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Thread: Recurring skin splits

  1. #1

    Recurring skin splits

    Hi,
    I'm hoping someone can give me new insight into this problem. Starting a little over a year ago, I developed a small (less than 1 inch) skin split between my butt cheeks. The split was superficial. Only the top layers of skin appeared to be affected; there was no bleeding or pus discharge. This happened around the time I was studying hard for the Law School Admission Test, so I was not as on top of my weight shifts as I should have been.
    Anyway, to make a long story short that first major episode of splitting and healing lasted from November to December, 2004. I was symptom-free for six months and was starting to return to a normal schedule -- commuting from my home in Berkeley to a law office in San Francisco where I'm interning -- when my skin split again in July. This time, I was in bed from July-November. The split would heal, then (1) I would stay off it for a couple more days, (2) I would get back to my wheelchair for a couple hours a day, (3) a few days after the split had healed, I would take my service dog for a 20 minute roll around the park, and (4) if the skin looked like it was holding up I would try to spend a full day in my chair (10 to 12 hours) and resume my normal activities. Then, roughly 10 or 12 days into this routine, the skin with split again and I would be back to square one.
    Last November, I visited Santa Clara Valley Medical Center to have this problem diagnosed by wound care nurses and physical and occupational therapists. Their unanimous opinion was that the split was not a "pressure sore." Moisture was the more likely cause, they agreed. Based on their assessment, I altered my routine to make sure the skin in and around the area was thoroughly dried after my bed bath and bowel program.
    There were no problems until March 8 when another split was detected. This one healed quickly after a couple of days in bed. I decided to test the theory that it was not pressure related so I returned to a full day in my wheelchair after it had healed. On March 17, it reopened again. Two days of bed rest and it was closed. I gave it one more day of bed rest just to be on the safe side and I got up again... one week later, it split. Same kind of split -- very shallow, less than 1/4" long, no bleeding or seepage -- in the same area between my butt cheeks in the crease.
    Like the ones before it, the March 24 split closed quickly. This time I decided to stay off it for a few more days after it had healed. And, like the March 17 split, I decided not to return to full day in my wheelchair, but, instead, to begin gradually spending longer periods of time beginning with two hours and increasing it by one hour a day.
    Today, it split again. This time, the split is longer than the ones before. Like the others, it is shallow. There is no bleeding or seepage. I am at a complete loss as to what to do about this problem. I'm supposed to start law school this fall and I am seriously doubting whether I have any future beyond managing these little cuts on my ass.

    Thank you in advance for any advice.

  2. #2
    Senior Member keps's Avatar
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    Hello and welcome, Toshio.

    I would ask whether this was a problem you had even before sci?

    I am prone to recurrent splitting, which is in the same area as you describe. It kept happening while I was rehabbing in the spinal unit. At first, the nurses wouldn't let me out of bed until it healed - which once took four days.
    But, when I told them that I had had this problem for years before my sci, they decided I could try getting up. I find that it does not make a difference whether I am up or not - it does not heal quicker for me if I stay in bed.
    I know mine is not a pressure related problem. I think it is to do with sweat/ generally prone to sore skin.

    What I have found most effective to help the split heal is vaseline. Put on to the (clean) split, it really seems to speed up the healing process (dressings never helped at all).

    Unlike yours, mine can bleed, but usually they are very shallow and don't bleed.
    I find they are worse in hot weather. I actually haven't had a split for some months now - probably because it's been winter.

    I'm wondering whether you may sweat more in that area when you are up in your chair - hence the splitting?

  3. #3
    Hi Toshio,

    It sounds like your wheelchair cushion is causing your skin to split. What brand of cushion do you use?

    I may be wrong but Rohos, IMO, are more likely to cause this type of skin splitting than a Jay2 cushion would. Rohos tend to "stretch" the skin and may be pulling that area in different directions causing your skin to split. If you have an opportunity perhaps try out a deep-profile Jay2 cushion. Unlike a Roho or the other air or even gel-filled cushions, the Jay2s retain the shape of your butt with a lightweight puddy-like material (it used to be called "Flo-Light"... but the name has changed) causing less stretching and sheering.

    Whatever brand or type of cushion you use, try another one.
    "Be kind, for everyone you meet is fighting a great battle." - Philo of Alexandria

  4. #4
    Hi Toshio,

    How do you transfer? I had a similar problem due to shearing. Also, what's your commode/shower chair like? Do you have a dr. in Berkeley? I live in the north bay now but was in Berkely till 2002. I can recommend a really good SCI nurse practicioner who may have some ideas for you.

    Peace,
    alissa
    "We must become the change we want to see in the world." Gandhi

  5. #5
    Hi Keps,
    Thanks for your helpful feedback.
    In answer to your question, I wasn't aware of any skin problems in that area before my accident eight years ago.
    Now that I do have this problem, I'm afraid that getting up on it would do more damage; instead of three or four days in bed, I would be looking at two or three weeks. You have no idea how much I want to believe that you're right... I'm just confused and worried.
    Best,
    Toshio

  6. #6
    Thanks, Bob.
    Yes, I understand critics of the Roho cushion (which is what I use) who contend the design is flawed because it has a tendency to spread the buttocks, causing the newly healed skin to reopen. The argument may have merit, but in the case of this most recent (April 2) split, it occurred after a day of bed rest that was intended to give the tissue extra healing time. This rules out the cushion as a factor.
    Thanks again,
    Toshio

  7. #7
    Hi Alissa,

    I transfer using a hoyer lift and a sling (without cutouts). I do my bowel program in bed. The folks down in Santa Clara said this is the best way.
    I would really appreciate a referral to someone in my local area, Berkeley.
    Thanks,
    Toshio

  8. #8
    Senior Member queen's Avatar
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    And here I thought I was the only one!

    I like Keps had this problem before sci, many times. Now since sci, I sit more and walk less so I've continued with drying area completely after showering and applying vaseline. Keeps it dry and yet lubricated, I guess.

    I haven't had a problem for over 8 years now, but I always check cause
    those little (((buggers)))) just have a way of sneakin' up on ya!

    Queen
    Your life is what you make it, and only you have that choice!

  9. #9
    Senior Member
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    You do know just cause its healed over, doesn't mean that it is fully healed. An extra day or 3 really isn't alot of extra time.

  10. #10
    Thanks, Queen.
    Yes, that's the beauty of forums like this one: Instead of feeling like the lone victim of a problem no one else has, here we have an opportunity to learn from shared experiences.
    Unlike you, I do not have much mobility below the level of injury. It sounds like you and Karen have in common this problem pre-SCI. I did not.
    I agree moisture is a factor, though to what extent it is the main cause of the skin split, is unclear.
    Best,
    Toshio

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