FLAP SURGERY

Hope & Bill · 09-23-2003, 03:58 PM

My B/F is having the flap surgery done next Tue. He has had the pressure sore for 10 months, got it in the hospital, has had lots of treatments for it, won't heal. It got smaller everyway but depth, is still very deep.Has anyone else had the surgery? We know he will have a picc line in, (again), had one for staph infection, he also got in hospital.
Also they say he needs to be in a clinatron bed, do they ever deliver them to homes, so after the first 2 weeks or so, he can come home for me to take care of him? He has had a recovercare air bed since coming home 9 months ago, and it has been great for his skin, no new skin breaks, wish they had him in one from the beginning of his stay in hospital, but.....
He is worried that when he has a bad spasm, his leg may bend all the way to his chest and tear the new flap. Will they maybe up his baclofen? He is a T-6 complete. Any words of wisdom will be appreciated. Also, as he will be on antibiotics, we are worried he will get diarrhea,which we were warned could get into the new surgical area. I'm sure all will go well, but am worried anyway, he has more than his share of bad luck and problems since the accident. thanks, Hope

WE'RE HOPING FOR THE BEST

Leo · 09-23-2003, 06:26 PM

Hi Hope&Bill,

Check this discusion out,
http://carecure.org/forum/showpost.php?p=25172

"All you have to decide is what to do with the time that is given you."
Gandolf the Gray

SCI-Nurse · 09-23-2003, 08:08 PM

His spasticity does need to be controlled. Uncontrolled spasms can cause not only tearing of the sutures, but formation of clot pockets (hematoma) under the flap that can cause flap breakdown. Increasing the dose of baclofen or temporarily adding meds such as Valium in the post-op period (especially the first two weeks) may well be indicated. Be sure his plastic surgeon is very experienced with SCI and flaps (not all are) and that he consults on this with his SCI physician.

There are Clinitron type beds that can be used at home. They are quite expensive, and weigh a lot, so this has to be taken into consideration. We always use a Clinitron for at least 5 weeks post-flap, then move to a LAL (low air-loss mattress) for the next two weeks at least. Getting off the Clinitron too soon can cause flap breakdown.

No sitting should be attempted for at least 6 weeks after surgery (even on the Clinitron or LAL bed). Sitting too soon is a frequent cause of flap breakdown as well.

(KLD)

lass · 09-23-2003, 08:48 PM

Good luck with the flap surgery. My BF and I noticed a big decrease in his spasms when he was on the Clinitron bed. Also, I dont know if it was because the antibiotics were IV administered, but he didn't have any problems with diarrhea. Just the opposite in fact, from the pain meds. The bed in the hopital ws full length sandpit. When he went to a nursing home, he started out on one that was top third airbed, bottom two thirds sandpit. He'd lost a LOT of weight, started trying to get a skin breakdown where the bed changed from air to sand, and is tall, so he couldn't move up or down the bed much, so it had to be switched to the full length sand type. Just something else to watch out for.

Hope & Bill · 09-24-2003, 05:10 AM

Thanks to everyone for the good thoughts, and to Leo for the other forum discussion, I hadn't seen that yet. I will make sure to ask them to ensure his spasms are under control, Lass, did your guy feel pain in the area? Is that why he was on pain meds? I never understand about AD since he has never (OH NO, I hope I just didn't jinx us) had it, but can pain he doesn't know he has since he can't feel cause it? Will they medicate him even though he has no feeling from the waist down to keep him quiet? That would be fine with me, as it might help with spasms. They are planning on changing the oral antibiotics to intravenous in the hospital. Thanks again guys!!

WE'RE HOPING FOR THE BEST

lass · 09-24-2003, 07:36 PM

The BF's injury is incomplete, and he did feel pain. They did a spinal block for his surgery- that just seemed weird. He's never had AD caused by pain, maybe because he can feel (some) pain? His sensation isn't 'normal'- he can't tell if his legs are cold until I touch them for example, but his behind hurt like hell when they'd do a dressing change before the surgery- is part of the reason they OD'd him on morphine one time.

SCI-Nurse · 09-25-2003, 07:51 AM

Unless a person has sensation, pain medication is usually not needed after flap surgery. AD must be watched for and if it occurs can be handled with medications such as nifedipine or minipress or clonidine.

Due to the length of surgery and the anesthesia needed, it is important to watch for and prevent pulmonary complications after surgery. Deep breathing exercises (usually using an incentive spirometer) every 2 hours and quad coughing to prevent secretion accumulation and/or atalectasis (collapse of small lung areas) is critical for anyone with SCI following major surgery.

(KLD)

09-23-2003, 03:58 PM	#1
Hope & Bill Member Join Date: Aug 2003 Location: BOOTHWYN, PA USA Posts: 30	FLAP SURGERY My B/F is having the flap surgery done next Tue. He has had the pressure sore for 10 months, got it in the hospital, has had lots of treatments for it, won't heal. It got smaller everyway but depth, is still very deep.Has anyone else had the surgery? We know he will have a picc line in, (again), had one for staph infection, he also got in hospital. Also they say he needs to be in a clinatron bed, do they ever deliver them to homes, so after the first 2 weeks or so, he can come home for me to take care of him? He has had a recovercare air bed since coming home 9 months ago, and it has been great for his skin, no new skin breaks, wish they had him in one from the beginning of his stay in hospital, but..... He is worried that when he has a bad spasm, his leg may bend all the way to his chest and tear the new flap. Will they maybe up his baclofen? He is a T-6 complete. Any words of wisdom will be appreciated. Also, as he will be on antibiotics, we are worried he will get diarrhea,which we were warned could get into the new surgical area. I'm sure all will go well, but am worried anyway, he has more than his share of bad luck and problems since the accident. thanks, Hope WE'RE HOPING FOR THE BEST

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09-23-2003, 06:26 PM	#2
Leo Senior Member Join Date: Jul 2001 Location: Yankton, South Dakota Posts: 3,950	Hi Hope&Bill, Check this discusion out, http://carecure.org/forum/showpost.php?p=25172 "All you have to decide is what to do with the time that is given you." Gandolf the Gray

09-23-2003, 08:08 PM	#3
SCI-Nurse Moderator Join Date: Jul 2001 Location: USA Posts: 41,331	His spasticity does need to be controlled. Uncontrolled spasms can cause not only tearing of the sutures, but formation of clot pockets (hematoma) under the flap that can cause flap breakdown. Increasing the dose of baclofen or temporarily adding meds such as Valium in the post-op period (especially the first two weeks) may well be indicated. Be sure his plastic surgeon is very experienced with SCI and flaps (not all are) and that he consults on this with his SCI physician. There are Clinitron type beds that can be used at home. They are quite expensive, and weigh a lot, so this has to be taken into consideration. We always use a Clinitron for at least 5 weeks post-flap, then move to a LAL (low air-loss mattress) for the next two weeks at least. Getting off the Clinitron too soon can cause flap breakdown. No sitting should be attempted for at least 6 weeks after surgery (even on the Clinitron or LAL bed). Sitting too soon is a frequent cause of flap breakdown as well. (KLD)

09-23-2003, 08:48 PM	#4
lass Senior Member Join Date: Jul 2002 Posts: 207	Good luck with the flap surgery. My BF and I noticed a big decrease in his spasms when he was on the Clinitron bed. Also, I dont know if it was because the antibiotics were IV administered, but he didn't have any problems with diarrhea. Just the opposite in fact, from the pain meds. The bed in the hopital ws full length sandpit. When he went to a nursing home, he started out on one that was top third airbed, bottom two thirds sandpit. He'd lost a LOT of weight, started trying to get a skin breakdown where the bed changed from air to sand, and is tall, so he couldn't move up or down the bed much, so it had to be switched to the full length sand type. Just something else to watch out for.

09-24-2003, 05:10 AM	#5
Hope & Bill Member Join Date: Aug 2003 Location: BOOTHWYN, PA USA Posts: 30	Thanks to everyone for the good thoughts, and to Leo for the other forum discussion, I hadn't seen that yet. I will make sure to ask them to ensure his spasms are under control, Lass, did your guy feel pain in the area? Is that why he was on pain meds? I never understand about AD since he has never (OH NO, I hope I just didn't jinx us) had it, but can pain he doesn't know he has since he can't feel cause it? Will they medicate him even though he has no feeling from the waist down to keep him quiet? That would be fine with me, as it might help with spasms. They are planning on changing the oral antibiotics to intravenous in the hospital. Thanks again guys!! WE'RE HOPING FOR THE BEST

09-24-2003, 07:36 PM	#6
lass Senior Member Join Date: Jul 2002 Posts: 207	The BF's injury is incomplete, and he did feel pain. They did a spinal block for his surgery- that just seemed weird. He's never had AD caused by pain, maybe because he can feel (some) pain? His sensation isn't 'normal'- he can't tell if his legs are cold until I touch them for example, but his behind hurt like hell when they'd do a dressing change before the surgery- is part of the reason they OD'd him on morphine one time.

09-25-2003, 07:51 AM	#7
SCI-Nurse Moderator Join Date: Jul 2001 Location: USA Posts: 41,331	Unless a person has sensation, pain medication is usually not needed after flap surgery. AD must be watched for and if it occurs can be handled with medications such as nifedipine or minipress or clonidine. Due to the length of surgery and the anesthesia needed, it is important to watch for and prevent pulmonary complications after surgery. Deep breathing exercises (usually using an incentive spirometer) every 2 hours and quad coughing to prevent secretion accumulation and/or atalectasis (collapse of small lung areas) is critical for anyone with SCI following major surgery. (KLD)