Page 3 of 3 FirstFirst 123
Results 21 to 30 of 30

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

  1. #21
    Senior Member lynnifer's Avatar
    Join Date
    Aug 2002
    Location
    Windsor ON Canada
    Posts
    18,237
    Forgive me for the intrusive question, but did you lose the legs due to pressure sores?
    Make America Sane Again. lol

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

  2. #22
    Graftjacket has been used primarily for diabetic ulcers and orthopedic applications. I am more familiar with Epifix, Oasis, or MatriStem for pressure ulcers.

    Graftjacket is made from human skin collagen layer. Oasis is made from the collagen layer of pig intestine, and MatriStem out of collagen layer of pig bladder. Epifix is made from dehydrated human amnion/chorion (placental) membrane. It is quite a bit more expensive than Oasis and MatriStem, but may be more effective.

    MatriStem and Epifix both come in both sheet form and in a powder that can be mixed into a slurry and injected down tracts or even into superficial viable tissue in the wound margins. We used them all at bedside and in clinic, as well as applications done in the OR, and all can be used under a NPWT (negative pressure wound therapy) system such as the V.A.C. although special methods of application are needed to protect the matrix material from disruption by the vacuum and sponge. Have seen some fairly spectacular results with these products in SCI pressure ulcers where the person is not a surgical candidate for a flap for a variety of reasons.

    (KLD)
    Last edited by SCI-Nurse; 09-27-2017 at 06:44 AM.
    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.

  3. #23
    Quote Originally Posted by SCI-Nurse View Post
    Graftjacket has been used primarily for diabetic ulcers and orthopedic applications. I am more familiar with Epifix, Oasis, or MatriStem for pressure ulcers.

    Graftjacket is made from human skin collagen layer. Oasis is made from the collagen layer of pig intestine, and MatriStem out of collagen layer of pig bladder. Epifix is made from dehydrated human amnion/chorion (placental) membrane. It is quite a bit more expensive than Oasis and MatriStem, but may be more effective.

    MatriStem and Epifix both come in both sheet form and in a powder that can be mixed into a slurry and injected down tracts or even into superficial viable tissue in the wound margins. We used them all at bedside and in clinic, as well as applications done in the OR, and all can be used under a NPWT (negative pressure wound therapy) system such as the V.A.C. although special methods of application are needed to protect the matrix material from disruption by the vacuum and sponge. Have seen some fairly spectacular results with these products in SCI pressure ulcers where the person is not a surgical candidate for a flap for a variety of reasons.

    (KLD)
    Is there a possibility to speak with you directly or obtain information, chart notes, or pictures regarding any of your experiences with these? My course of antibiotics is through October 17, and I hope to go to the OR and get this show on the road at that time. I'd like to pass the information on to my plastic surgeon or get him in contact with you.

    Don't know if it's possible, but it would mean the world to me.

  4. #24
    You can send me a PM, but you could also have your plastic surgeon talk with the plastic surgeons that I have worked with most recently: Kevin Broder, MD and/or Richard Bodor, MD (both at UCSD and the VA in San Diego). I am retired now, so no longer working in wound care, and could not share patient photos or records due to HIPAA issues regardless.

    http://profiles.ucsd.edu/kevin.broder

    http://www.vitals.com/doctors/Dr_Ric...or/credentials

    (KLD)
    Last edited by SCI-Nurse; 09-27-2017 at 02:37 PM.
    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. #25
    Hopefully this doesn?t muddy the waters too much because entirely anecdotal, but a family friend (C6, now deceased) had a very successful experience with Graftjacket for a stage 4 ischial wound. She was in central Florida and probably went down to UM/Jackson for wound care.

  6. #26
    Quote Originally Posted by SCI-Nurse View Post
    You can send me a PM, but you could also have your plastic surgeon talk with the plastic surgeons that I have worked with most recently: Kevin Broder, MD and/or Richard Bodor, MD (both at UCSD and the VA in San Diego). I am retired now, so no longer working in wound care, and could not share patient photos or records due to HIPAA issues regardless.

    http://profiles.ucsd.edu/kevin.broder

    http://www.vitals.com/doctors/Dr_Ric...or/credentials

    (KLD)
    I've forwarded the information. Have you worked with someone who's gone the route of a fillet flap?

    Quote Originally Posted by annev308 View Post
    Hopefully this doesn?t muddy the waters too much because entirely anecdotal, but a family friend (C6, now deceased) had a very successful experience with Graftjacket for a stage 4 ischial wound. She was in central Florida and probably went down to UM/Jackson for wound care.
    Thank you for your post. That's 2 people now who've had success with Graftjacket. Anecdotal or not, at this point I have nothing to lose.

  7. #27
    My nurse measured the wound today when changing the VAC, and it the undermining has gotten larger.

    I've been in bed, barely do anything now, and it just gets worse. What's the point? This is really taking the wind out of my sails.

  8. #28
    Senior Member lynnifer's Avatar
    Join Date
    Aug 2002
    Location
    Windsor ON Canada
    Posts
    18,237
    I have so been there. Listen, there HAS to be bone involvement. Nothing will heal unless the bone is taken care of ... the doc must have missed some.

    There is some literature that, even though us flaccids can't feel it or twitch muscles, that e-stim does work on healing wounds.

    Don't give up. There's always something new around the corner!

    In the meantime, I remember reading about this a decade ago:

    https://www.advancedreconstruction.c...ressure-sores/
    Make America Sane Again. lol

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

  9. #29
    Senior Member lynnifer's Avatar
    Join Date
    Aug 2002
    Location
    Windsor ON Canada
    Posts
    18,237
    Any update? I want to see you finish med school and be successful.
    Make America Sane Again. lol

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

  10. #30
    Quote Originally Posted by lynnifer View Post
    Any update? I want to see you finish med school and be successful.
    Hey lynnifer, thanks for checking in. Just laying here in bed, waiting it seems. My course of IV/oral antibiotics goes through next week, but I'm scared I'm just going to end up in the exact same position because once I come off of them, I'll still have an open wound just ready to be re-infected. It happened before, so I'm kinda worried about that.

    The VAC doesn't seem to be doing anything at all. The nurse measured it and the undermining is bigger. I know you think there's bony involvement, but my docs don't think so (hell, you could be right). Osteo isn't an easy thing to diagnose, I read some studies on imaging for osteo diagnoses and it's far from conclusive.

    My plastic surgeon contacted the long term acute care facility (LTAC) that he originally wanted me at after the first flap to coordinate and secure me a spot. They have limited beds for medicaid, and after my first flap I ended up at a really subpar LTAC because I kept getting bumped down the list at the preferred one. The LTAC I was at after the first flap could have definitely played a part in all of this.

    I think I will be pursuing a fillet flap, which will involve losing the rest of my left leg (don't have much femur left anyway) and disarticulating my hip on that left side. That way, we can utilize all that remaining soft tissue to fill the wound, which will be coupled with further shaving down of the IT with an osteome.

    Quote Originally Posted by SCI-Nurse View Post
    (KLD)
    KLD, have you seen a fillet carried out before? I am trying to push for a bilateral fillet, even though I don't currently have a wound on my right IT for multiple reasons: avoid leg length discrepancy, avoid compensatory seating changes, keeping things symmetrical, setting myself up for the future with as much padding as possible under my ITs, shaving both ITs and not just one. On the right side I'm viewing it more as a prophylactic measure, and when bringing it up the first time my surgeon wasn't too keen on it. I will discuss it with him more though, because I'm weighing risk/reward, and even though it's another surgical procedure I feel like it could help me more than hurt me and drastically increase my quality of life.

    If I was to be an HDA on the left and AKA on the right, I was thinking I would start seeing larger points of pressure under my right IT because that side will be more stable and I'll compensate. What are your thoughts?

    One more random question: I have hip contractures. Without the weight of an entire leg, I often wake up at night with my stumps at 90 degrees sticking up in the air or out to the side. Reading some of the flap protocols, they talk about eliminating all flexion until the seating begins. Do you think flexion at the hips secondary to contracture could have caused my flap to fail? With a fillet flap, this would completely eliminate the contractures, which are quite painful, in all honesty.

Similar Threads

  1. Various Treatments for Stage IV Ischial Ulcer
    By wheeliegirl in forum Care
    Replies: 17
    Last Post: 12-09-2015, 10:01 PM
  2. Replies: 26
    Last Post: 05-30-2015, 09:08 PM
  3. Ischial Flap Surgery Success Rate
    By kwip in forum Care
    Replies: 8
    Last Post: 07-27-2012, 09:24 PM
  4. Ischial Muscle Flap
    By semajh7 in forum Care
    Replies: 8
    Last Post: 02-02-2010, 03:53 PM
  5. Replies: 9
    Last Post: 09-10-2009, 08:22 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •