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Thread: my VAC bandage is going bad; help!

  1. #1

    my VAC bandage is going bad; help!

    This is what's going on in a nutshell.


    I've got complete SCI L1 since about half a year ago, late 60's, very little upper body strength, overweight, transfers are accomplished by my aide dragging me across a sliding board.


    About 7/9/2014 my aide notices an abrasion a few inches long and one inch wide on the left butt cheek.


    7/11/2014 my urologist removes my Foley catheter. I become incontinent and I'm often wearing a wet diaper. A pressure ulcer develops where the abrasion had been.
    My visiting nurse urges me to wear a condom catheter and to spend most of the day lying in bed on my right side. I try to use the condom catheter, however it keeps falling off. Also, going to bed during the day is very inconvenient.


    8/5/2014 I am hospitalized after I begin going into septic shock due to the spread of infection from the pressure ulcer. I test positive for MRSA.


    8/13/2014 The wound is completely debrided, exposing a hole about four inches deep reaching the bone. Negative-pressure wound therapy, aka vacuum-assisted closure, is begun.
    Needless to say, I was given a ton of IV antibiotics and I'm now on Zyvox.


    Yesterday I was discharged with a VAC bandage and portable little pump.


    Before reaching the elevator, the pump says that there is a leakage. We go back to my hospital room and the dressing is falling off. A doctor replaces it and tries to tape it on as strongly as possible.


    Before bed last night, the pump starts beeping again, indicating leakage. My aide tells me that the dressing has begun peeling off. Furthermore, I had a bowel movement in my diaper. Some feces are soiling the dressing.


    Right now, 3:00 am, I don't know what to do. I'm scared of having to stay in bed for a month while this heals in order to avoid disturbing the bandage. I'm scared of needing reconstructive surgery, which I've heard is not always so successful either. I'm scared of getting further infections in the wound site.


    And just by the way, while in the hospital, a deep tissue injury in the right butt was discovered during a CT scan. So this may be developing again on my other butt cheek.


    This just seems endless and hopeless. I wonder if others have gone through something similar (and lived to talk about it).

  2. #2
    Senior Member lynnifer's Avatar
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    Yes - many have. You're not alone. I've done the vac, but on my foot. Your butt is a terrible place to have one so sorry about that.

    Unfortunately from what you describe, I think it's best to stay in bed immobile while you have the vac on ... the vac and dressings are expensive (waiting lists where I live to get one) so give it time to do its thing. There HAS to be a way to tape it to stay on .. my ankle was pretty awkward but we managed.

    The diaper .. this needs to go. Why did they take your foley catheter out? I would ask and maybe request it again OR try to keep the condom cath on somehow (sorry I'm female so not sure how plausible that is).

    As an L1, you must not be able to feel lit when you have a bowel movement? Are you on any kind of program (going same time every two days, etc?) I think that would help greatly instead of accidents. Whomever wants the diaper on is being lazy because it's detrimental to your health at this point - especially if you have a DTI (deep tissue injury) on the other cheek.

    What mattress are you currently laying on? If you can get your hands on a LAL mattress (low air loss) or I use a mattress overlay that circulates air that I purchased from eBay? What sort of seating do you have in your wheelchair? Do you have access to a hoyer lift so this won't happen again?

    Nutrition is SERIOUSLY important when you have wounds. Hydration too. You're losing lots through that wound! It's a good idea to take a multi-vitamin, B12 and some protein (in shakes, eggs or lean cuts of meat). There's an old recipe going around when nothing else works called The Harvard Recipe.

    10,000 u of Vitamin A
    B complex (multi-vitamin)
    500mg Vitamin C 2x per day
    500mg Vitamin D
    400 iu Vitamin E 2x per day
    Zinc 50-250mg
    2000mg L-Arginine (builds tissue - this one is important but expensive to buy as a supplement!)

    Something else I like is GNC's Hair Skin Nails (HSN) .. sounds funny but I saw improvement using it. Must be the biotin in it. Expensive as well.

    Also, don't be ashamed to share here if you feel some depression coming on. Many of us have been there including myself. It sucks to be stuck in bed!

    Keep taking your antibiotics religiously .. and a pro-biotic can't hurt either (I like Align).

    Keep us updated on how you're doing! Hopefully the nurse chimes in!
    Roses are red. Tacos are enjoyable. Don't blame immigrants, because you're unemployable.

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

  3. #3
    Senior Member pfcs49's Avatar
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    Wow! You are having a hell of an intro to your injuries!
    I'm T12/L1 complete, 67yo, ~200lbs, 19 years post injury.
    I can relate to your troubles. They probably seem overwhelming, but hold it as possibility that they aren't.
    I wore a condom cath for years until my urodynamics changed; at that point I got a suprapubic catheter, which has been a delight. When I wore the condom, I had a constant struggle to keep the skin good so the cath would adhere. The area just behind the head of the penis would get irritated and break down, staying wet with lymphatic fluid and causing the cath to de-laminate. I went through all sorts of experiments to control it; the most effective was to only apply the condom cath to the head of the penis and put kleenex in the concavity behind that adhered to the sticky cath and left it "parked" off the wet/healing area. I have always been very active and was fairly successful doing this although there were "blowouts". The skin of the penis seems to repair itself very quickly and these times lasted only 3-4 days. It would never heal without getting it in to the air. Also, I used a skin barrier prep when the skin was healthy; these preps are pretty useless when there is exudate, though.

    I'm no expert on pressure sores on the butt. I had my first (and better be my last!) two years ago. AFAIK a Clinitron bed is a necessity for relief and healing. Air Fluidized Bed ? Clinitron? Rite Hite? | Hill-Rom?
    My ischial wound was to the bone and came out of left field. I had debridment then a flap surgery. After the surgery I was in the rented bed for ~10 weeks before getting up for the first time for 15 minutes, twice a day.
    I don't know how I was able to do it, but it wasn't so bad. My out of bed time was slowly increased until ~2 months later I was pretty much back to normal.

    My wound was in such proximity to my rectum that it was suggested I get a colostomy-at least a temporary one. Dealing with doing a bowel program on the clinitron bed made this a no-brainer! So, since Feb of 2012, I have had a permanent colostomy and it has been quite satisfying-much simpler/quicker/cleaner and no hours spen on the throne! More time for fun.

    Yes-I said fun. You probably feel like your life is over and your troubles insurmountable. I certainly have had that experience. Trust me-if you direct your energy towards fixing the mess you've become, it WILL get better. It will require determination and discipline, but as you see incremental results, you will slowly turn your life around. I gave up a lot to get in this seat, but I gained a lot also! I'm a recovering alcoholic (31yrs). For me, the choice is simple: if I give up and decide life sucks, I'll die. I choose life every day and it's worked well for me. Don't give up on yourself-help is on the way if you'll let it in.

    PS: Lynnifer's comments about vitamins, L Arginyne, and health diet/hydration are absolutely true and pertinent.
    Also, although I've heard of deep wounds like yours healing after very long times in bed, I think flap surgery is the norm.
    And, after transferring into my chair just once after about 5 weeks and finding that I couldn't even begin to lift myself off the cushion with my arms, I embarked on doing exercises in bed avery day with dumbbells and elastics. When I finally got that opportunity to transfer out of bed, I was able to do it! It was kinda sketchy, but it was successful! What a great day June 4th 2012 was!
    Last edited by pfcs49; 08-20-2014 at 01:38 PM.

  4. #4
    Thank you guys so much!

    My Foley was removed because it was causing UTIs. I was planning on switching to an intermittent, but I just ended up peeing in my diaper.

    My doctor has advised me to do bowel extractions with a suppository. My wife won't allow it. She believes I can do without that because she thinks I'm miraculously going to walk in a few months and I don't need artificial aides like that.


    I'm getting a dynamic pressure mattress in a few days.
    Last edited by johngoodman; 08-20-2014 at 02:51 PM.

  5. #5
    Senior Member pfcs49's Avatar
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    John-I used Majic Bullet suppositories from the time I rehabbed in 1995 until my colostomy. They are pretty much de-rigeur for PLU (people like us) and are harmless, cut down on wear and tear to the rectum, and save time as well. Perhaps there is a spinal support group for your wife or maybe she could be active here with her concerns which are, I imagine, very real and very great.

  6. #6
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    I had a similar problem with my right ischium, and we did a debridement and wound vac (in bed) for 10 weeks. At that time it looked nearly closed, but was still all the way to the bone, and larger as it got deeper. The wound vac had closed the surface while leaving the wound open at depth. They then did a flap surgery and 10 weeks in a Clinitron. That was 10 years ago, and the flap is still in good shape. I've seen a number of testaments here over the years that indicate that the wound vac seldom works on SCI butt wounds.

    I use mini-enemas, and find they work quite well for me. The magic bullet seemed to lose effectiveness after 8 or 9 years of use and I made the switch.
    Don - Grad Student Emeritus
    T3 ASIA A 26 years post injury

  7. #7
    John-
    you have some issues that need addressing, but none that are insurmountable. Unfortunately, two of the three are contributing to your skin problems. However, here is what I would recommend:

    1. For your skin- since you need a vac for your wound, it needs to stay on and working. Did you get a visiting nurse referral? If not, you need one. They can help you problem solve the dressing and also help to provide wound care.

    2. For your bladder - you need to become continent. If that means an indwelling catheter, then you need to go back to it if even for just a short time. Again, a visiting nurse may be able to help you problem solve the external. Ideally, you should be on intermittent cath, but that may need to wait until you get your skin under control.

    3. For your bowel- no matter what your wife says, you need to be on a bowel routine. You can give her the information that is posted on this site titled Neurogenic Bowel Management. That may help her to understand more. I would also be willing to answer any questions she might have.

    You also need to stay off the area(s). The mattress will help, but you still need to turn and be positioned. Also, make sure you eat a well balanced diet, drink plenty of fluids and make sure you get plenty of protein.

    hope this helps.

    CKF

  8. #8
    Member
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    John, you have a lot more to worry about than how much weight you can curl. Let go of that worry for now and concentrate on your pressure sore needs. You are in a good place for information and encouragement, keep asking those questions. Wishing you well.

  9. #9
    First of all, thank you all so, so much for your time and caring. I really love all of you.

    This is what's happening now.

    I got a new bed today: Masonair LS9500 Turn-Style Lateral Rotation Mattress. It costs almost $3,000. Medicare paid. It can automatically tilt you up to 40 degrees on your right side, left side and back again. My wife is ecstatic. Myself, not so much. Transfering from it to a chair is a disaster. It's like sitting on a 10 inch pile of squishy balloons and it occaisionally makes a noise like a little vacuum cleaner.

    I have a visiting nurse who puts on my VAC dressing every morning. So far it's never lasted more than 12 hours, so she comes daily. I asked her how many hours per day I can sit in my chair. She said ask my PT. I asked my PT. He asked what my surgeon said. My surgeon didn't say anything. The PT suggested a wheelchair cushion with a hole in it where the wound is, like a sort of donut, and doing pressure relieving exercises in the chair.

    Based on what I'm hearing and reading I have doubts about a VAC working for my sore.

    But on the other hand, I don't want to stay in bed for weeks. I think it would drive me nuts.

    So I'm sitting all day in a chair, paralyzed from the waist down with a stage 4 pressure ulcer completely penetrating the gluteus maximus above the ischial tuberosity and infected with MRSA. I've got a VAC dressing, which is off half the time anyway. When it's off my wound is often contaminated with feces. And no one seems concerned. My wife thinks a $3,000 mattress should surely fix anything and anyway I'll be walking again soon.

    I'm confused. Am I fiddling while Rome burns? And why don't my health care providers read my wife the riot act?


  10. #10
    An online friend of mine suggested a ‘reading man flap’ or Z-plasty surgery. Has anyone had experience or heard about this?

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