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Thread: Sitting schedule post flap

  1. #1
    Senior Member landrover's Avatar
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    Sitting schedule post flap

    Hi, what is the typical seating program following a flap on the ischial? I'm trying to get an idea when I can return to work.

  2. #2
    This is the program we use successfully:

    Immediately post-op:
    All turns post op by at least 3 people, not allowing the joint above or below the flap to bend. No stretching of the incision. No sitting or use of trapeze in the Clinitron. No use of the foam wedge for 3 weeks. Total bedrest...all Xrays, etc. must be portable (no putting you onto gurneys, etc.). No range of motion to the involved leg(s). Drink extra fluids as the Clinitron makes you loose a lot of fluids (you need an extra quart daily). Extra protein and calories needed in your diet too, and be sure you are taking a good multivitamin.

    At the end of 5 weeks, if everything goes OK, a good stretching program should be done by a PT PRIOR to starting sitting. We start stretching with range of motion exercises to the hip and knee on the involved side at the end of 5 weeks after surgery (7 days prior to starting sitting). Over that week, there should be a gradual stretching to the point where both hip and knee are being stretched to 90-100 degrees. This can be combined with VERY gentle massage over the graft incision line using coco butter or Eucern Cream to moisturize the scar and get it used to stretching. Failure to do this can result in ripping or tearing along the suture line when sitting begins. Sitting should not start until at least 6 weeks post-op.

    We allow the use of a prone gurney and movement to a low air loss mattress during week 6 if everything looks great. That is continued for another 3-6 months.

    This is the routine we use for the sitting program, which starts after 6 weeks (of course this needs to be combined with the proper cushion and every 10-15 min. weight shifts). Check skin after every sitting period:
    Day 1: 15 min. sitting
    Day 2: advance to 15 min. 2X daily
    Day 5: advance to 30 min. 2X daily
    Day 8: advance to 1 hour 2X daily
    Day 11: advance to 1 1/2 hour 2X daily
    Day 14: advance to 2 hours daily ( you can start up to 30 min. of well padded commode/shower chair use daily; this is included in total time)
    Day 17: 2 1/2 hours 2X daily
    Day 21: advance to 3 hours 2X daily
    Day 25: advance to 4 hours 2X daily
    Day 30: advance to 6 hours daily
    Day 35: advance to 8 hours daily
    Day 40: advance to 10 hours daily
    If at any time the skin is red after sitting and does not fade within 30 minutes, sitting is stopped until the skin is totally clear, and then the person reverts back to the previous 2 steps in this progression and starts again.

    We do not allow slide board transfers for at least a month after the sitting program starts.

    (KLD)

  3. #3
    What KLD said looks pretty well what I've done as well. Good luck with surgery and recovery. Have plenty of books and movies to help keep your sanity intact.
    C2/3 quad since February 20, 1985.

  4. #4
    This is wonderfully detailed info that I haven't seen all in one place before. It not only provides a very vivid picture of what recovery from flap surgery will be like, it's a pretty strong incentive to take whatever measures are possible to avoid going through this. Thank you!

    All turns post op by at least 3 people, not allowing the joint above or below the flap to bend.
    What is the turning schedule on a Clinitron bed?

    Drink extra fluids as the Clinitron makes you loose a lot of fluids (you need an extra quart daily).
    This is really interesting. What is it about the Clinitron that causes you to lose that much fluid?

    Trainman, Rybread and anyone else who's had flap surgery -- I have a whole lot of respect for you for enduring all this. It must be/have been terribly grueling on both body and mind.
    It is easier to find men who will volunteer to die, than to find those who are willing to endure pain with patience.

    ~Julius Caesar


  5. #5
    Quote Originally Posted by thehipcrip View Post
    This is really interesting. What is it about the Clinitron that causes you to lose that much fluid?
    The Clinitron has air and stand beads constantly blowing up against you under a sheet had a slightly higher temperature so it tends to wipe out any moisture on your body rather quick that it produces.

    Quote Originally Posted by thehipcrip View Post
    Trainman, Rybread and anyone else who's had flap surgery -- I have a whole lot of respect for you for enduring all this. It must be/have been terribly grueling on both body and mind.
    Thank you. It's really difficult to stick to those rules but as long as you do, it all turns out well.
    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
    Quote Originally Posted by thehipcrip View Post
    What is the turning schedule on a Clinitron bed?
    We turn every 4 hours on the Clinitron. It is important for your lungs and for your range of motion to still turn. We also turn you on your side to do bowel care.

    Quote Originally Posted by thehipcrip View Post
    What is it about the Clinitron that causes you to lose that much fluid?
    As Rybread says, the heated, blowing air of the Clinitron (air fluidized bed) causing high rates of what is called "insensible" fluid loss, just as a hot dry desert wind does when you are outdoors.

    (KLD)

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