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Thread: Has anyone had a wound surgery on their hip?

  1. #1

    Has anyone had a wound surgery on their hip?

    I've had a wound on my hip for the last 8 years, and long story short, I am going to have surgery on it in May. The doctor says that after the surgery I will only be able to sit up for 4 hours at a time for the first 3 months. I don't understand why though since the wound is on my hip and not my backside. When I am sitting up, I am not putting any pressure on my hip. Has anyone else had a wound on their hip and got it surgically repaired? Did you also have sitting restrictions?
    I was injured 2 weeks after my 16th birthday on June 14th, 2004. My level of injury is C5 complete, but I can move my wrist.

    My screen name comes from the movie The Eternal Sunshine of the Spotless Mind

  2. #2
    If you are talking about your trochanter area, this is the 3rd most common location for a pressure ulcer in people with SCI (after the ischium and sacrum). Trochanter pressure (ulcers) injuries most often occur from laying on your side in bed on a non-pressure reducing surface, or with the top leg forward (which puts excessive pressure on the trochanter) or from sitting with a significant pelvic obliquity, or from rubbing or pressure from the wheelchair wheel or solid clothing guard.

    First, it will be very important to determine if you have any underlying osteomyelitis, as the bone is very close to the surface over the trochanter. If so, that must first be treated. An MRI and bone biopsy (done during a surgical debridement) is a common way to determine this.

    Post operative care for a trochanter flap is the same as for a sacral or ischial flap. For us, that meant 5-6 weeks minimum on an air-fluidized bed on total bedrest, then transition to a low-air-loss (LAL) bed for the next 6 months. If everything progresses well post-op, sitting starts after 6 weeks, and starts at 30 minutes once daily, then after 3-5 days increasing to 30 minutes twice daily, increasing by 30 minutes twice daily every 3-5 days. A seating evaluation is also done the first time the person gets up, so we only progress with a seating program once any problems with sitting pressures and posture have been corrected. If everything goes well, then the person is at 4 hours twice daily after 3-4 weeks, and the seating time increased by 30 minutes every week. Most can sit 8-10 hours by the end of 4 months post-op. Careful skin inspection after each sitting episode is critical, and the time must be reduced, or sitting even eliminated for a while if any disruption of the surgical site is noted, or if there are non-blanching red areas. Using this protocol we had a high success rate with flaps for closure of pressure (ulcers) injuries in all bony areas of the pelvis.

    (KLD)

  3. #3
    Thank you for that information. That sounds like a very different protocol than the one I was told about. I'm seeing a doctor at Shepherd spinal center in Atlanta Georgia. They said that I will be in the bed for the first 3 weeks and then I will be able to sit up for 4 hours at a time for the first 3 months, and then increase it one hour every 3 months.

    First 3 months - sit for 4 hours, lay down for two, sit four another two hours, lay down for two, etc.
    Next 3 months - 5 hours, lay down for two, get back up,
    Next 3 months - 6 hours etc., etc.

    What hospital are you from? I want to stay longer at Shepherd but they said that they can't keep me for more than 3 weeks. Did the hospital that you worked at keep people for

    And I had an MRI that said that I did or might have osteomyelitis.
    I was injured 2 weeks after my 16th birthday on June 14th, 2004. My level of injury is C5 complete, but I can move my wrist.

    My screen name comes from the movie The Eternal Sunshine of the Spotless Mind

  4. #4
    I worked in a VA SCI Center. We were able to keep Veterans for their entire program...often a 6 month hospitalization.

    Osteomyelitis needs to be properly diagnosed (bone biopsy and culture) and treated BEFORE a flap is attempted.

    Medicare and Medi-caid limit the time of acute hospitalization you can have for a flap. Many go home on bedrest before they start their sitting program. Others go to a nursing home or LTAC until they can start sitting. We would never sit someone 4 hours the first time they get someone up. l would suggest getting a second opinion from a plastic surgeon experienced in SCI flaps...perhaps at Emory.

    (KLD)

  5. #5
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    MeetMeInMontauk, That recovery protocol doesn't sound right to me. I've had three flaps over the past ten years and the recovery has always been the same. 6 weeks laying flat in an air-fluidized bed 24/7. Then you start a sitting protocol and the initial duration for me was 15 minutes the first day and then slightly progressing for approximately 2 weeks after that. Before you get to any of that you need to address the possible osteomyelitis. That needs to be cleared up before you do anything and that usually means 6 weeks of IV antibiotics. The information you're getting from your doctor doesn't sound right and that's surprising coming from the Shepherd Center. They have a very good reputation. I would discuss this again with your doctors and get a clear understanding of the order of events. It should look something like the following:

    1. Clear up any osteomyelitis - 6+ weeks antibiotics
    2. Post Surgery - 6+ weeks in an air-fluidized bed (e.g. Clinitron)
    3. Sitting Protocol - 2+ weeks gradual increase of sitting time

    I would not go with what you have been told so far. It's a recipe for failure. Don't agree to anything until you are comfortable with the plan of care.

  6. #6
    Hi, it does concern me that both of you have told me that the procedures/aftercare was very different than what I've been told. Like you said though, Shepherd is a hospital that specializes in spinal cord injury so I am confused about how they could possibly get this wrong. I've had two different doctors at Shepherd tell me the same thing, unless somehow I have misunderstood them. I am going to Emory also to get another second opinion there. I'll let you know what they tell me. Thank you both for your help.
    I was injured 2 weeks after my 16th birthday on June 14th, 2004. My level of injury is C5 complete, but I can move my wrist.

    My screen name comes from the movie The Eternal Sunshine of the Spotless Mind

  7. #7
    If the bone is showing to the air, you'll have osteomyelitis. Every time mine has done that they've had to trim the bone down a little. On the last flap surgery I had on the right ischium the doctor seen the osteomyelitis and arthritis in the bone and decided to just take my whole hip out. Since I sit in a chair, my insurance would not cover a replacement hip so my right leg floats without a hip. I wouldn't stress it too much, just make sure you get a good seating evaluation afterwards and you get the right cushion you need to keep yourself from having to get another one.
    C-5/6, 7-9-2000
    Scottsdale, AZ

    Make the best out of today because yesterday is gone and tomorrow may never come. Nobody knows that better than those of us that have almost died from spinal cord injury.

  8. #8
    Senior Member lynnifer's Avatar
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    I wonder if they gave you a different protocol because of where the wound is located on your hip - you said you don't sit on it? What cushion do you use and what kind of bed? Worst thing would be to get that wound fixed and get another from putting too much pressure on the other side.

    Osteo is more than likely present in a wound 8yrs old. It's been my experience that it never goes away - lies waiting for another weak spot or when your immune system is low.
    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

  9. #9
    Quote Originally Posted by lynnifer View Post
    I wonder if they gave you a different protocol because of where the wound is located on your hip - you said you don't sit on it? What cushion do you use and what kind of bed? Worst thing would be to get that wound fixed and get another from putting too much pressure on the other side.

    Osteo is more than likely present in a wound 8yrs old. It's been my experience that it never goes away - lies waiting for another weak spot or when your immune system is low.
    Spot on... especially when you have a UTI

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