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Thread: Discharging from skilled after Flap and panicking!

  1. #1

    Discharging from skilled after Flap and panicking!

    I am discharging from skilled this morning after over three months post-flap. As I posted previously, the day I arrived at SNF from 1 week post-op in hospital, my flap was sheered open. We assume from all the transferring via EMT and staff from gurney to Clinitron and then from that Clinitron to two others as they kept losing fluidization due to humidity. The past month I have been on an airflow memory foam type mattress as the Clinitrons kept having issues with the sand firming up. I have been most diligent about pressure while in this bed and changing positioning. My surgeon has visited me at SNF every week since I've been here to follow up and assess the wound.

    My wound finally closed a few days ago but is only newly so. I have done no sitting therapy other than sitting up in the air-memory foam bed and have thankfully had no issues from that. No redness, etc.

    This discharge is now terrifying me for a couple of reasons. My insurance ran out as of yesterday, hence my leaving without having done proper sitting protocol. When I leave today it will be my first time out of bed at all, in 3 months. Physical Therapy cannot assist nor will they supervise the transfer from bed to chair for the transport home via para-transport. I am officially off their case load and they are unable to even advise me in any way. No one here has any idea or charted info as to my transfer abilities so we are basically winging it. They are proposing I use the Hoyer to go from bed to chair, however, I am feeling that would be more dangerous to my wound tissue than using my transfer board. My nurse here is doing her very best to help me work this out but it's still a gamble. It is in no way possible for me to extend my stay here (if anyone is going to suggest that). At home I will be following a very strict protocol, even more conservative than my surgeon has outlined...just to be on the safer side. I will also have Home Health for my wound and my assigned nurse is advanced wound care and was assigned to me all of last year while on the V.A.C. so he knows my wound inside and out.

    I suppose I have no specific question, just all the advice I can get at the moment. I have a couple of hours before I get up and into chair.
    Last edited by oncetherwasagirl; 12-11-2017 at 01:12 PM.

  2. #2
    I would not be sitting at all yet with a newly closed flap. The secondary intention closure is still very weak, and could open up. Can you go home via gurney transport? What kind of mattress do you have at home? Have you had a seating re-evaluation for cushion selection yet? A mechanical lift prevents the shearing type damage to a newly closed flap that you get with a slide board, but the sling needs to be properly applied and removed, and should be used over clothing (not right on your skin).

    I would recommend remaining non-sitting for at least 2 more weeks, and then cautiously start a seating program. See if your insurance will allow you an acute rehab stay for the start of the seating program. This is the program we used:

    Day 1: sit for no longer than 15 minutes, doing a computerized seating interface study at the same time to be sure that the correct cushion is being used. Inspect skin immediately upon return to bed. If any severe non-fading redness or any separation of the incision, do not proceed with sitting program.

    Day 2 & 3: Sit for 30 minutes once daily. If any severe non-fading redness or any separation of the incision, do not proceed with sitting program.

    Day 4: Sit for 30 minutes twice daily, with at least 2 hours of downtime between. If any severe non-fading redness or any separation of the incision, do not proceed with sitting program.

    Day 5 & 6: continue with 30 min. twice daily as above.

    Day 7: Sit for 60 minutes twice daily, with at least 2 hours of downtime between. If any severe non-fading redness or any separation of the incision, do not proceed with sitting program.

    Continue with this, increasing sitting time by 30 minutes every 3-4 days. If any severe non-fading redness or any separation of the incision, do not proceed with sitting program. Once you have 6 hours of sitting, you can start sitting just once daily and increase the time by 30 minutes every 3-4 days.

    (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.

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