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Thread: How do I prevent shearing (maybe?) wounds?

  1. #1

    How do I prevent shearing (maybe?) wounds?

    Hi, I?m a C4/5 quad and I?ve been dealing with a skin wounds issue for the past few months. It started back in mid February and has been alternating between healing and getting worse.

    I?ve been to the wound clinic at my hospital but they aren?t sure what is causing these wounds.

    They think it?s from shearing or moisture but aren?t sure. I was hoping I could get a second opinion from the people here because there would be more collective experience dealing with spinal cord injury related things.

    Here?s a picture that I just took today which is pretty graphic so click at your own discretion
    https://m.imgur.com/a/h3nytvE

    I really don?t know what?s causing it and how to really prevent them from happening or getting worse.

    So my caretaker comes at 7 AM to get me ready for class. I normally wear sweatpants or exercise pants because they are just easier to manage instead of jeans. I?ve always been wearing them for a few years now but it?s only recently that I started getting these wounds.
    I sit on a Roho Quattro which has been properly inflated. I also tilt back as far as possible for pressure relief every three or four hours.

    As for what?s changed in these past few months, I?ve started going back to school so I?m normally in my chair for up to 12 hours a day but simultaneously I?ve also gotten a new caretaker who isn?t exactly the most attentive person. I don?t know whether it?s a caretaker related problem or seat duration related problem or shearing related problem but here are my theories.

    1. It?s a caretaker related issue where they just aren?t paying enough attention.
    2. It?s shearing caused by my pants ( i?m trying not to wear underwear because I?m worried that it might get worse but I don?t know whether it would help or not)
    3. It?s a moisture related wounds from me just being seated too long
    4. My skin is so dry that it?s cracking? This theory is a bit of a stretch but I might as well just put it out there just in case.
    5. It?s a pressure related wound.

    If it is indeed related to me being up in my chair for up to 12 hours a day, I don?t know what I can do to prevent it because I need to be up in order to go to class, do homework etc.

    I was just hoping that somebody on this forum already has some experience with similar ones and could give me some tips and advice on what to do in my situation. Thanks in advance!

  2. #2
    I wonder if the caretaker is rinsing that area well enough in the shower, then not drying properly? I would make certain that soap is rinsed completely off that area and also that it's thoroughly dried. Perhaps they're not washing the area also?

  3. #3
    Pressure is the main cause initially. Shearing will worsen it and so will moisture. Shearing is thought to be major cause of tunneling and undermining. Shearing occurs when tissue is , such as your rear end, is drug across a surface. Transferring, moving if not clear surface contribute. So, no sliding board on surface with wound, when being repositioned in bed, have to relieve pressure. Had to do right. All you can do is tell is be aware, use lift, lift sheet etc... and be raised as much from the surface as possible.
    Weight shifts should be done every 15 minutes to prevent pressure injury. Shifting side to side, tilting, change in position of wheelchair as much as possible but 10-15 degrees will help ,leaning forward.
    Needs to continue if pressure injury develops but unfortunately once it is there then it is so difficult to heal because almost impossible to not have shear/friction and no pressure. Lying flat in bed is pretty hard to do.
    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.

  4. #4
    Thanks so much for your input! Floyd private message me saying that it was a pressure related wound. Originally I was skeptical because the doctor and even a therapist who checked my cushion, all mentioned that the area is not a pressure wound prone place. I thought about it overnight and it actually seems kind of likely now.

    Just a few weeks ago, I did a pressure mapping for my new wheelchair and blue meant it was good but Red meant bad. Almost all of the areas of concern from the pressure mapping line up with my wounds. This feels like too much of a coincidence to be ignored.

    I also do lean in a little bit to the right when I’m sitting. I’m not sure why but I think it might have something to do with my Heterotopic ossification in my right hip. This was a concern back when I first got injured five years ago but they give me medicine and then really didn’t talk about it anymore. I haven’t thought about it for the past few years either. Is it something I should be concerned about again?

  5. #5
    Senior Member smokey's Avatar
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    Gee, it looks like a shearing injury to me.....or maybe shearing AND pressure AND maybe not drying off properly after showering or washing up. If you use a slide board, spray and buff the board with Niagra spray starch or Pledge daily. Try some Gold Bond baby powder with cornstarch on your ass and nut sack (after the wound is healed over with skin), use a hair dryer in the morning to be sure you are dried off "down there", do more pressure reliefs, and you should probably lay in bed until it heals up. I know it really sucks but better to spend 2 weeks in bed now than 2 months in a hospital and rehab facility after having a plastic surgeon carve up your ass like a Jack O'Lantern.

    https://www.walmart.com/ip/Gold-Bond...&wl13=&veh=sem

  6. #6
    If you have red areas on the pressure map you need to find a better cushion if you intend to be up all day. Or if it is a Roho go back and get pressure mapped trying different cushion pressures.

  7. #7
    also don't slide on bare skin. Use a slippery material. Cheapest pillow casde material, best- sating or shiny polyester, but the best way - when there is some concerned area is to transfer without touching anything. I know that kind of defeats independence and/or less strain on caregiver. If someone ..even nurse.. pull you up in bed...they should lift as much as possible and NOT drag. That is why the half sheet or pads are called "lift" sheet.
    Also... don't let anyone pull you up under the shoulders can get frozen shoulder and other shoulder injuries or make issues worse ( Don't do it in any patient actually).
    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. #8
    Pressure mapping is very important.. not just when an area has developed. Seating specialist can help so much and also bolsters, etc.. can support your body so you don't lean or leans less. Contact one as soon as you notice your body getting
    wanky. Or that is my non medical term. Those that there shoulders go forward and start getting that hunchbacking going on.- there may be exercises such as trying to push your head back against the hedrest I can speak from personal experience because I was in a accident and even though not major injury my shoulders would roll forward. I still do the exercises... when sitting at a red light. It builds up the neck muscles and shoulder muscles.
    Unfortunately people get out of rehab, stop doing the ROM , therabands, home exercise program and issues develop and can be very fast or slowly worsen. You will lose strength also. If you don't use a muscle in 3 days , it starts to weaken and not to mention more spasticity.

    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.

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