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Thread: Pressure Sore - 3rd Surgery

  1. #1
    Senior Member
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    Mar 2005
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    Indianapolis, IN
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    195

    Pressure Sore - 3rd Surgery

    I have a pressure sore on my right hip near the Ischium. I'm a T-4 Para - 21 years post injury. This sore developed about 4 years ago and I spent nearly a year trying to get it to close up while I was working full time. Finally I decided to have surgery to close the sore. The surgery did not go well and I spent 7 weeks bedfast waiting for it to heal. After about a year the sore opened again and I spent several months having it treated at a wound clinic and staying off of it as much as possible. Finally the wound clinic Dr. decided that too much scar tissue had formed and needed to be removed. I used a different surgeon and had a second surgery to remove the scar tissue. Then I spent another 6 weeks bedfast while healing. This took care of the problem for about a year and a half. Now I have another stage 2 sore in the scar that was worked on before. The sore closed at one point, but it lasted less than a month. Now this coming Friday (12/21/07) I am going to have a third surgery. The plan this time is to core out the wound down to healthy tissue. If needed, the surgeon will use some type of artificial muscle and skin. Then instead of closing the wound with stitches, they will put a wound pump on the site and keep me in the hospital for 3 days. The idea is to get the healthy tissue to grow from the inside out and prevent scar tissue from forming. I will then come home on Monday (Christmas Eve) and spend at least 6 weeks in bed again. Does this sound like something that will work? Anyone have ideas or suggestions. Would a flap and roll be a better course of action even if it is a bigger surgery? Thanks in advance.
    Brad
    New Palestine, IN
    "If everything is under control, you are going too slow." - Mario Andretti

  2. #2
    I hope you are dealing with a plastic surgeon who is very experienced in doing pressure ulcer surgery in someone with SCI. It is rare that you flap the same site more than 2X. A VAC used for only 6 weeks is also unlikely to fully close a major defect. At best, it may prepare the area for another flap if there is muscle left to flap with. Of course you must stay completely off the site until it is fully closed, then get a seating evaluation and new cushion, perhaps a different chair, and do a slow and gradual (and very careful) seating program.

    No matter what, after a pressure ulcer, even with a flap, the area will never be normal again, and it is likely you will be able to go back to sitting 10-15 hours daily again. Scar tissue is much more fragile than normal skin, and aging makes your skin not only more easily damaged by pressure, but also more difficult to heal. 6 weeks is the bar minimum of bedrest needed after a flap, even for someone who is young.

    Nutrition is also critical in all of this. If your pre-albumin and albumin levels are not optimal, surgery should not be attempted.

    (KLD)

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