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Thread: Stage II Isch pressure sore

  1. #1
    Senior Member McDuff's Avatar
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    May 2004
    Dallas area, Tx

    Stage II Isch pressure sore

    Well, I got one. !@#$% Amazingly enough, I got it on the left side where I have partial sensation. We had been battling red spot for awhile, finally opened up. Setting up another pressure mapping session, last one showed all blues and greens, but maybe things have changed.

    Questions: (haven't seen these in past post searches)

    I have a low air loss mattress. Is it good enough just laying on my back? Or do I have to lay on my side for full pressure relief?(It is uncomfortable for me) The Nurse-Practioner only said to do lots of pressure relief, I suggested bed rest since this has been around awhile.

    The N-P put Duoderm followed by Sof-foam(sp) on it. This actually felt worse when in my chair. Is this the right combo?

    At times there is puss, other times just blood spot. When N-P saw it was only blood so she thought it "looked" pretty good. Is the puss something to worry about?

    "Rather be ridin' than rollin'"

  2. #2
    Senior Member Aly's Avatar
    Join Date
    Feb 2005
    Radford, Va
    I personally stay away from duoderm. I have not had a pressure sore since 95 with the exception of blisters on my heels from my shoes. Anyway, duoderm made the sores I had before that worse. I think most of that is due to the fact my skin is very sensitive to adhesive tapes. When I had in a central line they had to use a plane clean bandage instead of opsite (sp)because my skin could not handle it. I was not aware I had this problem until after my accident and 93. Since then I've met several quads who had this problem. Just what I would pass along the information.


    The trick is in what one emphasizes. We either make ourselves miserable or we make ourselves strong. The amount of work is the same.
    Don Juan Matus

  3. #3
    the duoderm does make more pressure in sitting but they did help
    my stage 2 p/s heal ,changing every two days,three days is better
    but only when drainage subsides,check frquently to ensure it doesn't
    shift around,i used 4x4's,too big but cutting them drains the medication in the bandage

    should change position on 2 hr rotation when possible,use pillow for knees
    and back when on side,

    do some searchs on the forums for time up,i had to limmit to
    30 or 60 min each 4 or 5 hours down even after stage 1 ,a month.

  4. #4
    An ischial ulcer is usually a result from sitting in an upward position without weight shifts or position changes, usually from sitting in an upright position. Even with the best cushion, you must do weight shifts at least every 30 minutes.
    The best cure is to keep pressure off the area until healed. You could get up in your wheel chair if you did not put pressure on this area such as a tilting wheelchair.If you stay in bed, do not sit up more than 30 degress and keep turned off that area.
    A hydrocolloid, Duoderm is just one of the many brands and was the original, is appropriate.Some Duoderm is changed every 2-3 days,the others are every 5-7 days.Even after it is healed, this area will be very easy to break down again for a while so watch it carefully.
    Eat lots of protein and take vitamins with zinc if you don't already.


  5. #5
    Senior Member
    Join Date
    Jan 2003
    Madison,Wisconsin, USA
    McDuff, sorry to hear about your sore. I think you need to see a wound specialist, they are at most hospitals and should know the best and newest treatments for pressure sores. The NP you saw should know that you have to keep all weight off that area and duoderm is not a very aggressive treatment. Your doctor needs to prescribe a wound specialist and also he/she could prescibe a better mattress for the duration, til you are healed. It has to be prescribed by a doctor for insurance to cover, and can be obtained from a medical supply place, we did it for my brother when he got a bedsore in the hospital. Debra

  6. #6
    Senior Member McDuff's Avatar
    Join Date
    May 2004
    Dallas area, Tx
    Thanks for the replies All:

    Aly - I luckily don't have any skin allergies to adhesive so hopefully this won't be an issue. I am Irish descent so do have "sensitive" skin though, wll keep my eye on it.

    Tried - I relly have no idea "how" duoderm works. They just said to leave on for couple days and replace. Does it promote drainage?
    Good tip on not cutting them, that was gonna be our plan. Even the NP cut hers.

    Nurse - Yeah <hangs head>, I did get a bit complacent about relief. Figured with some sensation that I could tell, yeah right.
    I am in a manual chair, no tilt. Trying my damndest to just stay down, but whooee is it boring. Glad for the web, I'd go nuts. Thanks for the incline number, gives me something concrete instead of guessing.
    Could you explain the workings of duoderm(et al)? What affect does it have? Will I scab over at all? When you say healed, is that full new skin. How long for that?
    I am drinking at least 1 EAS shake/day for protein. Take generic multivitamin, says contains 15mg(100%) zinc.

    Lilsister - Thanks. Worst part, it *hurts*. Think I woulda known better. I asked about a wound care referral, she didn't think needed. I have a scheduled visit w/doc in 2 weeks. If not better by then, definitely will.
    I hope I will be healed long before I could get a new/temp mattress in place.

    "Rather be ridin' than rollin'"

  7. #7
    Mcduff,the duoderm promotes new skin integrity,protects and medicates,it also
    absorbs debris and dead skin .Keep warm
    and have lite massage away from area,not too close but mayby the hamstring area to
    promote good ciculation,

    Hopefully it could heal,(close) without a scab in 2 or 3 wk,but couuld take a month.However most people usually close with
    a small scab or a hard skin area,if so the scab has to be monitored closely,np has to carefully debride it,np can tell whether the skin is ok or not under scab,at that point,cream can be litely put on area to soften the hardened skin,Aveeno or Calivan,
    keep with the lite massage (not on area but
    hamstring)Technically a scab is a stage 2.
    Once the hard skin/scab is gone,continue with cream twice/day,on the area.
    once healed you should stay off it for the same number of weeks it took to close.
    You can cheat a bit but make sure you monitor it or have skin checks,take care
    and Irish spirits will help!

  8. #8
    The hydrocolloid (Duoderm) works by covering the skin, keeping it moist and allowing it to repair itself-called granulation. It is appropriate for a Stage 1 or 2- you could have used the Duorderm when it was a stage 1. You definitely need a wound specialist if it is or becomes a Stage 3. Years ago, telling my age now, we used to do all the wrong things and dry out "decubiti" with all kinds of things.
    The NPUAP(national pressure ulcer advisory panel)is the recognized authority on PU and they have alot of information and pictures.Of course, alot on the web in general.


  9. #9
    mcduff, do u sleep on yuour side, if not you hould, i have slept on my rt side for 15 years. my theory is to have all pressiure off my ass all night, im normaslly only in bed 6-8 hrs but w/ total pressure relief. my butt doesnt even get red, try it.

    "Man is bound to follow the adventurous promptings of his scientific and inventive mind and to admire himself for his splendid achievements" Carl Jung

  10. #10
    Senior Member McDuff's Avatar
    Join Date
    May 2004
    Dallas area, Tx
    Tried - thanks for the detailed writeup, sounds like good advice. Not scheduled for anymore NP visits so my wife appreciates the advice. Man, the number of weeks you talk about is scary. It'll take some "Irish spirits" to keep me under control.

    Nurse - I'll remember for future ref about using duoderm earlier. I'll keep a close eye for any tunneling and hit wound spec if so.

    Fuente - unfortunately I don't by nature. When AB I would start on my side but be on my back soon after. Now, I find it uncomfortable, kinda painful. I agree w/ your theory, total butt rest, gotta be good. Have been trying to stay on my side in little bits and maybe work up to more.

    "Rather be ridin' than rollin'"

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