Trouble in Paradise

Leigh · 03-05-2004, 06:57 PM

Can you share information with me, please? This is regarding an ischial decubitus ulcer that I developed in February of 2003 and has continued to haunt me for the past year. I am an incomplete C7 quad with 20 years of SCI experience and no problems until now. The challenge is: I had surgery consisting of debridement and partial ostectomy. Repair was undertaken using a gluteus maximus muscular cutaneous island flap. I spent quite a bit of time in the fluid/air bed until I was released from the hospital to return home at the end of March. In June of 2003, the well-healed wound began to fill with serous fluid and I have been going to the M.D. for fluid aspiration ever since that time!! The surgeons in the remote island area where I live have nixed any treatments other than aspiration thus far.

Now, of course, the doctor says it is time for a second surgery to remove the recurrent wound seroma ("cyst") but he cannot assure me that the fluid sac will not return. I can't be the only person who ever had this problem and I sure would like to hear from you!! Would anyone who has had a similar experience please leave a message? I am very grateful........Leigh

Wise Young · 03-05-2004, 10:35 PM

Leigh, seromas result from "seepage" of serum (the fluid of blood) from damaged blood vessels into the tissue. They often take a long time to resolve, i.e. from 3-6 months. A year is too long and your surgeon is probably correct in not being able to assure you that a seroma will not occur.

You should be aware of several consequences of seromas that are being aspirated. Serum in the seromas contain protein and depending on the amount taken out, may represent loss of a significant amount of protein. You should take extra fluids and protein to replace what is lost.

The presence of a cavity encourages the formation of a layer of cells that produces the serous fluid. Some surgeons choose to remove this fluid producing layer, closing the cavity with a quilting stitch and placing a drain to remove fluids until the tissue heals. Other surgeons may choose to put an irritant material into the cyst, to induce inflammation, which stimulates healing. Some surgeons use fibrinogen to seal the cavity, using a drain to remove fluids until the layers heal. In the end, it is really the drains that do the job, preventing the formation of a cyst and allowing the layers to adhere and heal.

Wise.

Mike C · 03-06-2004, 07:24 AM

Leigh,

What caused this type of decubitus ulcer if you don´t mind me asking? Could it have been prevented?

"So I have stayed as I am, without regret, seperated from the normal human condition." Guy Sajer

Wise Young · 03-06-2004, 07:38 AM

Mike C, seromas occur whenever there is a cavity left behind in the tissue. Because blood vessels form and line the surfaces of the cavity, they don't have tissue completely surrounding them. Such blood vessels leak serum. This occurs in surgery all the time, whenever large amounts of tissues are dissected and opened. To prevent their occurrence, surgeons place "drains" which are really flat rubber tubes in the tissue, allowing fluid to drain out, so that layers of tissue can come together and adhere to each other. The drain is gradually removed as the amount of drainage decreases, so that the wound can heal inside out. Seromas are very common after abdomenal surgery, skin flaps, mastectomies, liposuction, and other surgeries that disrupt internal tissue layers. Wise.

Aquitaine · 03-06-2004, 03:11 PM

Hi Leigh,

I can't provide anywhere near Dr. Youngs technical help, but I've been through these surgeries and can at least give moral support. My second surgery was not an "island" flap however, my surgeon did what he called a "VtoY" flap, where a "V" was cut in the thigh below the wound, then the healthy skin was moved up and the open area was pulled together to end up with a "Y" looking incision. The advantage to this was, if any problems happened again, the flap could be pulled up again, making a "longer" Y. Apparently this can be done 3-4 times if you are unfortunate enough to require it

. Decubitus ulcers are awful things, my worst nightmare even today is from an ulcer hemoraging one morning. I got up and was standing in front of the mirror of my bathroom, washing up, brushing teeth, etc. When I happened to look down after a few minutes, the floor was covered with blood. Luckily my first operation with the Y incision was enough and I have been (knock on wood) ulcer free for almost 4 years since then. You might want to ask your surgeon about the VtoY, as I understand it, its a pretty new procedure. I wish you all the best, and hope this next surgery does the trick.

Regards

Never underestimate an individual,
Never overestimate a bureaucracy.

03-05-2004, 06:57 PM	#1
Leigh Junior Member Join Date: Mar 2004 Location: Kailua-Kona, HI 96740 USA Posts: 3	Trouble in Paradise Can you share information with me, please? This is regarding an ischial decubitus ulcer that I developed in February of 2003 and has continued to haunt me for the past year. I am an incomplete C7 quad with 20 years of SCI experience and no problems until now. The challenge is: I had surgery consisting of debridement and partial ostectomy. Repair was undertaken using a gluteus maximus muscular cutaneous island flap. I spent quite a bit of time in the fluid/air bed until I was released from the hospital to return home at the end of March. In June of 2003, the well-healed wound began to fill with serous fluid and I have been going to the M.D. for fluid aspiration ever since that time!! The surgeons in the remote island area where I live have nixed any treatments other than aspiration thus far. Now, of course, the doctor says it is time for a second surgery to remove the recurrent wound seroma ("cyst") but he cannot assure me that the fluid sac will not return. I can't be the only person who ever had this problem and I sure would like to hear from you!! Would anyone who has had a similar experience please leave a message? I am very grateful........Leigh

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03-05-2004, 10:35 PM	#2
Wise Young Administrator Join Date: Jul 2001 Location: New Brunswick, NJ, USA Posts: 37,975	Leigh, seromas result from "seepage" of serum (the fluid of blood) from damaged blood vessels into the tissue. They often take a long time to resolve, i.e. from 3-6 months. A year is too long and your surgeon is probably correct in not being able to assure you that a seroma will not occur. You should be aware of several consequences of seromas that are being aspirated. Serum in the seromas contain protein and depending on the amount taken out, may represent loss of a significant amount of protein. You should take extra fluids and protein to replace what is lost. The presence of a cavity encourages the formation of a layer of cells that produces the serous fluid. Some surgeons choose to remove this fluid producing layer, closing the cavity with a quilting stitch and placing a drain to remove fluids until the tissue heals. Other surgeons may choose to put an irritant material into the cyst, to induce inflammation, which stimulates healing. Some surgeons use fibrinogen to seal the cavity, using a drain to remove fluids until the layers heal. In the end, it is really the drains that do the job, preventing the formation of a cyst and allowing the layers to adhere and heal. Wise.

03-06-2004, 07:24 AM	#3
Mike C Moderator Join Date: Jul 2001 Location: Deutschland Posts: 4,894	Leigh, What caused this type of decubitus ulcer if you don´t mind me asking? Could it have been prevented? "So I have stayed as I am, without regret, seperated from the normal human condition." Guy Sajer

03-06-2004, 07:38 AM	#4
Wise Young Administrator Join Date: Jul 2001 Location: New Brunswick, NJ, USA Posts: 37,975	Mike C, seromas occur whenever there is a cavity left behind in the tissue. Because blood vessels form and line the surfaces of the cavity, they don't have tissue completely surrounding them. Such blood vessels leak serum. This occurs in surgery all the time, whenever large amounts of tissues are dissected and opened. To prevent their occurrence, surgeons place "drains" which are really flat rubber tubes in the tissue, allowing fluid to drain out, so that layers of tissue can come together and adhere to each other. The drain is gradually removed as the amount of drainage decreases, so that the wound can heal inside out. Seromas are very common after abdomenal surgery, skin flaps, mastectomies, liposuction, and other surgeries that disrupt internal tissue layers. Wise.

03-06-2004, 03:11 PM	#5
Aquitaine Senior Member Join Date: Dec 2003 Location: Bay Area, California Posts: 185	Hi Leigh, I can't provide anywhere near Dr. Youngs technical help, but I've been through these surgeries and can at least give moral support. My second surgery was not an "island" flap however, my surgeon did what he called a "VtoY" flap, where a "V" was cut in the thigh below the wound, then the healthy skin was moved up and the open area was pulled together to end up with a "Y" looking incision. The advantage to this was, if any problems happened again, the flap could be pulled up again, making a "longer" Y. Apparently this can be done 3-4 times if you are unfortunate enough to require it . Decubitus ulcers are awful things, my worst nightmare even today is from an ulcer hemoraging one morning. I got up and was standing in front of the mirror of my bathroom, washing up, brushing teeth, etc. When I happened to look down after a few minutes, the floor was covered with blood. Luckily my first operation with the Y incision was enough and I have been (knock on wood) ulcer free for almost 4 years since then. You might want to ask your surgeon about the VtoY, as I understand it, its a pretty new procedure. I wish you all the best, and hope this next surgery does the trick. Regards Never underestimate an individual, Never overestimate a bureaucracy.