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Thread: Stage 4 pressure sore plus torn rotator cuffs

  1. #1

    Stage 4 pressure sore plus torn rotator cuffs

    I?m a 74-year old T9-T10 herniated disk paraplegic

    I?ve had an ischial pressure ulcer for about 1 year. The wound became Stage IV about 6 months ago and at that point I got on a wound vac and was in the hospital and a nursing facility for 6 weeks on IV antibiotics for Osteomyelitis.

    Since then I?ve been at home and still on the wound vac. For the first couple months at home I was on a normal mattress, but for the last month have used a PressureGuard Easy Air LR mattress (one of those that varies pressure constantly). During the day I am up 2 hours at a time and in bed for 1 hour in between (doctor?s suggestion). I have a reclining wheelchair with a RoHo cushion, and recline once or twice a day while I?m up sitting. At night I turn every 3-4 hours. I often have a burning sensation (though I don?t have much sensation below the chest) both sitting and laying down. Both of my rotator cuffs are very bad, making it painful to lay in bed for a long time. Laying on my side seems like it would take more pressure off of the wound, but that makes the shoulders even worse so about half of the time I?m on my back. Most doctors have told me that shoulder surgery is a bad idea since it would be very hard for me to recover given that my arms are currently all I can move.

    The sore is currently 1cm wide, 2cm long and 2.3cm deep, but has significant tunneling (4.5cm in one direction). It doesn?t seem to be getting worse, but is not getting better. My doctor, known as a very good flap surgeon, said that with all of the old tissue on the wound it will be difficult for it to heal on its own. They plan to debride it in 6 weeks, but are recommending flap surgery. I suspect that she?s thought all along that I would end up needing flap surgery, but has ?babysat? (her words) me for a few months until she thinks I will be more convinced.

    I am reluctant to consider flap surgery because I think my shoulder pain during the several weeks of bed rest would be excruciating.

    Does anyone have experience with the combination of a pressure sore and bad shoulders, or with flap surgery recovery and bad shoulders?

    Does it sound likely that the wound will heal without flap surgery? Any suggestions for how I can lie in bed to avoid pressure on the sore and pain in my shoulders? Has anyone ever used pressure mapping to evaluate positions in bed? Not sure if I can get anyone to come out and do this.

    Is being up 2 hours at a time too much?

    Would much appreciate any advice.

  2. #2
    With any kind of sore you should be in bed only and not putting ANY PRESSURE ON IT AT ALL. A pressure sore that you are constantly putting pressure on WILL NOT HEAL and WILL only get worse. At this point surgery is probably the only option. But a doctor who has experience with pressure sores and flap surgeries will be more able to help than we will. I went thru the very same thing 3 years ago and ended up having a flap done and so far i have had no issues since. I am very careful now however to not get another sore. What about a clinitron bed for home? Just another option
    T6 Incomplete due to a Spinal cord infarction July 2009

  3. #3
    Senior Member
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    It seems that the wound vac does not do well on deep pressure sores. There are a number of us on this forum who have spent 6 to 10 weeks on a wound vac only to find that the wound is tunneled and a flap is the only alternative. I had an even smaller wound with 5 cm of tunneling. During recovery on the wound vac and after the flap surgery, there were NO up times in a chair.
    Don - Grad Student Emeritus
    T3 ASIA A 26 years post injury

  4. #4
    I have to disagree with your doctor. Being up on that wound for any length of time is too much. Under the circumstances with your shoulder pain issues you probably ought to be on a Clinatron bed/mattress. You did not mention if you are taking any pain meds. I get enough relief from tramidol to make sleeping on my side tolerable. I also have had my shoulder joints injected with steroids and that helped. I am using a PressureGuard Easy Air without the rotation to protect areas that have scar tissue from old wounds. It is a good bed for this purpose and perhaps treating less severe wounds. I have not done any pressure mapping but I can say that it does not come close to providing the pressure distribution that Clinatrons do. Research has been done that indicates the best positioning in bed to protect the butt area from pressure is lying so there is about a 30 degree angle between the back/buttocks and the bed surface plane. That reduces or eliminates pressure from the ischial areas and the sacrum and hips which are vulnerable to sore development from beds.

    Has your doc considered any of the high tech treatments available for treating wounds like Graftjacket? http://www.woundsource.com/product/g...-scaffold-fsts If it were me, a 77 year old long-term quad, I would go that route before I tried surgery. But any approach is likely to be a waste if you are not able to stay off the wound completely and get on a Clinatron or equivalent. You are in a real bind. Extended periods of immobilization are difficult to recover from by us oldsters.
    You will find a guide to preserving shoulder function @
    http://www.rstce.pitt.edu/RSTCE_Reso...imb_Injury.pdf

    See my personal webpage @
    http://cccforum55.freehostia.com/

  5. #5
    Senior Member lynnifer's Avatar
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    Go for the flap - quickest way out of this mess. Your recovery will be intensive to work back up to strength again, but at least you won't be at risk of sepsis.
    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

  6. #6
    I can't address the pressure sore, but in recent years I spent 5 months in a nursing home after pneumonia. Paralyzed from chest down, it was difficult for me to reposition in bed as the aging process has resulted in weaker, often painful, shoulders. I tied lightest rubberized exercise bands to each bed rail and exercised with them several times each day. Still use bands as needed in my hospital bed at home. This was mainly for "range of motion" for my shoulders, and maybe a bit of strengthening. One shoulder with chronic pain, I try to do light stretching, and "shrugging" shoulder to get relief. Take Motrin on occasion, which helps. I'm very careful exercising shoulders if there's pain.

    It would be great if you could get a PT to consult with about your shoulders. Recently a PT helped me a lot by suggesting I sit next to a table, placing whole arm on table and slowly moving it along as if reaching for something. I had instant relief. Doesn't last long, of course but it felt great.

  7. #7
    The wound VAC helps reduce the size of your wound even if a surgeon is planning on doing a debridement and a surgical flap closure. If you've had surgery in the same area before or the wound has a lot of dead tissue in it debridement will help get rid of that in order for it to be closed better or to heal better.

    pbr

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