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Thread: Back in bed again

  1. #1

    Back in bed again

    I feel like reaching for the razor blade at the moment. Unfortunately I am back in bed at the moment with this dreaded sinus tract. It's probably about one or 2 mm in diameter, and 3 cm in length and runs at an angle underneath my skin from my sit bones upwards. I was in bed from the end of December until the middle of March. The nurses have measured 0.5 cm back then, she measured the same on Friday, however on Saturday the nurse measured 3 cm. The only difference was the other nurse used the end of a swab, the nurse on Saturday used a piece of wet gauze which she rolled into a very narrow length and then inserted that. I'm beginning to think that maybe this sinus was there all along and maybe just healed over at one end.


    Anyway, the entrance is just a very small split. It was a small hole, or resembling a dimple which then change shape. Apart from that, the rest of the skin looks okay, no redness, nothing at all,. The nurses are using Aquacel as a packing and Duo-Derm as an external dressing whilst I am lying in bed.


    I was supposed to be going up to Salisbury to see the seating engineers in May, they are going to attempt to make a special Roho/foam hybrid cushion that would address the high pressures that I am still getting. They are not too bad, just a couple of hot spots, but very small nevertheless. Silly thing is, since I started getting up I have been carrying out my pressure tilts every few minutes, in fact I have probably been leaning back more than I've been sitting up. So for this to happen again, it's very very distressing as I feel that I haven't got any where to go from here.


    Sadly, I have had to cancel these extremely important appointments with this seating engineer. What is most annoying as I was supposed to be meeting a representative from Roho on June 2. By all accounts he has been following my problems with the cushion is going to be there to try and advise and help, looks like that won't happen now. I'm still trying to be positive and look on the bright side, but it's wearing quite thin now, I feel like everything is against me, I've done absolutely everything to try and stop this happening, but it still isn't good enough.

  2. #2
    Senior Member WPDaggy's Avatar
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    When I had a skin breakdown around my coccyx I pinched off the "tits" on my Roho in that area so the tailbone wouldn't be touching when I sat in the chair. I sprayed the area with Vetericyn VF in the morning before getting in my chair and at night when I went to bed. The area healed in a couple days. I've done this twice over the years and both times it worked like a charm. I realize your wound is worse than a skin breakdown, but maybe you could pinch off the cells where the sore is and it would allow you to make your appointment.

    Best wishes!
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  3. #3
    Ironside, this scenario is common in someone who has a deep pocket and possibly osteomyelitis underlying the pressure ulcer. Have you been evaluated for this?? It is likely that you need surgery to get this cleaned up. You should have some blood work (CRP, sed rate, WBC) and ideally and MRI to see if osteomyelitis is present in your ischium.

    (KLD)

  4. #4
    I'm not sure it is not quite this bad. I was told this morning by the nurse that they have found an infection which I am now on antibiotics for. However, we're talking a fairly small area. I don't think he would look at what I've got and immediately reached for the scalpel, put it that way. We are only talking about 1 cm, probably slightly less. I have included a photo which I have cropped down so you can only see the outside of the sinus. As you can see, there's no pressure ulcer on the outside at all. Also, the sinus doesn't seem to run deep, it seemed to run upwards underneath the skin. However, I have taken on board your suggestion and will be sending an e-mail to my spinal cord injury unit this evening for them to ponder over. However, as I've not been feeling unwell, I don't think I have a serious infection.

    I think it's probably worth mentioning that photos always exaggerate something and make it look more horrible than it does with the naked eye.Name:  sinus2.jpg
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Size:  12.2 KB

  5. #5
    Sinus tracts can be quite small on the outside, but grow larger inside. This is a pressure ulcer. Many people can have serious bone infections (osteomyelitis) without any symptoms at all. You still need to get it checked out.

    (KLD)

  6. #6
    I do have the nurses coming in every day at the moment and they are packing it with Aquacel. Thankfully it doesn't appear to be very big at all inside. We've had a good look at it and it appears to be a very narrow tube, possibly one or 2 mm which maybe up to 3 cm in length, but I'm not altogether sure because it's not easy to measure them properly without sticking something solid in there. If there was some infection on the bone, would the sinus originate from this area? The one I've got doesn't appear to be going down towards the bone. Also, I don't think there's any kind of abscess since there's not much discharge coming out, in fact even though a swab did indicate an infection, it does not appear to be an infection that is creating lots of discharge.

  7. #7
    A tract like this can very easily go all the way to the bone. It can close up a little, then open up again.

    Just had a patient with this same type of wound a couple of weeks ago. Got an MRI, found pretty extensive osteomyelitis. His CRP was also elevated, as well as his sed rate. He had a debridement and bone biopsy (for bone infection culture) and is now on 6 weeks of IV antibiotics to treat this. Never had fevers or chills, never had extensive drainage, felt fine.

    If you want to know why this wound never seems to heal, you need to look further than what appears to have been done to date.

    (KLD)

  8. #8
    Things are looking really good. The nurse is very pleased with the progress.. I'll take a photo tomorrow and you will see the improvement, at least from the outside.

    When I had a similar problem back in 2004, I actually spent the whole of the year feeling unwell. On quite a few occasions I had to stay in bed simply because I felt so incredibly ill. It wasn't until the day before that big tsunami when it all came to a head and the sinus broke the surface. That was definitely a serious ulcer, you could get your finger into it. With the benefit of hindsight, I now know that it must have been brewing up for months.

    I have passed on your comments to all the nurses and it is something we are going to look at, although the wound nurse who was here today didn't think it was the case. But I think it's definitely better to be safe than sorry

  9. #9
    I thought I would give you an update on my condition. Things are definitely moving in the right direction fairly quickly. The nurse Helen said she could hardly get any packing in this morning. Yesterday the doctor came up and liaised with the nurse so we could discuss where we go from. I've basically done some research myself and have decided that it's probably about time about to control of the situation. So I've been using your guidance (SCI nurse) and it has been decided that I will be having a sinogram. Now here lies the problem, my point then isn't for about 3-4 weeks. By this time this sinus is going to be almost non-existent. Now whether there will be something still remaining under the skin that we do it now about, I have no idea. What I'm saying is that surely the sinogram will be ineffective because they won't be able to get any dye in. There was talk of an MRI as well, but I think this would just be looking towards problems with the bone. At the moment, I am using Duo Derm and for the last two nights my bed sheets have been completely clear of any exudates.


    Anyway, just thought I would let you know what's happening, if you have any advice them please feel free to chime in.

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