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    Please any help with this....

    Dear friends and SCI Nurses, I`m from Peru, I found this website in 2002, since my uncle had an accident. Since that time, my uncle these last 2 years have had problems with a wound he had in the left buttock , and two months ago , after two surgeries he had recovered from that..., but some weeks ago he presented in the right buttock some reddening, then a part of it turned brown and black..., but without wounds! some doctors said it was not important..., but two days ago he presented some fever, and now he is hospitalizaded..., doctor said he has some blood vessel inside, and maybe an infection too because that part inflated and doctors suctioned kind of water they found there, and on friday doctors will see inside after a surgery.., and they say that is caused because he hasn´t muscle on that area... (my uncle don´t stand up since more than 1.5 years because of the wounds and the iron supports, that don´t allow it) , and I´m so concerned and sad about this. I think it is too much , the accident was too much, and now these other problems that we dont understand why happens..., I would be grateful if somebody would tell me what to do with this problem , since maybe the doctors here don´t know very well about these problems..., what can we do to avoid the same will happen again.., and what suggestions will give me to obtain my uncle take a good quality of life. He is 54 years old.


    Did your uncle have a myocutaneous flap surgery done by a plastic surgeon to close the previous pressure ulcer, or did a general surgeon just sew the edges together?

    Brown or black tissue is very bad. This is either a deep tissue injury (DTI) pressure ulcer or an open wound that is covered with black leathering material called eschar (sort of a type of scab). Either way, it indicates extensive tissue damage. It is likely that he has an abscess under this which is infected and causing his high fever. He may have bone infection (osteomyelitis) too.

    He really needs a physician who is an expert in pressure ulcer surgical treatment and recovery. This is usually a plastic surgeon. He may need to go to a large teaching/university hospital to find one who knows what they are doing with a SCI pressure ulcer. It may be that he will have to have a myocutaneous flap done. This is a very complex surgery that requires very specialized post-operative care, with a special bed for 5-6 weeks of total bedrest with no movement of the involved hip or knee allowed at all. Proper nutrition is also critical, and should be optimized PRIOR to such a surgery as well. A specialized progressive sitting program after 6 weeks (if all goes well) is also critical.

    It is critical that your uncle take actions to prevent pressure ulcers in the future. This booklet is the best resource that I can share with you now. Print it out and share it with him (be sure to print the Spanish language version):

    If it is possible to get good quality digital photos of his wounds I would be glad to look at them for you. Send me a PM and I can tell you how to get them to me privately.

    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.


      Dear SCI Nurse, at first thank you very much for answering my post.

      My uncle had a general surgeon, not a myocutaneous flap surgery.

      My doubt is: that surgery seems to be ok now, although it had to be practiced two times..., (first time everything was ok we think but after myuncle used the supports to start their exercises again his buttock turned again brown and had to be operated again)

      The problem now is the other buttock that never had a wound there, only it started red, then brown ...and black, and then inflating, but without wound and is rare because he was not sitting too much time because he is still recovering after the surgery of the other buttock that was made on March first week.

      Some kind of infection could have passed from the recently operated buttock to the sane buttock ? which now has the problem....

      Could you recommend me any kind of diet to make he recover or gain some weight?

      Thank you so much again....

      He is going to be operated today, and I won´t could take the photo now, but I will maintain in touch, I will appreciate your answers...


        Dear SCI Nurse, after my last posting I traduced a word I didn´t know, and understood better about flap, which I have heard to the doctors who made the last surgery, but I think they are not plastic surgeon..., I will confirm it....

        But that las surgery was going well..., I dont know what happened with the other buttock that never had an ulcer, and there wasn´t cause to produce that...because he was in bed almost all the time...


          Is there any way you can send me a digital photo? I am not able to tell much by just a verbal description of this wound.

          The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.


            How is your uncle's diet and what does he sit on?

            Could he take a multi-vitamin at the very least?
            Roses are red. Tacos are enjoyable. Don't blame immigrants, because you're unemployable.

            T-11 Flaccid Paraplegic due to TM July 1985 @ age 12


              Hello SCI Nurse, I'm again here, cause I need urgent help with the same problem. Can you believe my uncle continued with the problem with the ulcer that after every surgery , when he starts sitting, that zone turns hot, then red, and when doctors examine that , they see some liquid in the ecography, and programme another surgery. This is the fifth surgery I think, in 3 years. I need to know what should we do, because doctors here in Peru dont know what more to do.

              Thank for any help



                Maria -
                It is a shame that this problem has continued. I have some suggestions; please forgive me if I say what you already know -
                • If he has not yet been treated by a surgeon who is an expert in pressure ulcers due to SCI, try again to find one.
                • He may be sitting on the fragile area too soon after the surgeries - the area may look fine on the surface, but it has not healed completely yet.
                • If any red is seen, he should stop sitting immediately.
                • That area will always be more fragile after once being damaged, even after it is completely healed, so he will always have to be extra careful.
                • When he is ready to sit again, he may need to use a better cushion that distributes the pressure over a larger area (such as a Roho cushion).
                • If you have not downloaded the booklet about pressure sores that nurse KLD gave you a link to (above), please do so. He should read it, and so should you and those others that help care for him. PVA also have excellent publications on other subjects related to SCI - see
                • Take every advantage of the help that KLD offers. It is a wonderful opportunity to get help from her.

                Best wishes
                - Richard


                  Maria, I have no better advice to give than what Richard has already given, but wanted to wish your uncle well and hope he finds the help he needs.

                  These pressure sores are not to be taken lightly, and once you have one, you must take extra care that they don't return. Don't let time go by before seeking help if you think you've found a hot spot.

                  Good luck.


                    Thank you very much for your answers, at first I will ask very well what kind of procedure doctors made and if they are reconstructive surgeons, if not I hope to find any qualified here in my country.
                    I will continue posting the news to get help from this excellent forum.



                      OSTEOMYELITIS, infection of the bone. I had this for almost 4 years and my general practice doctor did not diagnose it. 3 failed surgeries because of it and still had the wound. Had it sewn up while taking intravenous antibiotics for a week before and a couple weeks after. I've had no problems since.

                      What type of cushion does he use?
                      I was sitting/living normally after my surgery using a ROHO 2 chamber cushion. I also was on a Vegan diet, and exercising these four years.

                      Diet and exercise are VERY IMPORTANT along with NO smoking, either by him or anyone in the household.


                      This was my story...



                        Hello friends, I have some updates , after asking to my uncle. (please sorry for my english)
                        I will comment the suggestions made by RIchard:
                        1. My uncle was treated by a surgeon specialized in reconstructive surgery, but I dont know if they are specialized in pressure ulcers due to SCI. I think there is no one specialized in that specific. Or it would be sufficient being surgeons specialized in reconstructive surgery??
                        2. I know the doctors see my uncle 5 weeks after surgery, see the area and tell him if he can start sitting, so he start sitting 15 minutes, but after 2 days he starts feeling the area hot. My question is, after how many weeks normally that wounds are ok so he can start sitting. Maybe he need to wait for a long time.
                        3. He wasn´t using a special cushion when he started to sit, he has one (I dont know if it is ok) , but don´t use it because he thinks is very tall for his wheelchair, I dont know if it is not the right cushion or we need to look for another wheelchair.
                        Can anyone tell me where can I buy the roho cushion since I`m in Peru ? and which one do you suggest me?
                        4. I read about myocutaneous flap procedure and I know doctors wanted to make that but said my uncle doesnt have enough muscle in leg or another part of the body since my uncle is thin, so I don´t know exactly what kind of surgery they made, they said they made a "colgajo"
                        5. CapnGimp, about your post:before this last surgery doctors found an infection in the bone, and they said it was little, so they gave him some antibiotics, but only before the surgery I think, but although that the wound continue inside, after an ecography made yesterday doctors say there is a kind of liquid there, so it indicates the surgery need to be done again. Do you know if that is ok??? or there is another way to get the wound healed without a new surgery????

                        6. If anyone has a diet to follow to get my uncle in better way I will appreciate it.
                        7. What kind of exercise can he do being prostrated? what do you recommend him to do in this condition to avoid boring.

                        8. Any advice anyone can give me will be very very appreciated!!



                          Hi, Maria, I am new on this forum but I have done a lot of research since my brother was injured two years ago. If there aren't many resources in Peru, maybe you should try Brazil. I hear there are some excellent surgeons and SCI clinics in Brazil. I don't now how far it is from you, but try Flourianopolis. There are some really intriguing things going on there... Best Wishes!


                            Maria -

                            I hope that a SCI-nurse will chime in with more expert information than I can give.

                            I think that CapnGimp is correct about the bone infection. My thoughts are that the area needs aggressive treatment with antibiotics for some time after it is cleaned out surgically. I presume that a white blood cell count would show when the infection has been conquered and antibiotics can be discontinued (nurse?).

                            Having never dealt with a bad pressure sore, I can't give advice on how long it takes to heal, but my thought is that it takes much longer than one would expect based on our "normal" experience of healing, and long after it looks OK on the surface.

                            The high profile Roho cushion (which, especially since your uncle is thin, I would think is most appropriate) is about 10 cm high, and is filled with air. My wife uses their Quadtro Select cushion.
                            The cushion needs to be the correct size for his chair. The cushion must also be inflated correctly and checked often, as severe damage can occur if it deflates.

                            A search of the Roho web site at found this distributor of Roho cushions in Lima:
                            Ortopedia Salvador E.I.R. Ltda.
                            Av. Militar 2488 Lince
                            phone 51 14 4199750
                            Best wishes,


                              I echo much of the advice that has already been given. But, here is some additional advice....

                              1. The surgeons should do a bone biopsy to determine if your uncle has osteomyelitis. (Infection in the bone) If he does, he needs to go on IV antibiotics for 6 weeks. We never do any surgery until that is cleared up.
                              2. 5 weeks after surgery is probably too early for your uncle to start sitting, especially since he does not have a special cushion and has had problems in the past. I would recommend at least 6 weeks of not sitting, but possibly even more. That is usually determined after physical examination of the wound.
                              3. When he starts to sit, make sure that the cushion (whichever one he is using) is being used properly. He needs to have a cushion and he needs to do weight shifts at least every 20-30 minutes.
                              4. When he starts sitting - start with 15 minutes once a day. If the area gets red or dark and it doesn't disappear within 30 minutes once he lies down, he needs to wait another couple of days. He really needs to take his time on sitting. He should increase his sitting, first by the number of times per day that he sits (for example, 1 15 minute session, then 2, then 3 per day.) Once he gets to 4 times a day, he can increase the time by 15 minutes, then the same routine as above.
                              5. As far as diet goes, one high in protein and high in calories is recommended. He may want to try to eat 5-6 small meals a day. The number of calories it takes to heal a wound is huge! Also, he needs to drink plenty of fluids.... 2-3 liters a day.
                              6. Rest is also important. Taking naps during the day will not hurt him.

                              I am not sure if I answered everything, but please feel free to post again and I will try to clarify anything you need me to.

                              Best of luck!

                              The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.