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Thread: Will this sacral wound EVER go away?! (Graphic Pic Warning)

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    Will this sacral wound EVER go away?! (Graphic Pic Warning)

    Hello forum! I have been reading a lot of the posts on wounds and just wanted to reach out for some hope. I am not a spinal cord injury but I do have a form of muscular dystrophy. For my age and type I am doing very well... no tubes or breathing assistance on a daily basis or anything like that. I work full time also and have been wheelchair bound since 8yrs old. I weigh 52lbs... no, not anorexic or anything ... I am just super tiny and my disease has wasted me too.

    So I have a roho quattro cushion, always have actually. I have a tempurpedic mattress. Let me explain how I got into this mess. I had a bony prominence (trust me at 52lbs there are lots!) on my sacrum and ishium. Never in all 34yrs have they come even CLOSE to breaking skin. Well, I was getting physical therapy and it was recommended to do "preventative" bandaging on those spots. We didn't know any better and thought yeah, prevention is good right?

    Well they began dressing them with duoderm. After a few weeks my ischium (which I of course sit on every day) began hurting... so I stopped that. I am ONLY touching my sacrum if in bed. But my mom rolls me sometimes HOURLY at night... no more than 3hrs in one spot for sure! Well they (they meaning home health care) were changing the bandages 2x a week. They told us to go ahead and shower in them... (I am sure you can see where this is going)... Well the one on my sacrum... it because kinda hurting some on day 2... I told my mom to take it off... well... the skin had totally masserated. We discontinued all services and my mom was PISSED!! We decided just to take care of it ourselves. Well it amounted to a scabby spot for almost a year. But, it finally began oozing a tad. I realized only by my sheets on my bed. So we called home health care back--BUT only because I knew someone that worked there and they said they had a new WOC RN. Great!!

    So he comes... tried to treat it with alginate, silvermed, collagenase, medhoney... just about everything. He couldn't get it debrided any and even when he took a curette to it it wouldn't bleed. **Might I add the thing doesn't hurt me one bit!** So he was suspecting osteo.

    Started going to a wound clinic... Debrided it SOME and wanted me to get an MRI... long story short... they doc that read my MRI was wrong, sent me to the hospital on the weekend in panic that basically I could drop dead any minute from meningititis. No joke. Spent 3 days in the hospital basically for a plastic surgeon to come in ... cut the whole wound out, do a bone biopsy and put a vac on. The surgeon said there were no visible signs of infected tissue, nor bone; in fact the bone was quite dense and healthy. Finally sent me home and 2wks later official that there was no osteo. So that was ruled out why the wound wouldn't heal. They also ruled out my nutrition as all my levels including protein intake were good.

    So once a week for the last 4 weeks I go to the wound clinic, and in between (3x a week) I got vac changes from my WOC RN. But, every time I go there is a lot of slough buildup. For the first 2 weeks they had me on continuous 125 pressure. Each week the general surgeon has to sharp debride it. The last two weeks they changed it to 175 pressure and intermittent 5/2 because sometimes that stimulates circulation. For the first time 2 weeks ago we actually had some granulation. Now there is a layer covering the bone and I have been having blood tinged fluid coming into my vac.

    Skin flap has been discussed and at one point they wanted me to do a consult (before there was any granulation) and to be frank... I am NOT a candidate. I can tell you that for sure. I get pneumonia in the blink of an eye if immobile and in bed for any length of time, I have a history of DVT clots in my leg that I take warfarin for, with my severe scoliosis and poor respiratory system; anesthesia is very dangerous as well as intubation on me would be difficult and dangerous. The 30 days in bed... umm yeah... I would lose any muscle strength I still have and end up bedridden.

    I have told them that if this requires any kind of surgery they better get DARN creative because the risks FAR outweigh any benefits. I told them I'd leave the van on as long as possible to get as much out of it as possible. The wound, of course is a stage IV. To me the wound still looks the same size give or take after 4 weeks. Of course it has to be reamed out each week. But the bed doesn't seem to be sloughing as much anymore and I feel more positive that I am seeing blood now and then also (which I wasn't before they turned up the pressure and intermittent).

    So I guess what I am wondering is... will this ever heal???? Am I a freak because it keeps sloughing? Might I add on top of me not laying on it very long, ever, that it never has ever gotten scraped from rolling or being picked up or anything. Im so light my mom and dad lift me straight up and I never get "dragged" on the wound.

    This has been a total nightmare!!! I feel like if we can get it to heal I would be a better candidate than some for reoccurrence because this didn't happen on my mom's watch, nor is there a prerequisite for things to happen that typically cause one to open anyway other than being bony. People assume when I tell them I have a "bed sore" that that just comes with my condition. Which of course it can, but I know for a FACT it wouldn't have if we hadn't let them do those bandages and get masserated. It measures about 3cm x 1.7 is all I know regarding size. My hopes are, even if it takes a long time... the bed keeps rising with granulation. How long do some people stay on wound vacs with obstinent wounds? At this rate it could be MONTHS I am thinking.

    Any advice would help.

    This pic is the most recent... on Monday of this week. I go back to the wound clinic tomorrow... again... I assume he will debride that slough again. The slough ain't NEAR what it was in the beginning... but still... sigh...
    Last edited by SCI-Nurse; 09-22-2011 at 01:40 AM.

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