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Thread: Advice on pressure sore and flap surgery

  1. #1
    Senior Member johnc1's Avatar
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    Advice on pressure sore and flap surgery

    I have a stage 4 pressure sore on my left ischial. It opened in September 2011. I did not know it was there, nothing visual, just sweating on the left side of my head that went away when I changed positions. I was treated with a wound vac until mid December, but the wound would not heal. I had surgery on Dec 15th to debreed the wound and check the bone for osteomyelits. The bone biopsy came back negative, but the MRI showed osteomyelits present. The wound was opened to about the size of a plum and I was hooked back up to the wound vac. I took Zyvox for 24 days, two times a day but my platelet and white blood cell count when down very low and my liver enzymes rose. I was changed to IV Vancomycin on January 20th and have that administered twice a day. The wound began healing and is now the size of a small oval grape. The tunnel that was present was originally about 7 cm and is now down to 1 cm.
    Everything else has filled in nicely.
    My plastic surgeon is from Loyola University Medical Center and is the lead plastic surgeon for the VA hospital associated with it. He is very familiar with pressure sores. His opinion is that I should have flap surgery. I am very healthy right now and the sore is at a stage that he feels that it would be a small flap surgery and a quick recovery. The wound is healing so fast at this point that I am wondering if I should just let it heal on it’s own, using the wound vac, or if I should have the surgery. My wound nurse wanted me to have the flap surgery months ago, but I just wasn’t healthy enough at the time. I have been laying in bed for five months and I want the best long term solution. Am I better off having the surgery or letting it heal as I have been.
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  2. #2
    Hi, Congrats on the progress. I had a flap on my left ischial butt on Januray 7th,2011. My wound opened in April 2010 and I fought it for 9 months with wound vac, Picc line antibiotics, bed rest, high protein diet and such. My healing hit a plataeu and I had no choice after all that time I wasted trying to heal it. I wish I would have had the flap early on. Everyone has to make the best decision for them but I would do it and get it over with before spring time. I would be concerned with it going in the opposite direction and taking longer to heal. The longer it's open leaves you open for infection. I would strongly consider it if you are able to get the proper care and attention afterwards. I healed at home and stayed on bed rest for 8 weeks. Mine was a lot bigger than yours so it probably wouldn't be as bad for you. A lot of folks will probably be by soon with lots of opinions and experiences from flaps as well. Hope you are fully healed soon.
    DFW TEXAS- T-10 since March 20th, 1994

  3. #3
    Senior Member johnc1's Avatar
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    Quote Originally Posted by offroaderswife View Post
    Hi, Congrats on the progress. I had a flap on my left ischial butt on Januray 7th,2011. My wound opened in April 2010 and I fought it for 9 months with wound vac, Picc line antibiotics, bed rest, high protein diet and such. My healing hit a plataeu and I had no choice after all that time I wasted trying to heal it. I wish I would have had the flap early on. Everyone has to make the best decision for them but I would do it and get it over with before spring time. I would be concerned with it going in the opposite direction and taking longer to heal. The longer it's open leaves you open for infection. I would strongly consider it if you are able to get the proper care and attention afterwards. I healed at home and stayed on bed rest for 8 weeks. Mine was a lot bigger than yours so it probably wouldn't be as bad for you. A lot of folks will probably be by soon with lots of opinions and experiences from flaps as well. Hope you are fully healed soon.
    How long after your home bed rest were you up and around and how durable is it now?

  4. #4
    The Dr told me I could sit in 30 minute increments for the first week and then start increasing my time by 15 minutes daily if there were no red spots or irritation after each sitting. I was terrified so I took it even slower than that. Mine has held up very well. No problems at all. I keep lotion on my butt to prevent dry skin and i get off my butt at least once a day for 30 minutes-1 hour. I do plenty of pressure releases and sit on a gel cushion when I drive. I try to protect it like a new born baby so I don't have to go through that again.
    DFW TEXAS- T-10 since March 20th, 1994

  5. #5
    I had a long term pressure sore.Met an excellent surgeon,Dr.VanWinkle,SW Florida.After my surgery I was up in weeks,[knock on wood] 3 years no problem.Be sure you get an A-1 Doc,I have heard of some surgeries not holding

  6. #6
    Senior Member lynnifer's Avatar
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    Definitely surgery. Fastest way to a normal life again and less risk that it will break down again (IF you invest the time after surgery to allow the skin some integrity).

    Great stuff on healing thus far! Looks very healthy.
    http://en.wikipedia.org/wiki/M%C3%BC...en_by_Internet

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

  7. #7
    I agree about the surgery being the quickest way around this, but I'm wondering about the osteomyleitis. I think
    that needs to be seriously addressed first. The wound looks very clean though. Good luck to you!

  8. #8
    HI,

    It would liekly heal either way, but the flap surgery has a greater chance of reducing the healing time. i Have seen many such sores that you describe heal well with flap surgery.
    However, speak in detail with the surgeon as our protocol following flap surgery is flat lying for 4 weeks (including while eating) and then sit up with wedging during meals for few weeks. It is usually not until week 6 that you can sit up and then in wheelchair for 15 min and progressing 15 min every 2 days as tolerated.

    Good communciation with your sugreon is crucial so you know what to expect. Things also may change based on your healing but it sounds like surgery would be a good option. You have had a hard road already.

    AAD

  9. #9
    Senior Member wheeliecoach's Avatar
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    We went the opposite approach for my husband. He has 4 sores (2 on hips with one going septic, 2 on butt cheeks which underminded and tunneled) and with him being so skinny...we did not feel that creating one more wound to cover another one was the right thing for him. He has been in hyperbarics and that has done wonders with him. They are almost healed and has been allowed to be upright for the majority of the day, as long as he is on a roho.

    To give you an idea...he had a sore that went septic overnight. He was in the hospital for 19 days and on vanco and the wound vac (which did not do anything except for suck blood out of him). He also had surgery to remove the bone that was infected with osteo.

    While most people do the flap surgery, I wanted to give you a different perspective. Everyone has to do what is right for them...and for my husband...flap surgery was not it.
    "Unless someone like you cares a whole awful lot nothing's going to get better. It's not." - Dr. Seuss

  10. #10
    no advice but good luck either way ya go. i got one on my hip i'm tryin to heal.

    is the granulated skin everybody mentions that white crusty lookin skin around the outside?

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