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Thread: Pressure Sore ?'s

  1. #1

    Exclamation Pressure Sore ?'s

    It's been a little over five years since I've had any problems with skin breakdown on my lower back/butt ? however I have one now. ugg. I just noticed it this morning and vna wound nurse will arrive tomorrow in the am. My normal reaction is one of urgency and alarm.

    My Own Wound Eval

    - dime size area, blanches around edges.
    - smaller pencil eraser sized opening above the top of bum crevice where the indentation is
    - about a week old estimate
    - dressing w/ gauze, polysporin on bandage and sitting with donut
    - in that place that exists between the backrest and the cushion (is there a name for this)

    Possible Causes:

    - backrest of wheelchair angle increased to almost 90 degrees, due to wheelchair mechanic incompetence (manual chair) December 30
    - rolling too early at night
    - loss of weight (~15lbs) due to nine-month IV treated infection


    1. I found some very soft foam, cut a doughnut hole in the middle roughly 3 inches in diameter and have been sitting on that. Does anyone have any suggestions on other medical or homemade pressure relief contraptions on the market? I'm currently working from my standing frame and using the donut in the same place. I think this should be okay?
    2. Since it is small, and I have Neanderthal Italian genetics; Should hair be removed? (the reason i missed it right away)
    3. In the past, the VNA has always recommended staying out of the wheelchair and remaining in bed. This obviously has a lot of negative life consequences and I've been able to resolve larger sores in the past without being bedridden. Any advice or ideas?

    Thank you in advance for anyone who took the time to read this and even more thanks for those who have some suggestions.

  2. #2
    I am not clear where the ulcer is. Can you post or send the SCI-Nurses a photo?

    If it is at the top of your buttocks crack, that is your coccyx. A little higher is your sacrum. Unless you are a really bad sacral sitter in your wheelchair, pressure ulcers in this area are nearly all caused by laying on your back too long on a hard surface, esp. with the head of the bed raised above 30 degrees.

    Donuts should never be used. They can actually make the pressure ulcer worse, as they foam or air filled chamber collapses to a hard ring that prevents any surface blood vessels from carrying oxygen rich blood to the area. Please get rid of the donut! Stay off it completely (laying side to side and prone only in bed) until the VNA can see it. Ideally you should also have a seating evaluation if you can arrange this. Don't use the donut in your standing frame either. If you are getting pressure there from your standing frame, you need to stop standing until it is healed, and then adjust the straps or pads.

    Keep it clean (rinse with saline solution or wound cleaner), but never use peroxide or Betadine. Clip hair (but do not shave) close around the wound if needed. Keep covered with a dressing that prevents the wound drying out. Put the Bacitracin ointment directly on the wound, then cover with a dressing like Telfa which excludes air. Change twice daily. Stay off it.


  3. #3
    I'll get a photo. It is the coccyx. Do I have to stay in bed 24 hours a day?

    I think it's either from the standing frame or from changing positions in bed. Either way this can be eliminated, however what can be done about mobility?

  4. #4
    Re your wheelchair. Some wheelchair backs can be loosened at the bottom. I could do that with my manual chair. Another thing that can cause a sore in that area is pressure from your pants seam especially if the pants are made of heavy rough jean material. To facilitate healing when up in the chair you may consider opening the seam at the bottom. When your nurse visits you should get in your chair and have her/him check where the wound is to see if there is pressure coming from the chair back or cushion. Then you can figure out an effective way to eliminate it. Good luck. Make healing it the priority in your life right now.
    You will find a guide to preserving shoulder function @

    See my personal webpage @

  5. #5
    Thank you both for the advice.

    The nurse wasn't as alarmed as I was. It turns out it is the sacrum and not the coccyx.

    I can pretty much relief all pressure, as long as my legs are slightly forward in the chair, and I loosened the lower back rest ? so the sore is in the bottom area between the cushion and the backrest.

    @scifor555- In terms of opening the same at the bottom. Are you suggesting that I cut a triangular shaped wedge out of the pants? Or something similar?

    In terms of standing, I was thinking of placing some form on either side of sore so that I can eliminating all pressure. The nurse said that the standing frame would not cause any problems but the advice in this forum is paramount.
    Last edited by Chaz19; 03-11-2015 at 03:32 PM. Reason: notifications

  6. #6
    If you wear jeans, the double thick seams in jeans, as well as the rear patch pockets, can cause problems with your skin. We recommend removing the patch pockets completely, and if possible, having a seamstress or tailor open up the middle rear seam and restitch it as a flat smooth seam (not doubled over as in most jeans). Also, remove any rivets on the back of the jeans.


  7. #7
    KLD's suggestions are pretty much the same as I would recommend. If you do not have access to someone with sewing skills (rare these days) you can split the seam starting from below the wound and ending a couple of inches above it. Then make horizontal cuts a couple of inches wide at the bottom of the seam slit. That will create a triangle shaped flap. I have done that with old pants that were about to be discarded anyway.

    And KLD's warning about jeans with rivets, leather patches, etc. is on target. When people are in a wheelchair that stuff is not visible anyhow. Because of the number of problems I have seen caused by jeans over the years I quit buying them. It's soft khakis all the time now that I am retired.
    You will find a guide to preserving shoulder function @

    See my personal webpage @

  8. #8
    Thank you both. I've been able to identify two or three sources of pressure and has taken your considerations into account. At this point, i'm heading in a positive direction. Reducing the tension on the back rest seems to be the ticket along with sitting slightly different. All of your suggestions are very helpful and implemented.

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