Pressure Sore healed, Now What?!?

[MNicholson81]

I had a stage IV pressue sore that has healed on my butt (ishiall) area. It has taken roughly 12 weeks bed ridden to heal. I sit up in my chair for the first time a few days ago for about 1 hour and get back in bed. Now I look at it 2 days later and it has taken a big step backwards!! It looks as if it did in week 8 or 9 with a little bit of discharge as well. My question is what is once you get a pressure sore healed what is the correct procedure to getting back up in the chair. I was only in my chair roughly 1 hour, doing pressure releifs every 15 min, and it looks this bad??! From what I understand the scar tissue is not as strong as regular skin however I am scared I will never be able to sit again? What do I do?

Thanks for any help.

Pic A is Friday Sept. 7
Pic B is Sunday Sept. 9

[SCI-Nurse]

You need to be totally off your butt until this is completely healed. You may do well to then apply a piece of hydrocolloid for any sitting you do. Also, avoid any sliding transfers for some time.

You are right. Scar tissue is never as strong as regular skin.

Once a stage IV has closed, you need to wait at least another week before sitting. It is also strongly encouraged to use your first sitting time (15 minutes) to do a seating evaluation and computerized interface pressure evaluation to determine if your seating surface and configuration is correct and maximized.

Our sitting program is as follows, either for a flap or conservative management closure. Each step is taken ONLY if skin inspection after each sitting is perfect; otherwise it is back to bedrest or backwards on the time frame (depending on the assessment). Sitting is daily, but progression is done like this:

Day 1: sit 15 minutes and have seating evaluation
Day 2: sit 30 minutes X2 (with at least 2 hours between)
Day 5: sit 1 hour X2 (with at least 2 hours in between)
Day 8: sit 1.5 hours X2 (with at least 2 hours in between)
Day 11: sit 2 hours X2 (with at least 2 hours in between)
Day 14: sit 2.5 hours X2 (with at least 2 hours in between)
Day 17: sit 3 hours X2 (with at least 2 hours in between)
Day 20: sit 3.5 hours X2 (with at least 2 hours in between)
Day 23: sit 4 hours X2 (with at least 2 hours in between)

Continue then to increase gradually (usually 1 hour every 5-7 days) to 8-10 hours of sitting daily. Weight shifts should be at least every 15 minutes, with skin inspection after every sitting episode.

(KLD)

[fishin'guy]

Gawd, I've got my first pressure sore, and it's like you've all said, it's damned hard to get rid of. It's a stage two, got better, now getting worse. I wrecked my car a month age, and no possibility of another in the near future, so lots of sitting. Oh well will prob, be lying instead.

[MNicholson81]

Thanks so much SCI Nurse. I will for sure use this program once I get my sore back healed. Very frustrating.... I am just very worried, seems as though I may never be able to get back up and back to work?!?

[gjnl]

I had a stage IV pressue sore that has healed on my butt (ishiall) area.

Pic A is Friday Sept. 7
Pic B is Sunday Sept. 9

From what I see on these pictures, that sore isn't healed completely. I would give it a bit more time to heal before starting to sit again. It can be tempting to start a sitting routine, but after you have seen 12 weeks of healing through, a couple more weeks will give the sore a better chance of staying closed. A big pat on the back for getting the sore healed to this point. Good work!!!

All the best,
GJ

[MNicholson81]

Thanks gjnl. Yeah, looking back I prob should not have been up last Friday. But only 1hour or so. I did not think 1 hour could make it break back down that quickly?!