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Thread: Stage 4 Ischial Wound Ruining my Life -- Failed flap <45 days after discharge

  1. #51
    Quote Originally Posted by lynnifer View Post
    May I ask ... one of the fears of mine in losing lower limbs, was that I'd drag the stump while transferring. Is that something that is happening and aiding in these wounds/infections? Docs have threatened to cut my limbs off more than once, but I remain steadfastly negative about it.
    Nope, not a single time. Losing the legs is one of the best things that happened to me post injury, totally increased my quality of life. Moving around is just 1000% easier, it's like a ball and chain of dead weight taken away. I've never once cut up my stumps. You couldn't pay me money to put my legs back on, it's that much better.

    The only downside of not having legs is losing the "shelf" that they make so you can carry stuff on your lap. I just adapted and figured out other ways to doing it. Well, also the center of gravity changes to your wheelchair, but what I did was shift the axles back 1" and had this weight made by a local metalsmith:






    I drilled 2 matching holes in my footplate, and added foam from an entrance mat (bought at Home Depot) to prevent rattling. The plate just notches into the footrest and provides the added weight to make me not as tippy. Right before I transfer in my truck I reach down and grab it, and when I get out I just slide it back onto the footrest.

  2. #52
    wow.... As a hospice nurse for 4yrs before my injury I've seen my share of wounds. One thing that always stood out, wounds are not always predictable. Meaning, we'd see patients that we were sure would get wounds; Example: lots of boney prominences, bed-ridden, no kind of nutrition, etc, yet never get a wound. Then patient's that ate well, always moving, adjusting position, etc, would sometimes get the wounds. Wounds, to me, just make no sense. I unfortunately got pressure wounds on each of my outer ankles. It's like it happened overnight, down to the bone, had them debrided then wound vac. For me, I know that I've always had sensitive skin, so it's not really a surprise to me. Maybe a small part of the problem is just that you have sensitive skin. Anyways, I can certainly sympathize, I was unable to start therapy until my wounds were healed.
    Also, I think that it's freaking amazing that you are going to school, and med-school at that~!! I'm a little over a year out from injury and I have still have a hard time (mentally) going out anywhere.
    I applaud you & hope the wounds eventually, and quickly resolve. *hugs*

  3. #53
    The largest tunnel increased from 5cm to 8cm in 1.5 weeks, after pretty much being 24/7 in bed while septic in the hospital.

    Just get me to surgery already.

  4. #54
    We would never do a flap until you had been treated for the osteo long enough that your CRP, WBC, and sed rate had returned to normal levels.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  5. #55
    Senior Member lynnifer's Avatar
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    I agree with the nurse - I had IV antibiotics for at least 6 weeks before surgery. Give your body the best chance at beating this.

    It must be so frustrating in that you lost the legs and now facing this ... but we're there with you. You're certainly not alone as many have had trouble with wounds. I, for one, want you to succeed!
    When injustice becomes law, resistance becomes duty.

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

  6. #56
    Quote Originally Posted by SCI-Nurse View Post
    We would never do a flap until you had been treated for the osteo long enough that your CRP, WBC, and sed rate had returned to normal levels.

    (KLD)
    They're trending in the correct direction. My surgeon recently co-authored a 2017 paper, and although it may be commonplace to wait to conduct a flap, there is actually no difference in outcome whether or not someone has osteomyelitis at the time of surgery. Paradoxically, those with osteo had better outcomes, likely because they were monitored and had better treatment:

    https://www.ncbi.nlm.nih.gov/pubmed/28458977

    CONCLUSION:
    Test properties of MRI for diagnosis of osteomyelitis in patients with chronic pressure ulcers have limited ability to diagnose osteomyelitis and do not aid in surgical management, but do increase health-care expense. The diagnosis of osteomyelitis by intraoperative bone cultures does not predict inferior outcomes and paradoxically may be associated with fewer postoperative complications.


    What I need is to get into surgery, have thorough debridement of both tissue and bone, and flap this wound before it continues to tunnel and get deeper.

  7. #57
    Are you saying when you are in your chair you have 0 pressure on parts? Pretty impossible if they touch any surface. But no matter the cushion, eight shifts/releases must be done every 15 minutes- and research was shown to prevent breakdown. Prevention is the key. The pressure injury is so difficult to heal & reopens or becomes infected easily in SCI because of the changes in the autonomic nervous system and blood supply.
    Even once totally healed - for good- the tensile strength of that skin is 80% of what it was before- so easier to breakdown again.
    CWO
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  8. #58
    Quote Originally Posted by SCI-Nurse View Post
    Are you saying when you are in your chair you have 0 pressure on parts? Pretty impossible if they touch any surface. But no matter the cushion, eight shifts/releases must be done every 15 minutes- and research was shown to prevent breakdown. Prevention is the key. The pressure injury is so difficult to heal & reopens or becomes infected easily in SCI because of the changes in the autonomic nervous system and blood supply.
    Even once totally healed - for good- the tensile strength of that skin is 80% of what it was before- so easier to breakdown again.
    CWO
    I was saying whether or not one has osteo shouldn't be a deciding factor of going to surgery or not, as it doesn't affect outcome. I'm pretty baffled at why this is getting deeper. I'm not in my chair nearly as much as I was when in school, and my ITs are literally floating in air, they aren't touching anything at all. When RIDE modified my cushion (the well is completely carved out) they also made me a custom seat pan which has a hole in it. You can reach under my chair and feel my ITs, there is 0 pressure on them. The only thing I'm thinking is the hammocking of the seat cushion cover plus outward tension of the skin from that area being suspended continues to make things worse.

    Regardless, I have no desire at this point to heal this by secondary intention, none at all considering the VAC did diddly squat to heal it. Fixing this through surgery, I feel, will set me up best for the future.

  9. #59
    Hi everyone, long time since the last update but a lot has happened. My feelings towards my previous surgeon started to change as the months carried on, I felt like my situation was of no importance to him and he no longer cared.

    Long of the short, I secured a different team at a different hospital, and they immediately found the root of the problem: untreated osteo. The previous surgeon did not clear the infection after my first flap, and afterwards assumed that he cleared it and told me there was definitely no osteo when I asked. If you remember, he also placed a Wound VAC on active osteomyelitis for over 8 weeks, a HUGE contraindication and in my eyes pure malpractice.

    Nonetheless, the osteomyelitis caused by MRSA spread throughout my pelvis. Last month on December 19 I went into surgery and had a hemipelvectomy performed. Not only did I lose the rest of my left leg, they also cut out the left half of my pelvis.

    I've been in a Clinitron ever since and just started the sitting protocol. I am so glad I found a reliable and thorough team, but on the other hand I'm so extremely angry at this situation. Sitting feels so incredibly strange now, and my body has drastically changed. I hope I can get back to playing sports and my life as it was before.

  10. #60
    Good to hear you are doing well. Sue that "Dr".

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