Odd wound problem

[Cspine]

For the past few years I have had a recurring surface wound directly between the base of my scrotum and my anus. No real depth, about the size of a quarter, no necrotic tissue or tunneling or anything like that. I would cover it with duo derm and after a week or two it would usually go away. The moisture has frequently been a problem. This last time I decided to go to a wound care specialist.

After some experimenting with different dressings, the wound is now about an inch and a half long and has begun to tunnel somehow and is about an inch deep. It looks kind of like a pressure ulcer at this point, but I don't see how. It's not like a pressure wound where the tissue dies and it rots out leaving a cone shape, the tissue at the deepest part actually looks the healthiest. the wound care specialist insists that it is a pressure ulcer, and he denies that anything that he did has made anything worse. I am concerned it might be a bacterial issue, but he refuses to have a cultured. It has never tunneled or become necrotic before.... and I don't see how that could be a pressure hotspot. I have a fat ass and a Verilite coushion. The current dressing is a tielle plus pad along with calcium alginate and cuticerin.

What could this be? What should I do? I will post a photo when I can.

sorry if this seems to be worded awkwardly, I am typing this out on my phone and it is being a bastard.

[CapnGimp]

i've had the same problem happen. Traced the cause to my cushion(failed factory recall...) Got a replacement and it took about 8 mos to get it entirely clear, including scabs/dry hard skin. My bone there is pointy and it returns everytime i sit on something besides cushion.
Cant think of name of it but has the separate air-filled sour cream container shaped doohickeys in separate compartments.
i kept veterycin and a wide bandaid over it to keep it clean and protect it.
check the bone there to see if it it causing it. if it tunnels get osteo ruled out quick!

[SCI-Nurse]

This is a common place for pressure ulcers in men with SCI. The area does get significant pressure for many when sitting from the inferior edge of the pubic bone. Sores in this area can easily go right into the urethra.

A seating re-evaluation, with computerized pressure mapping to see what is happening in this area as far as pressures with your posture, and evaluation for cushion or other seating posture changes to improve pressures here would seem to be warranted. Of course you should not be sitting on it, esp. if it is getting worse.

(KLD)

[Cspine]

This is a common place for pressure ulcers in men with SCI. The area does get significant pressure for many when sitting from the inferior edge of the pubic bone. Sores in this area can easily go right into the urethra.

A seating re-evaluation, with computerized pressure mapping to see what is happening in this area as far as pressures with your posture, and evaluation for cushion or other seating posture changes to improve pressures here would seem to be warranted. Of course you should not be sitting on it, esp. if it is getting worse.

(KLD)

I threw a shit fit and got the doc to agree to pressure map etcetra, I had to threaten to go to his supervisory board. It's further south though, not where there is bone. It's pretty much exactly where a vagina would be if I had one.

[Cspine]

KLD, after reviewing the photos and measurements, it look like you are correct in regards to the origin of the pressure. Knowing this, I have identified the orgin of the highest pressure and heavy sheering while moist. All have been while in bed and I have eliminated them.

I have not yet been to be pressure mapped. Untill I go... Any suggestions how to reduce pressure in this area? I've been in bed on my side the past few days and have only gotten up once for a couple hours. I'm using a verilite air coushion.