over stretching as by pressure. After it heals, keep a protective bandage on it for a while and massage the area a couple times a day to help the scar tissue become more flexible.
    You will find a guide to preserving shoulder function @
    http://www.rstce.pitt.edu/RSTCE_Reso...imb_Injury.pdf

    See my personal webpage @
    http://cccforum55.freehostia.com/

  5. #5
    Senior Member Jeff B's Avatar
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    Sitting on a just healed pressure sore for 3 hours is probably too aggressive a start. The flesh will be soft and weak for quite awhile. You would not put your shoes on and go for a long run as soon as a blister healed. You would carefully walk around on it for a few days at least until it toughened up again.

    After the current damage is healed I would suggest just getting up in the morning for no more than ½ hour max for the first time. Then get back off your bottom and check the area immediately to see how it responded. If it is ok (not red, definitely not bleeding) then maybe try another ½ hour max later in the day. If there are absolutely no problems then you can gradually increase the time you are up by ½ hour at a time always checking after each session and only increasing if everything is ok and decreasing if there are any problems.

    Since you are only going to be up for such a short time I would not even bother putting on pants to avoid the risk of wrinkles but maybe wear some boxers or something to make sure you don’t rub the sore area when transferring (at your level you should be able to keep you bottom from dragging but you have probably lost strength from being in bed, so be careful). You won’t be going anywhere yet so being not dressed will also remove the temptation to stay up longer than you should to “make it worth the effort” it took to get dressed and up.

    It takes discipline and patience to do it this way but the short term hassle will still end up getting you back to being in your chair full time sooner than if you rush it and reinjure the area.

    I am a bit concerned that the area was still bleeding. Are you sure that it was totally healed from the inside bottom of the wound up to the outside and not just closed up at the surface with the inside still not completely healed?

    Also make surd that if you have a bandage or dressing on the wound that it is not going to be putting any pressure on it.

    If you are going to follow the advice to massage the area after it heals that SCIfor55yrs gave above then make sure you wait until it is 100% healed and massage it very gently, probably not directly over the wound.

  6. #6
    It is a good idea to really take your time sitting once the area is healed. That means starting at 15-30 minutes twice a day - checking the area very carefully for any sign of intolerance. Gradually increase the time you sit in 15 - 30 minute intervals, depending on how your skin tolerates it. You may see some reddness when you first get out of your chair - if that goes away within 30 minutes you are ok to sit again. If not, then you need to stay off of it and back down the time that you start sitting again.

    Make sure that you are hydrated and that you con't to eat a well balanced, high protein diet for another couple of weeks. Also, it sounds as though you need a new cushion. The ideal is to have pressure mapping done- however, if you can't, pleae try to see a PT who might be able to give you some different options.

    Take your time- as you know - it takes a long time to heal one of these once you get it.

    CKF

  7. #7
    Senior Member Jeff B's Avatar
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    I agree on the new cushion. You need to determine what caused the sore in the first place and correct the problem before you start getting up again. If you don't it will happen even easier the next time because the area will be weaker.

  8. #8
    Remember that any pressure ulcer that is deeper than a stage II and fills in by secondary intention (not surgery) is only scar tissue. As such, it is actually more fragile and weaker than regular skin, and it takes as much as a year for the scar to mature to its maximum strength. The area will always be vulnerable and less forgiving than normal skin. The scar may remain pinker than normal skin.

    Once a pressure ulcer like this has healed (closed over) we recommend continuing with several more weeks of down time, and then start a gentle range of motion program, combined with keeping the scar well lubricated (Aquaphor or coco butter are great), to the joint above and below the scar. This will help it to gradually stretch rather than tear, which can be a problem for inflexible scar vs. regular skin. We may do this over a week to get a hip and knee (for example) to a good 90 degrees.

    Then we start a progressive sitting program much like after a flap. This means 1) getting a computerized seating eval done the first day up (15 minutes twice that day), then 2) the second day (if everything looks good) going to 30 minutes twice daily for 3 days, then 60 minutes twice daily for 3 days, then 1.5 hours twice daily for 3 days, then 2 hours twice daily for 3 days, etc. It will take, if everything goes perfectly, nearly 3 weeks to get to 3 hours twice daily, and nearly a month to get to 4 hours twice daily. If at any time, the skin is darker pink and does not fade in less than 20 minutes after sitting, you must go back to the previous time limit and progress more slowly. If the skin is broken, it is total bedrest again, and then start over.

    (KLD)

  9. #9
    SCI-Nurse's (CKF,KLD), Stephen212, SCIfor55yrs and JeffB,

    Thanks a lot for your advice, you don't know how valuable it is to me. You guys are the best.

    A.J.

  10. #10
    Quote Originally Posted by Neo View Post
    I've had good success with only vaseline gauze and keeping the wound moist and not wet, I've been off it completely for a couple of months now and that's how it healed.
    Sunlight and fresh air work wonders on sores, they also keep the area dry which makes it heal faster. It may have been a blessing that it reopened because it doesn't sound like it was completely healed. The sore needs to heal from the inside out. High protein diet is very important as well. Good luck!

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