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Thread: Questions about upcoming wound flap surgery of right ischium

  1. #1

    Questions about upcoming wound flap surgery of right ischium

    I have rotational skin flap surgery scheduled in March to repair stage 4 wound on the right ischium. I'm told it will be about 3 days in hospital and then to rehab center for a few weeks. Is a Clinitron bed the best choice after surgery and in rehab, or is there another option? Not sure yet what type of bed the rehab will have. Does medicare cover a Clinitron bed in home? I have an alternating air pressure mattress at home; is this sufficient?
    Any pros or cons re the clinitron vs the air mattress?

    What would be a realistic time in bed before sitting protocol is started, assuming there are no complications?

    Also have concerns about bowel regime (using suppositories & manual disempaction) in bed after surgery and keeping the wound clean. Anyone have experience with this issue?

    Thanks, any input would be greatly appreciated.

  2. #2
    Clinitrons are a brand of air fluidized bed. This is the best bed for recovery from a flap. We kept our flap patients on an air fluidized bed for 5 weeks minimum, and then for another week of bedrest on a low air loss (not an alternating pressure overlay) before starting sitting, and used a low air loss mattress for a total of 6 months post op. So no sitting for 6 weeks post-op.

    You do manual removal, not "disimpaction", for normal bowel care (unless you are actually impacted). Don't use that term or the nurses will be reluctant to do this procedure for you. The nursing staff should do your bowel care for at least the first 3 weeks post-op to be sure that they don't contaminate the wound. A transparent dressing (like OpSite) can be placed over the incision/dressing to keep the wound protected during bowel care.

    (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.

  3. #3
    Quote Originally Posted by Quickie View Post
    I have rotational skin flap surgery scheduled in March to repair stage 4 wound on the right ischium. I'm told it will be about 3 days in hospital and then to rehab center for a few weeks. Is a Clinitron bed the best choice after surgery and in rehab, or is there another option? Not sure yet what type of bed the rehab will have. Does medicare cover a Clinitron bed in home? I have an alternating air pressure mattress at home; is this sufficient?
    Any pros or cons re the clinitron vs the air mattress?

    What would be a realistic time in bed before sitting protocol is started, assuming there are no complications?

    Also have concerns about bowel regime (using suppositories & manual disempaction) in bed after surgery and keeping the wound clean. Anyone have experience with this issue?

    Thanks, any input would be greatly appreciated.
    Hi Quickie,

    I'm just finishing up my second flap this year (at the tail end of my seating protocol). You should absolutely make sure they have a Clinitron bed. Those things are gold standard and will prevent any pressure issues post flap. I started my seating protocol at week 6 like SCI-Nurse mentioned. I can send you the seating protocol chart I have and you can print it out for your plastics team to see if they want to use it.

    I was actually able to continue using the IryPump and irrigating my bowels every other day while in bed with a system of bed chux and a fracture pan. I would lay on my side opposite from the flap and do my thing. I wouldn't worry about the bowel program, it sucks doing it in a bed and with another individual helping you out if you're not used to that, but it's very doable.

    You're in for a long haul, but I hope it's smooth sailing. Let me know if you want my protocol.

  4. #4

    Questions about upcoming wound flap surgery of right ischium

    Hello
    My flap surgery is scheduled for April 12th and I have a few questions. About how long will I be in the hospital? I need my wife to be with me for the entire length of my stay. Can arrangements be made for her to stay in my room overnight or is this something we work out when I get to the floor after surgery? Also, I am considering going home when I?m discharged instead of going to a rehab facility. However, I need to know ahead of time what care will be required while I recuperate. Are there any special equipment needs? What is the timeline for having stitches removed? When to start sitting protocol and what is the sitting protocol? I currently have VNS of NY coming to my home three times a week for wound care. Should this be increased to daily while I recuperate? Will OT/PT assistance be required when I begin the sitting protocol.

    If someone can contact me prior to the surgery date to go through my questions, I would appreciate it.

    Thanks.

  5. #5
    Quote Originally Posted by Quickie View Post
    My flap surgery is scheduled for April 12th and I have a few questions. About how long will I be in the hospital?
    This will depend on your surgeon and insurance. Ask the surgeon. Typically most insurances will give you 5-7 days of acute hospital stay for a flap, and then you will need to go to a subacute (ie, nursing home) facility or home on bedrest.

    Quote Originally Posted by Quickie View Post
    I need my wife to be with me for the entire length of my stay. Can arrangements be made for her to stay in my room overnight or is this something we work out when I get to the floor after surgery?
    This is up to the hospital. You should call them now and ask if they have family rooming-in arrangements. Not all hospitals do.

    Quote Originally Posted by Quickie View Post
    Also, I am considering going home when I'm discharged instead of going to a rehab facility. However, I need to know ahead of time what care will be required while I recuperate. Are there any special equipment needs? What is the timeline for having stitches removed? When to start sitting protocol and what is the sitting protocol?
    It is unlikely you are eligible to be discharged to an acute rehab facility. Many subacute facilities (ie, nursing homes) call themselves rehab centers, but they do not provide the level of care of an acute rehab facility. Some people are able to go as an inpatient to an acute rehab facility when they are ready to start their sitting program (usually 6 weeks post-op, if everything goes perfectly with flap healing).

    At the SCI center where I worked, we left JP drains in until they stopped draining (usually 3-4 weeks post-op) and removed the sutures, if everything looked perfect at the beginning of week 5. Often we removed 1/2 the sutures at that time, then the remaining at the end of the 5th week, but always before sitting started.

    Ideally, you should be on an air-fluided bed (Clinitron is a brand name) for 5 weeks post-op, and then on a low-air-loss mattress. Ideally, you should have a computerized interface pressure seating evaluation the first time you sit, and than start your sitting program on the wheelchair cushion determined by that evaluation to be best for your re-configured butt.

    Quote Originally Posted by Quickie View Post
    I currently have VNS of NY coming to my home three times a week for wound care. Should this be increased to daily while I recuperate? Will OT/PT assistance be required when I begin the sitting protocol.
    You would need a RN to change post-op dressings and assess the wound, plus administer any IV antibiotics needed if you do this at home. How often this is needed would be determined by your surgeon.

    Ideally, a PT or OT knowledgeable in flap healing and sitting programs, together with a good wound care nurse, should determine your sitting schedule. The one we used was usually a version of the one below. Progression of times is ONLY done if the wound and flap look good upon inspection both immediately after sitting and before the next sitting session. Worsening should indicate stopping the sitting program completely until the issue resolves, and then resume at Day 1:

    Day 1: sit 15 minutes once (doing the interface pressure interface study at the same time)
    Day 2: sit 30 minutes, with weight shifts done every 10 minutes, once.
    Day 3: sit 30 minutes, with weight shifts done every 10 minutes, once.

    Day 4-6: sit 30 minutes, with weight shifts done every 10 minutes, twice. (at least 2 hours between sitting sessions)

    Day 7-9: sit 1 hour, with weight shifts done every 10 minutes, twice. (at least 2 hours between sitting sessions)

    Day 10-12: sit 1.5 hour, with weight shifts done every 10 minutes, twice. (at least 2 hours between sitting sessions)

    Day 13-15: sit 2 hours, with weight shifts done every 10 minutes, twice. (at least 2 hours between sitting sessions)

    Day 16-18: sit 2.5 hours, with weight shifts done every 10 minutes, twice. (at least 2 hours between sitting sessions)

    Day 19-21: sit 3 hours, with weight shifts done every 10 minutes, twice. (at least 2 hours between sitting sessions)

    Day 22-24: sit 4 hours, with weight shifts done every 10 minutes, twice. (at least 2 hours between sitting sessions)

    After day 25, start sitting once daily, for 6 hours, and increase that time 1/2 hour every week.

    (KLD)
    Last edited by SCI-Nurse; 03-30-2018 at 02:52 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.

  6. #6
    I should add that we allowed sitting on a well padded commode/shower chair for up to 30 minutes, counted into the sitting time, once the person achieved 3 hrs. twice daily sitting. Until then, bowel care in bed, and bed baths unless a stretcher shower is an option. Some surgeons do not allow any type of tub or shower baths while stitches are still in place.

    (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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