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Thread: Week two post op wound flap; questions ( C5 quad )

  1. #1

    Week two post op wound flap; questions ( C5 quad )

    Hi I am two weeks post wound flap surgery on my right ischium ( I had surgery on 4/12 and was home on 4/13 ) and I just had a few questions for anyone who might know anything. I've been in a wheelchair for 35 years and this is my first surgery.

    1. Does anyone have any personal experience with this with seating protocols post surgery and any advice you may have or what you did? How long did it take you to get back into your regular sitting routine?

    2. I am interested in doing therapy at home, anyone have experience with this and could you recommend anything? I am also interested in seeing if I could get mapping done at home for a new wheelchair cushion and was wondering if anyone else had this done and if you know of any new cushions that have alternating pressure that works well. I have been using a low air alternating pressure mattress for quite some time and it works well.

    If anyone has any experience with wound flap surgery/post op therapy, please share!

    Thanks in advance for your advice.

  2. #2
    Hi Quickie,

    Did I read correctly that you discharged the day after surgery? That seems shocking to me even if you will begin seating protocol at home.

    I just had my first flap done this past August as well (T11/complete, 38 yrs) on my left Ischium. My situation was unfortunate in that they tore my flap open a week post-op when transferring me to gurney for ambulance ride to skilled facility. That set my flap healing back by a couple of months as they put me back on wound vac. The normal/average 6-8 weeks initial recovery period dragged on from September to December (all done in skilled facility which sucked big time). I returned home bed-bound for another month til it closed up entirely. Once my wound was finally closed, I began seating protocol at home under supervision of home health PT, nursing and a general guideline provided by my surgeon... which to me did not seem aggressive enough so I followed the suggestions of the SCI nurses here on the forum instead. They are definitely a great resource for this info and I am sure they will reply soon to your post.

    I will add, just for the sake of knowing, that since I began getting up out of bed in January I have had approx 4 minor shearings at the Isichial area of the flap. It was not serious and each shear was about the size of a pencil eraser in diameter. They all healed quickly with simple bandaging and pressure relief, etc. We finally figured out the exact cause of my shearing, which was in transferring via sliding board from chair to bed. When we figured the cause I began using a soft terrycloth handtowel under the Isichial area which relieved the shearing nearly completely. I'm closed up now and not having any issues with it but diligence is necessary.

    I have been to seating clinic to be fitted for new chair and cushion. I was told I wasn't able to have that done until the wound was healed completely and I was sitting up for at least 8 hrs a day. I have not been pressure mapped yet but was told I could do that immediately after wound closure. Mine mapping and cushion molding is delayed only because my new chair has to come in first.

    Different circumstances than you but I hope that gave you some ideas none the less.
    Hope you heal up fast and well!

  3. #3
    I had surgery two and a half years ago. Of course, everyone is different,, but here's what I did.

    Stayed in bed for two months. At that point the area looked nice and healed so I started my sitting routine by getting in the chair for 15 min. and then back into bed to check my skin. I would wait a few hours before sitting for another 15 min. and then did a skin check. I did that twice the first day as my caregiver came in the morning and evening. On the second day, I changed to 30 min. in the chair, sitting twice that day. If everything continues to look good, you can continue this pattern until you are sitting without the area becoming red. If you see any problems, cut back your sitting time.

    After 2 months in bed, completely off the area...

    First day - 15 min sitting x 2
    second day - 30 min x 2
    third day - 30 min x 3
    fourth day - 1 hour x 2
    fifth day - 1 hour x 3
    sixth day - 2 hours x 2
    etc...

    I also got down in bed for a full day on every seventh day as an extra precaution,, which I think really helped it heal. It gave the area an extra rest in between my sitting schedule.. I did that for 2 to 3 months.

    I'm sure you already know to up your protein level and do pressure releases when you begin your sitting routine.

    The area really takes a good year to mend so I took it very easy that first year after my surgery and didn't go out much. There's no way I wanted to have a problem and start the process again. The time really did go by fast.

    I have a low air alternating pressure mattress as well and it works just fine. I sit on a quadro/roho manual chair combination and lift my but for pressure relief so I don't have any experience with your other inquiries..

  4. #4
    Seating protocols vary from surgeon to surgeon as well as how complex your surgery was and your post-op course. That being said, 6-8 weeks post up is generally when people begin to sit. Initially it can be slow. It starts with 5 minutes twice a day and goes to three times per day after 2successful consecutive days of twice a day. From here it progresses to 15 minutes three times a day, 30 minutes three times a day, 45 minutes, than an hour. From there, 2 hours, than 3 , etc. Once you hit 4 hours twice a day, you can move it fairly quickly.

    My advice to you is to start with home PT, but then go to outpatient. Much more can be accomplished in outpatient, in a quicker amount of time. As far as pressure mapping at home, I don't know anyone who does it. That does not mean it can't be done at home, just not heard of it.

    ckf
    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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