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Thread: wound on back:where should flap come from?

  1. #1

    wound on back:where should flap come from?

    Hi


    I am currently in hospital in Australia with a wound on her lower back which went down to the metal screws in my spinal fusion.


    I came in here anticipating a surgical department head of a vac dressing. However the surgeon found gangrene and necrotic tissue and had to cut it all the way down until the metal was exposed.


    Apparently the very bottom layer of tissue is necrotic and doesn't b;need, and therefore I'm being referred to a plastic surgeon for flap surgery. The spinal injuries board is currently full so I am waiting for a bed.


    In the meantime I am wondering where the best location would be to obtain the flap? Could it come from the other side of my back? I am nervous of using areas I sit on such as the butt- as I have never had pressured areas there before and I am aware that the flap scar would weaken that skin.


    The neurosurgeon in this hospital suggested using my lat muscle- as t5 para


    I am not at all keen to use some of the only muscles which do work and a use for transfers etc.


    Finally, as this is on my back would I need to be when they dressed like the other flap surgery is on here? My chair has the entire backrest removed in this region and so there is no pressure??.?
    Would appreciate any input from nurses or anyone has had a flap in this region has everything I've read has about the buttock,coxynx etcc.


    Currently I'm on IV antibiotics and getting four hourly dressing changes with saline packing part until a bed becomes available this hospital is not equipped to deal with spinal-cord injuries so cant to provide further surgery or treatment?? I simply am waiting to get in bed in a spiral facility.


    Any Aussies aware of a private hospital which can deal with this procedure? I have health insurance to cover it is simply don't know which facility to contact??. Given that everyone keeps telling me this is life-threatening because of the chance of infection getting into metal concerned about waiting.


    Thank you so much in advance for any advice
    "The impossible is just that which hasn't been done yet.Impossible is nothing"

  2. #2
    Here is a photo if it helps the nurses
    "The impossible is just that which hasn't been done yet.Impossible is nothing"

  3. #3
    Have you seen the plastic surgeon? The plastic surgeon will get input from neurosurgeon but he is the expert on flaps and looking at the best viable choice.
    CWO

  4. #4
    Senior Member lynnifer's Avatar
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    The IV antibiotics may do a lot over their course .. let them get in there and do their thing. Awful spot for a wound... but I would blame infected hardware more than pressure. I won't pin my left foot because of this.
    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

  5. #5
    Hi CWO

    thanks for reply I AGREE i need to ask a surgeon. My problem is that this hospital does't HAVE a plastics person who specialises in this area. He does aesthetics stuff like boob jobs- this hospital doesnt cater for sci and flap surgeries
    woun management etc etc. but I'm stuck here until a bed is free at a spinal unit (up to 2 yr wait) or till I work out where else to go. Don't get me wrong nurses and drs are lovely and caring, and neuro suegeon needed due to area of surgery- but now I need to find and be admitted by a wound care dr.

    So I'm trying to educate myself to advocate for transfer or consult with someone who can help maybe minus the waiting list of spinal unit? There is no one here to answer my questions they just say wait till you get to the spinal unit- no timeframe on that requires an acute patient to rehab and leave.

    QUESTIONS

    1 Does it look like flap surgery is my ONLY option? That seems like a last resort option for me.
    2 would a wound vac be worth trying first?
    3 What happens if the bottom layer of tissue is dead but all above are ok. can the dead be cut out and rest allowed to heal over? Can good stuff heal over the bad
    4 in essence i know i need a plastics peson. But for now would help to know what the process would be. Would it be possible to start with wound vac, then flap if vac doesnt work....as a vac can be done in many hospitals here whereas the flap is only done at spinal unit due to specialised equipment, multidisciplinary team care managing bladder and bowel on bedrest etc.

    I am guessing I NEED a flap based on reading here and from friends experiences, but literally all both my surgeons here say is wait till you get to a spinal specialist. MEANWHILE i have a wound on bottom of foot and my back Not healing, getting slogh again. THE DRS TEL ME IM IN A 'HOLDING PATTERN' designed to fight infection and do dresssings till they can transfer me to spinal unit.And that it's life threatening if i get infection in bone and metal so I want to get out of here to somewhere that can help! This is a neuro and rehab with gymnasium and physio etc.... but not staffed by people I need.

    The lack of any doctor here I can talk to is why I've turned to this community for advice/experience. Never had a severe wound like this before. does it look like I need a flap surgery, wound vac- perhaps with more info I can try to find a different hospital to transfer to that hasn't such a long waiting list. I have insurance that will pay so cost isn't the issue.

    I WANT TO GO IN EDUCATED about my options and what surgeons may say, what treatment i DO need. Clearly i NEED TO GET OUT OF THIS HOSPITAL TO ONE WHERE I CAN SEE A RECONSTRUCTIVE PLASTIC SURGEON. I am in a ward with no plastics reconstruction doctor and which today r ran out of prescribed dressings and all week has to borrow from other wards - not sustainable.

    Basically I'm just sitting here with a drip and dressing changes watching wounds go sloughy again. My home care nurse wants me transferred elswheree but cannot get discarge people to agree to a transfer to any where but spinal unit.She feels at least if i go elsewhere to 'wait' I could have debridement and a vac on my foot and continue anti biotic on heel. Also she h?? ?great experience with sic wunds and nders about trying a vac on my back first as mor conserve†I've and would at leat be doing some†hing proactive. Unfortunately She has no authority to come in here and advise on treatment or transfer to anotherr facility - was told i wont be discharged to anywhere but spinal unit but there are no beds. I'm scared cant wait that long with no intervention wounds are starting tot look as mucky as before surgery...........

    Would really appreciate any input also from an emotional standpoint so I can prepare myself for wha† I may be facing.... obviously a vac is totally different to months in bed.

    ˇhanks for reading sorry if I've rambled

    bt∑- wounds are not from pressure my (former) assistance dog pulled and my power wheelchair tipped over. the impact of fall caused foot wound which was a calloused but months later opened and was 2 cm deep. wundn o oBack started as an egg shaped lump no apparent reason OT assed seeing bed car etc for pressure. either random or also relate∂ †? ƒall somehow. after many anti biotics it opened superficially and ∂?†eriorated paisley lately sedate oral antibiotics.... was hard tfind surgeno and hops†al willing to take an sic patient ( jam totally independent with all self care in here all they do is dressings and obs and IV)

    Anyway appreciate any insights as to what to expect and advocate for

    thanks heaps

    FOOT PICTURE

    https://dl.dropboxusercontent.com/u/...s/IMG_5059.JPG
    "The impossible is just that which hasn't been done yet.Impossible is nothing"

  6. #6
    All plastic surgeons are trained in flaps but definitely need SCI experience and SCI doctors. If it is exposed down to the metal/bone - typically a flap is in order because they have to put the muscle in. Debride till they get viable skin- yes, the wound is ALWAYS larger following debridement. The wound vac helps underlying tissue-specifically skin, fat via negative pressure. It helps the cells to regenerate- for example skin- first granulates then heals-very slowly. And since muscle is involved that is what he is most likely trying to replace.

    There is also synthetic skin etc.. from pigs and all kinds of fancy things but once it is down to the metal/bone
    And you will have to stay off the area for many months. We keep ours on in a "sand" bed. Once healed.. a special seating program of a few minutes at a time and slowly increased-.. and watching the area after. This area will always be susceptible to breakdown again- it will never have the tensile strength- the most is up to 80%.
    Osteomyelitis? per biopsy -treatment with culture specific IV antibiotics for 6 weeks to 3 months.
    And the hardware can harvest bacteria (seeding) and sometime has to be removed if can't clear the infection.
    CWO

  7. #7
    Senior Member lynnifer's Avatar
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    Are you on any specialized bed at the moment?
    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

  8. #8
    Hi

    lynnifer yes I'm on the only pressure relieving mattress in this hospital- one with a rotating air cells. even the so at the moment I'm figuring the best way to keep pressure of this is sit up as much as possible as then it's not touching anything.

    thank you for the medical information CWO am attempting to find plastic surgeon with wound manage experience that I can see in another hospital at least to maintain until I can get to the spinal injury unit. unfortunately it only has 40 beds so needs an acute person such as a recent injury to be fully recovered and discharge before beds become available...

    nursing staff here are very concerned that my rent is developing Muck and a bad smell again... but are powerless to do anything without any doctor giving directions.

    will keep you all updated now if I manage to get out of here to somewhere that has a doctor who can treat me

    appreciate the technical knowledge CWO helps me in googling/calling around and researching for a doctor.

    you guys are the best
    "The impossible is just that which hasn't been done yet.Impossible is nothing"

  9. #9
    Senior Member lynnifer's Avatar
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    I assume the hospital has an infection specialist and you've been seen by them?
    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

  10. #10
    It definitely looks like a flap is needed, and I am also very worried about the hardware being seeded with infection.

    Is there a SCI rehab center in Australia that is know for being the best? Call/email everyone there and ask who the best surgeon is for this.

    Call/email the plastic surgery departments of the biggest academic research hospitals in the country.

    It's amazing how many email addresses you can find online. Take advantage of this. Send a well written, short email with your story around to see what comes back. Follow-up emails with phone calls.

    Sounds like you haven't seen the plastic surgeon yet, am I right? Get ready to politely ask them their opinion, and where the flap might come from. Yes, they aren't experts, but they may know something. They are not going to be your surgeon, so don't worry so much if they don't know much. Ask them how many flap surgeries they have done.... and how many were done on SCI patients, and it what locations of the body. When they say none/few... then you ask them who does these type of surgeries that you could consult with. If they don't know, ask them if they could look into it. Just keep questioning... politely.. but firmly. Even if they wont be your surgeon ultimately, they can be a source of information.

    I would also post on this website (below) which seems to have a large international following.

    http://www.apparelyzed.com/forums/

    Meanwhile, you have a little time. Eat. Protein protein protein. Vitamins. While you have all this time, have the nutritionist come and see you, make sure PT and OT are coming to see you.

    I'm very sorry you have to deal with this.

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