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Thread: For me to get my flap surgery done...

  1. #1

    For me to get my flap surgery done...

    As many of you know, I have a stage 4 pressure ulcer on my left ischium and a stage two on my right. In order for the surgeon I currently have two do a flap surgery on those two ischiums, he is requiring I have zero spasms and I get a colostomy. A colostomy, really?! I didn't have to have that last time I had a flap surgery. And absolutely no spasms, I have my pump turned up so high right now that I'm just about topped out on intrathecal baclofen and he still thinks I'm too tight. And it's leaving me with an echo sound when I hear stuff. How many of you guys have had to do this stuff to get a flap done? This is absolutely ridiculous. I really want to get this thing closed so I can get back on with my life but I don't think he will ever do the surgery because of my spasms. I'm going for a second opinion next week.
    C-5/6, 7-9-2000
    Scottsdale, AZ

    Make the best out of today because yesterday is gone and tomorrow may never come. Nobody knows that better than those of us that have almost died from spinal cord injury.

  2. #2
    The colostomy may be a good idea if the wound or incision will be near the flap. Stool contamination is a major risk fractor for flap infections. It can be temporary, although I find many people who have a temporary one for their skin later change their mind and keep it.

    We do want to see spasticity controlled, but not totally absent. We have used external baclofen pumps, and recently did Botox injections for a pt. having a flap who was pretty much maxed out on his oral meds, but I would not want to have the goal, and don't think it is realistic to try to make the person totally flaccid. For one thing, it would significant increase your risks for both muscle atropy/wasting, and increase your risks for DVT. Spasticity should be controlled though as it can cause both ripping of the suture line and hematoma (trapped blood under the incision) that can make it more likely to have flap failure.

    Is this physician at Barrows/St. Joseph by any chance?

    I think getting another opinion is a good idea.

    (KLD)

  3. #3
    My physician is here at the Mayo Clinic. Unfortunately, neither one of my insurances contract with anyone at Barrows. I already have a baclofen pump and like I say, it is pretty much maxed out for right now leaving my head foggy and me hearing echoes when I watch TV or listen to people. It's quite obnoxious. He just did a flap on my sacrum seven months ago and we didn't need a colostomy then nor did he insist that my spasms were nonexistent. That's why I'm kind of thinking he just doesn't want to do it. He is also talking about some problems with my urethra since I would have to get both ischiums done. Does that make sense to you? I'm really tired of being in bed all the time and need to get back on with my life. I have an appointment Wednesday morning to see a new doctor and see what he has to say. I'll let you know then.
    C-5/6, 7-9-2000
    Scottsdale, AZ

    Make the best out of today because yesterday is gone and tomorrow may never come. Nobody knows that better than those of us that have almost died from spinal cord injury.

  4. #4
    Just playing devil's advocate here - and believe, I'm not one to charge to the defense of doctors, lol - but maybe he's had a bad experience with a similar surgery recently that's kind of 'spooked' him?

    What he's suggesting does sound kinda over the top - glad you're going for a 2nd opinion. Hope this one gives you better news!
    _____________

  5. #5
    Senior Member
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    Seek a second opinion. It wont hurt then you can have a choice.

    I know when we have bad experiences in our OR ( I work in a hospital) most times they institute across the board(for every patient) procedures to prevent it from re-occurring regardless of the proabability for the bad to happen again.
    T12-L2; Burst fracture L1: Incomplete walking with AFO's and cane since 1989

    My goal in life is to be as good of a person my dog already thinks I am. ~Author Unknown

  6. #6
    Well I went to get my second opinion yesterday morning and it sounded much more reasonable than what my doctor at the Mayo Clinic wanted me to do. He was fully aware that it is almost impossible for me to completely eliminate my spasms and that if things were too tight, he could easily use Botox to loosen the muscle. Not only that, but he's not going to make me wait forever like my doctor at the Mayo Clinic has. He has an opening in the middle of next month. It was such a relief to have a doctor who didn't look down on me, agreed that it's probably not necessary for me to get a colostomy and that a few days postsurgery I would be fed intravenously to avoid any accidental bowel movement and be prone for it to heal up properly. But only for a few days. I can't remember the last time I got on my belly, so it will probably be good for me. It was so nice to talk to someone who took my concerns into play instead of just telling me how it has to be.
    C-5/6, 7-9-2000
    Scottsdale, AZ

    Make the best out of today because yesterday is gone and tomorrow may never come. Nobody knows that better than those of us that have almost died from spinal cord injury.

  7. #7
    Senior Member
    Join Date
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    Massachusetts
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    222
    rybread, glad to hear your second opinion went well. I've been injured 23 years and have had very similar problems with bi lateral ishi breakdown. Have tried virtually anything and everything to correct this. Probably 10 different cushions etc. etc. you may want to look into THE RIDE CUSHION. I had battled these sores for over 20 years as I said. In fall 2005, I had very deep surgery removing necrotic tissue and grinding down of the ishi bones themselves. Spent some time in bed on Clinatron and slowly started getting up after several months, 2 hours or so. Wound clinic always wanted to do flap surgery, but wounds continued healing. I had a appointment every 4 weeks at wound center, wounds continued to heal slowly and steadily. Soon I was up 8 hours a day with wounds continuing to steadily heal. Went to wound center yesterday, both wounds less than 5mm deep and continuing to heal. Originally they were well over 6.5 cm.

    As I said, I tried every cushion, wheelchairs with tilt, everything imaginable. The new RIDE CUSHION, made every difference for me. Now everyone is different, what works for one person doesn't always work for another. But I would at least talk to a good pt at a seating clinic about that cushion. Spalding rehab in Boston has several high level quads with consistent ishi problems that have healed on this cushion.

    Surgery of any kind isn't something to just jump into. Dr. Young in his lectures always talks about getting off baclofen. You want some spasms to promote circulation and lessen atrophy. You are probably having increased spasms because of the pain of the ulcers themselves.

    Anyway good luck
    Shamrock

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