My flap transition of week 6 to REHAB

[michael5462]

Hi,

I had a flap on Friday, August 17. Tomorrow, September 14, will mark four weeks in a Clinitron bed. My wound nurse and doctor are extremely please with how the surgical site looks. I have 23, I think they are called staples and they are beginning to fall out. My surgeon is requiring that I stay in bed for six weeks. I an anxious to get the hell out of this nursing home.

My question is, based on individuals who have had flaps before. Were you able to begin rehab on week six and utilize a sliding board to transfer from your bed to your wheelchair? If not, approximately, how much longer do I have to wait for this flap to get strong enough? I'm tired of this but I guess I always need to remember that "patience is a virtue."

I appreciate your help.

[SCI-Nurse]

If everything goes PERFECTLY with the healing after a flap:

Our program starts to do hip ROM at the end of week 5, right after the last staples are removed. We then start very gentle soft tissue massage along with a lubricanting skin cream along the scar to help prevent "binding down" of tissue which can interfere with a sitting program. ROM is gradually (over the week) increased to achieve 90 degrees of hip and knee flexion while monitoring closely for any excessive tension on the incision line.

We also go to a LAL mattress off the air fluidized bed at the end of week 5.

At the beginning of week 7, we start a sitting program. NO SLIDE BOARD TRANSFERS though! Only transfers with mechanical lift and sling that is well padded, and removed after the transfer to the chair.

Sitting program usual progression (again, if everything goes perfectly):

Day 1: sit 15 minutes; only long enough to do a computerized pressure testing evaluation of chair and cushion/seating system (which was ordered tentatively prior to this time).

Day 2: sit 30 minutes. Weight shifts every 10-15 minutes. Meticulous skin inspection after each sitting episode.

Day 3: sit 30 minutes X2. Continue daily.

Day 6: sit 60 minutes X2. Continue daily.

Day 9: sit 1.5 hours X2. Continue daily.

Day 12: sit 2.0 hours minutes X2. Continue daily.

Day 15: sit 2.5 hours minutes X2. Continue daily.

Day 18: sit 3.0 hours minutes X2. Continue daily. Start to include use of a well-padded shower/commode chair for bowel care/shower (no more than 30 minutes) within that sitting time limit.

Day 21: sit 3.5 hours minutes X2. Continue daily.

Day 24: sit 4.0 hours minutes X2. Continue daily. Start slide board transfer training as long as the person can slide without causing friction/tension to the scar area.

At this point we usually allow some to be discharged home and continue the gradual increase of their sitting time to 8-10 hours daily.

We continue with the LAL mattress at home for 6 months after the flap; longer for some.

(KLD)

[smokey]

Michael, this is a great question. I"m a C-7 guy and I had a flap done 10 months ago so I know your situation all too well. Like you, I also did a stretch in a Clinitron bed. However, I stayed in it 10 weeks because I had to sit up in bed frequently to empty my ostomy bag, eat and get cleaned up in the morning. They wanted to transition me into some other mattress after 6 weeks but I fought them and stayed on it 10 weeks. As such, I could only get in and out of the Clinitron with a Hoyer lift. Yes, it's dehumanizing and made me feel like cargo but it was better for my surgical incision than using a sliding board to get in and out of bed. It was a big fight but they wanted me to use a slide board after only 6 weeks! No way was that right and I flat out refused to use a slide board so soon and I also insisted on staying in the Clinitron bed. Why would I want to challenge the strength and durability of the incision after just 6 weeks? These people were so fucking stupid at the rehab facility. I only used a slide board when I returned home which was 10 weeks after surgery. Frankly, even then I think was risky but I do not have a Hoyer lift in my house and I really didn't want one.
Also, the whole time I was in the rehab shithole I used my own 5 and 8lbs. handweights continuously to keep my arms in shape. I also used my Steel Bow isometric exercise tube (I still use both everyday even now).
Like KLD pointed out you will be on a graduated sitting protocol for a while. Just be patient and disciplined. Hopefully your surgery was done properly and now it's up to you to not screw it up.

[cjhawk38]

My 14 year old daughter had a flap done on August 13th. She came home by ambulance on August 21st to a Clinitron at Home bed. On August 31st she went back by ambulance to have the 62 staples removed and to begin sitting 15 minutes a day. She is up to 3 hours and 45 minutes today and we are going back to the doctor today for a follow up. When she gets in the chair I have to lift her because the bed is too high to transfer.

Cindy

[KyleP2112]

I had a flap surgery in the past also...all has gone well since. It's all about making a slow transition to sitting more each day. Make sure to do extra weight-shifts/pressure relief while the surgery site is healing.

---------
C4/5, incomplete, powerchair user

[michael5462]

Hi Everyone,

I have already shared that I am in a nursing home in a Clinitron bed and had a flap done on my ccoyxic. (sp) Everything was going really well with my recovery with how the surgical site looks until yesterday when my wound doctor said that there is a bunch of fluid inside so my wound nurse got three syringes and the doctor filled one of them up all of the way with this yellow colored liquid. He ended up filling two of them up and then he got another type of syringe and drained blood I guess. I had these plastic ball like devices (I don't know what they were called) connected to my surgical site that collected blood and then at the end, the color turned yellow. The nurse at the end of every shift drain the balls and measured how much liquid was inside. He took those ball like devices off at week three. I am doing my best to explain this. I was so upset about it, I don't remember what he said about why this was happening. I look at this as a set back. The wound nurse is now dressing my wound daily instead of three times a week and today, a little bit of fluid is back. Could this be caused by me strengthening my left and right arm for about an hour daily with a 6 lb. dumbbell? Or maybe he took those plastic balls off to early that were attached to the surgical site? I remember asking him if he could put the balls back in and he said it wasn't possible.

What in the hell is going on here?

A frustrated 50 year old man requesting some help.

Michael

[lynnifer]

Don't fret .. yellow fluid is just blood plasma or by-products. The fact that blood is reaching your wound is great ... if there wasn't blood, I would be hella worried! Blood brings oxygen and nutrients to heal.

Are you lifting weight while on your backside? If so, I'd stop it. It could be 'shear' against the hard starchy nursing home sheets ... I wonder about putting a sheepskin underneath you to stop the shearing?

Difficult to get enough nutrients and water when stuck in bed. Are you taking multi-vitamins, protein and iron to help heal?

[SCI-Nurse]

A seroma and/or hematoma like this is NOT a good complication at this point. Seromas frequently cause flap failure as they interfere with adhesion of the different tissues layers in the flap. Draining with a syringe may help, but commonly they must be drained and then a method of pulling the tissue layers together to get them to heal properly is required (ie, surgery).

The JP (Jackson-Pratt) drains you had in place cannot be simply replaced without surgery either. This is why they should stay in place as long as they are still draining...often 4-5 weeks after surgery. The bulb is attached to a drain (long tube with holes in it) that is anywhere from 8-14" long underneath the flap. The only way to replace it is to open up the incision again. Typically 2-3 drains are used for a pressure ulcer flap.

The flap needs to be watched carefully at this point. If the syringe drainage is not successful, then further surgical procedures may be needed. I am afraid this needs to put off any sitting program at this time.

(KLD)

[thehipcrip]

Michael, I'm really sorry to hear you've had a setback. I can hear the despair and frustration in your "voice" — it's heartbreaking! You have my empathy (I've been there and done that several times, and understand just how hard your heart drops when you experience complications.)

Do your best to hang tough. It may sound hokey, but try spending some time each day visualizing the the fluid going away, and the tissue and muscle healing and growing stronger. You have my best wishes that this will resolve quickly and you can heal without any further surgery.

[smashms]

sounds like those drains may have ben removed a bit too soon, i know for my flap i had to be draining less than 100cc a day. which is not that much it is like a tablespoon worth. i would avoid any sitting though.