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Thread: Stage IV Pressure Ulcer question

  1. #1

    Stage IV Pressure Ulcer question

    I have a stage IV. I was in the hospital for it the first week of June. The wound is on my bottom. It is to the bone. My surgeon has had me on a wound vac for the past 3 weeks. My wife, she changes out the vac, is concerned about infection in the bone. She says it seems to be healing near the surface but not around the bone. I have not been running any fevers and am on oral antibiotics. Should I urge the doctor to be more aggressive in the treatment, as in a flap or any other treatments? Should I request a bone scan? I am quite worried about this. I have been a t-10 for 5 years and have never had any skin issues.

  2. #2
    Senior Member lynnifer's Avatar
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    Yes, inquire about a bone scan but go through an infection specialist for it - they know what to look for. If there is bone infection (osteomyelitis), IV antibiotics paired with orals on a long term basis might kill it - encourage your infection specialist to go aggressive as it's the only way.

    Otherwise, on the rear, bone scraping is done to remove the infected tissue (I had that done almost twenty years ago) during flap surgery.

    Write this summer off ... but hopefully you'll be back to a fighting regimen by the fall! You're doing all the other things? Staying off it, eating a diet rich in nutrients (protein), etc?

    I'm sorry I don't have any experience with the wound vac ... but plenty around here seem to have had success with it!
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  3. #3
    As Lynifer said, you need to coordinate your wound care doc with an infectious disease doc, get a bone scan and cultures of the bone to see if there is infection. They can even do a needle biopsy of the bone itself. We had the same situation; were on a wound vac, were seeing results at the more surface areas of the wound. As long as there's infection, the wound won't close - it's like the body is saying, 'uh-uh, not gonna do it'. We finally ended up with muscle graft surgery; took 6-8 weeks after the surgery before sitting at all - even in bed - but now he's good to go!!!
    _____________

  4. #4
    Thank you for the replies. I am staying off of it as much as possible. I am on it for about an hour max each time I have to cath, usually 4 times per day. I am also on it for a max of 3 hours each evening preparing dinner for wife and kids. Does that seem too much? I am eating a high protein diet. I sleep on some sort of air mattress that has a machine attached to it. I also have a wheelchair cushion that can be attached to the same machine. I am sorry, the name of the system escapes me. It was originally developed for the US Navy for use with their dolphin transportation.

  5. #5
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    Also, you need tissue to heal. Tissue needs cover the bone, then you'll see the progress.

  6. #6
    Senior Member Kenny L's Avatar
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    mine went to the bone too, tuned black. they cut all damaged tissue away ans scraped the bone of, did flap- things have been well since December 06
    but, thats just my experience. do you sleep on some type of alternating pressure relief mattress or cover?

  7. #7
    You should stay off of it. If you MUST put pressure on the area, be sure and do weight shifts at least every 15 minutes.
    CWO

  8. #8
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    I agree with CWO ( SCI-Nurse). Definitely stay off the area b/c decubtis ulcers can rapidly grow. I had stage IV ulcers and I had a bone scan with both of them because of the risk of osteomyletis. I would also go and visit a wound care clinic and speak to a wound care specialist and find ways to close it if t the vac isn't working. ( there are ways, but it takes a long time without a skin flap). If you have osteomyeltis, it is unlikely that it will close on it's own. Make sure to keep the wound clean and packed, so it doesn't tunnel more.
    I had stage IV ulcers that needed skin flaps in order to heal. I was in the hospital twice having the bone debrided ( osteomyeltis) and having skin flaps. For the second one I had, I had to be in bed for 25 days. It definitely wasn't fun, but I am glad that they are gone! I also had one on my sacrum due to not lifting ( I got it a few months after I got hurt). Did the doctor recommend doing a pressure seat mapping through an OT? That might also help you from getting other wounds in the future. I have a roho cushion and it has definitely helped.
    Best,
    Jessica

  9. #9
    Quote Originally Posted by ricandshe
    Thank you for the replies. I am staying off of it as much as possible. I am on it for about an hour max each time I have to cath, usually 4 times per day. I am also on it for a max of 3 hours each evening preparing dinner for wife and kids. Does that seem too much? I am eating a high protein diet. I sleep on some sort of air mattress that has a machine attached to it. I also have a wheelchair cushion that can be attached to the same machine. I am sorry, the name of the system escapes me. It was originally developed for the US Navy for use with their dolphin transportation.
    Yes, that's too much time on your butt - staying off it means staying off it. Why do you have to prepare dinner for your wife and kids? I don't know what your situation is,and don't mean to sound harsh, please don't take it that way. But look at it like this - if you had two broken legs, and were in double casts, would you still be up preparing dinner? Hope not!

    When you say a high protein diet, what do you mean? Are you getting at least 100 grams of good protein a day? Extra vitamin C, zinc, and arginine all help in the wound healing process. If you do a search here, you'll find some good posts about diet, protein and wound healing.

    Lots of luck!
    _____________

  10. #10
    add a protein supp 2x day and zinc. my aunt[wound care rn] says when to the bone u should assume osteo.
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