slow healing wound

mhinds · 06-24-2004, 06:46 PM

My son has been dealing with an ischial pressure sore for 2.5 years. He has had three surgeries on it and has been in bed most of that time. Before the last surgery (Feb. 5, 2004) it was determined that he had osteomylitis. That is cured now, but the last flap surgery used a leg muscle and the incision was very large. He was in the hospital for 15 days, during which the whole thing turned black. It was debrided, and he was sent home to use the VAC. He stayed on that for 3 months and got some healing, but the wound plateaued at about 9 cm by 4.5 cm. We discontinued the VAC on June 3 and started topical hyperbaric oxygen. Everything looks good, but the size of the wound has not changed much. This has gone on too long! Does anyone have any ideas on what we could do? He is a 25 year old, C5-6 incomplete. Injured 3.5 years ago.

Sue Pendleton · 06-25-2004, 07:11 AM

http://www.cooksis.com/products/oasis_wound/index.html

SCI-Nurse · 06-25-2004, 07:51 AM

mh- it sounds like you have been doing all the best treatment for the wound. The Vac is good, hyperbaric oxygen is also good.
The process behind wound development and healing is pretty extensive. I know you know this from what you have been dealing with.
Let me make sure though.
Seating system- is it appropriate, has he had pressure mapping done to see how he sits, what cushion is best?
Is the osteomyelitis really gone?
How is his nutrition, is he getting the right nutrition, protein, vitamins to promote healing.
Bowel/bladder- making sure the wound is not wet/ soiled with urine/stool.
How are his transfers- make sure he is not hitting the area, especially against the wheels with transfers.

Hope this helps.

JM

mhinds · 06-25-2004, 01:38 PM

JM,
Thank you for your reply. David's physical therapist asures us that the osteo is gone.
Tthe wound is a healthy red and e had a hcluture done before the last surgery. It came back negative for osteo ( or anything else for that matter). We are very careful during the bowel program so I don't think that is a problem. David does not get up at all right now. He doesn't even sit up in bed for meals. He is on a pressure relif air bed. We have not had pressure mapping done for seating, but will do that when he is able to be up again. Just today we were told about the SIS Oasis Wound Matrix. Do you think that is something worth trying? Is it indicated for situations like this one? Thanks.

Mh

mhinds · 06-26-2004, 06:10 PM

Sue,

What do you know about the Oasis SIS product? My son's therapist mentioned it and then you did too. I am researching it and will ask his plastic surgeon to thnk about using it.

Right now we are using both the VAC and topical hyperbric oxygenation.

Mh

lynnifer · 06-26-2004, 07:33 PM

I tried the Oasis product - but unfortunately not enough to garner an opinion. The darn stuff's so expensive - $125 Canadian for 10cm x 10cm. I tired ordering directly from the manufacturer .. but as always they want nothing to do with patients .. they only want to deal with doctor's ET's etc.

I have tried Regranex and it works miracles (I think it's much better than the Oasis because with one application I saw a difference whereas I tried two and a half weeks with the pig intestine stuff i.e. Oasis). It's indicated for diabetic foot ulcers but it worked miracles for me .. and this is with 10yr old heel ulcers I thought would never heal. Mind you, the Regranex is mucho expensive as well, but it was covered by my employers drug benefits with permission from a doctor.

As well ... I had the same problem with osteomyelitis. Two years ago I went on my first PICC line and I saw dramatic healing. I've been on my second PICC line for six weeks now and I've broken through the plateau I had reached again. At one point 30% of my left foot was involved and doctors wanted to amputate. Today - it's the size of my pinky finger from the second knuckle down.

The quirky thing with osteomyelitis is that it is the gift that keeps on giving ... comes back and back as it's difficult to beat. Perhaps 'overkill' with the antibiotics on PICC line again will do it .. but if you've plateaued .. I'd ask to see the Infection Specialist and get an xray of the area to see if the bone infection could possibly be rearing its ugly head again. Or I think a blood test for WBC.

For aftercare (I'm struggling with this now as my skin is *sooo* dry and cracks and threatens to re-open again) .. dermal therapy (www.dermaltherapy.com) is also an amazing product and one I reccommend because of my good experience with it. It's so important to keep the newly healed skin clean from exudate of the wound and moisturized.

Something else I almost forgot to mention .. diet. Eating more protein will help. I tried to avoid sugar as well (who knows if I'm right - probably not) but I figured bacteria feed off of sugar so I tried to stay away from it. Plenty of fluids. I don't know about your son, but I became extremely depressed as well because the complications are a constant reminder of limitations .. a depressed person will not heal.

Good luck. I know it's frustrating as hell. I still insist dealing with pressure sores are worse than being paralyzed.

Pressure Sore Queen.

[This message was edited by lynnifer on 06-26-04 at 10:51 PM.]

mhinds · 06-27-2004, 08:56 PM

I hadn't considered that the osteomylitis might be hanging around. The wound does not look infected at all. It is a bright red and has plenty of granulation. However, I will ask about the x-ray. It was an infectious disease specialist who diagnosed osteo, so we may have to go back to him. What is WBC? I have never heard of that one. David had a PICC line for a long time and used a number of potent antibiotics. We thought we had it licked.

Also, we have a prescription for Reganix. We have not seen the results you mentioned, but since we have it, we are using it.

I expected the Oasis to be expensive. It may be prohibitive if it isn't covered by insurance.

Thanks for your help.

Mh

SCI-Nurse · 06-28-2004, 03:20 PM

WBC stands for White Blood Count. It is done with a complete blood count or CBC. PLG

Sue Pendleton · 06-29-2004, 07:16 AM

Like Lynnifer suggested not everything works for everyone. My only experience with the Oasis is a friend who also had heels that were open for about 2 years and nothing was healing them. He had the first generation version sewn on in the hospital by his plastic surgeon. The healing began so quickly that his surgeon came out to the boonies to take regular pictures of the process. Now this was before it was all packaged up so pretty and his surgeon had to speak to the veternarians at Purdue before ordering it.

If nothing else is working at getting skin to heal I'd ask a couple of plastic surgeons about this stuff. It supposedly leaves little to no scarring from what I've read. And it is cheaper than amputations or more skin grafts that might cause even longer hospitilizations, in the USA that is.

Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow."

mhinds · 07-02-2004, 06:46 PM

Thanks, Sue. I have received some literature from Cook Biotech which I will share with David's plastic surgeon. The Oasis product looks good and we are willing to try anything at this point. We have seen some healing since we combined hyperbaric oxygen, the VAC and Regranix. Maybe the darn thing will heal with this combination. I appreciate your helpful comments.

Mh

06-24-2004, 06:46 PM	#1
mhinds Member Join Date: Apr 2002 Posts: 58	slow healing wound My son has been dealing with an ischial pressure sore for 2.5 years. He has had three surgeries on it and has been in bed most of that time. Before the last surgery (Feb. 5, 2004) it was determined that he had osteomylitis. That is cured now, but the last flap surgery used a leg muscle and the incision was very large. He was in the hospital for 15 days, during which the whole thing turned black. It was debrided, and he was sent home to use the VAC. He stayed on that for 3 months and got some healing, but the wound plateaued at about 9 cm by 4.5 cm. We discontinued the VAC on June 3 and started topical hyperbaric oxygen. Everything looks good, but the size of the wound has not changed much. This has gone on too long! Does anyone have any ideas on what we could do? He is a 25 year old, C5-6 incomplete. Injured 3.5 years ago.

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06-25-2004, 07:11 AM	#2
Sue Pendleton Moderator Join Date: Jul 2001 Location: Wisconsin USA Posts: 9,108	http://www.cooksis.com/products/oasis_wound/index.html

06-25-2004, 07:51 AM	#3
SCI-Nurse Moderator Join Date: Jul 2001 Location: USA Posts: 41,324	mh- it sounds like you have been doing all the best treatment for the wound. The Vac is good, hyperbaric oxygen is also good. The process behind wound development and healing is pretty extensive. I know you know this from what you have been dealing with. Let me make sure though. Seating system- is it appropriate, has he had pressure mapping done to see how he sits, what cushion is best? Is the osteomyelitis really gone? How is his nutrition, is he getting the right nutrition, protein, vitamins to promote healing. Bowel/bladder- making sure the wound is not wet/ soiled with urine/stool. How are his transfers- make sure he is not hitting the area, especially against the wheels with transfers. Hope this helps. JM

06-25-2004, 01:38 PM	#4
mhinds Member Join Date: Apr 2002 Posts: 58	JM, Thank you for your reply. David's physical therapist asures us that the osteo is gone. Tthe wound is a healthy red and e had a hcluture done before the last surgery. It came back negative for osteo ( or anything else for that matter). We are very careful during the bowel program so I don't think that is a problem. David does not get up at all right now. He doesn't even sit up in bed for meals. He is on a pressure relif air bed. We have not had pressure mapping done for seating, but will do that when he is able to be up again. Just today we were told about the SIS Oasis Wound Matrix. Do you think that is something worth trying? Is it indicated for situations like this one? Thanks. Mh

06-26-2004, 06:10 PM	#5
mhinds Member Join Date: Apr 2002 Posts: 58	Sue, What do you know about the Oasis SIS product? My son's therapist mentioned it and then you did too. I am researching it and will ask his plastic surgeon to thnk about using it. Right now we are using both the VAC and topical hyperbric oxygenation. Mh

06-26-2004, 07:33 PM	#6
lynnifer Senior Member Join Date: Aug 2002 Location: Windsor ON Canada Posts: 15,301	I tried the Oasis product - but unfortunately not enough to garner an opinion. The darn stuff's so expensive - $125 Canadian for 10cm x 10cm. I tired ordering directly from the manufacturer .. but as always they want nothing to do with patients .. they only want to deal with doctor's ET's etc. I have tried Regranex and it works miracles (I think it's much better than the Oasis because with one application I saw a difference whereas I tried two and a half weeks with the pig intestine stuff i.e. Oasis). It's indicated for diabetic foot ulcers but it worked miracles for me .. and this is with 10yr old heel ulcers I thought would never heal. Mind you, the Regranex is mucho expensive as well, but it was covered by my employers drug benefits with permission from a doctor. As well ... I had the same problem with osteomyelitis. Two years ago I went on my first PICC line and I saw dramatic healing. I've been on my second PICC line for six weeks now and I've broken through the plateau I had reached again. At one point 30% of my left foot was involved and doctors wanted to amputate. Today - it's the size of my pinky finger from the second knuckle down. The quirky thing with osteomyelitis is that it is the gift that keeps on giving ... comes back and back as it's difficult to beat. Perhaps 'overkill' with the antibiotics on PICC line again will do it .. but if you've plateaued .. I'd ask to see the Infection Specialist and get an xray of the area to see if the bone infection could possibly be rearing its ugly head again. Or I think a blood test for WBC. For aftercare (I'm struggling with this now as my skin is sooo dry and cracks and threatens to re-open again) .. dermal therapy (www.dermaltherapy.com) is also an amazing product and one I reccommend because of my good experience with it. It's so important to keep the newly healed skin clean from exudate of the wound and moisturized. Something else I almost forgot to mention .. diet. Eating more protein will help. I tried to avoid sugar as well (who knows if I'm right - probably not) but I figured bacteria feed off of sugar so I tried to stay away from it. Plenty of fluids. I don't know about your son, but I became extremely depressed as well because the complications are a constant reminder of limitations .. a depressed person will not heal. Good luck. I know it's frustrating as hell. I still insist dealing with pressure sores are worse than being paralyzed. Pressure Sore Queen. [This message was edited by lynnifer on 06-26-04 at 10:51 PM.]

06-27-2004, 08:56 PM	#7
mhinds Member Join Date: Apr 2002 Posts: 58	I hadn't considered that the osteomylitis might be hanging around. The wound does not look infected at all. It is a bright red and has plenty of granulation. However, I will ask about the x-ray. It was an infectious disease specialist who diagnosed osteo, so we may have to go back to him. What is WBC? I have never heard of that one. David had a PICC line for a long time and used a number of potent antibiotics. We thought we had it licked. Also, we have a prescription for Reganix. We have not seen the results you mentioned, but since we have it, we are using it. I expected the Oasis to be expensive. It may be prohibitive if it isn't covered by insurance. Thanks for your help. Mh

06-28-2004, 03:20 PM	#8
SCI-Nurse Moderator Join Date: Jul 2001 Location: USA Posts: 41,324	WBC stands for White Blood Count. It is done with a complete blood count or CBC. PLG

06-29-2004, 07:16 AM	#9
Sue Pendleton Moderator Join Date: Jul 2001 Location: Wisconsin USA Posts: 9,108	Like Lynnifer suggested not everything works for everyone. My only experience with the Oasis is a friend who also had heels that were open for about 2 years and nothing was healing them. He had the first generation version sewn on in the hospital by his plastic surgeon. The healing began so quickly that his surgeon came out to the boonies to take regular pictures of the process. Now this was before it was all packaged up so pretty and his surgeon had to speak to the veternarians at Purdue before ordering it. If nothing else is working at getting skin to heal I'd ask a couple of plastic surgeons about this stuff. It supposedly leaves little to no scarring from what I've read. And it is cheaper than amputations or more skin grafts that might cause even longer hospitilizations, in the USA that is. Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow."

07-02-2004, 06:46 PM	#10
mhinds Member Join Date: Apr 2002 Posts: 58	Thanks, Sue. I have received some literature from Cook Biotech which I will share with David's plastic surgeon. The Oasis product looks good and we are willing to try anything at this point. We have seen some healing since we combined hyperbaric oxygen, the VAC and Regranix. Maybe the darn thing will heal with this combination. I appreciate your helpful comments. Mh