Wound vac or possible flap surgery

[Patrick Madsen]

I had a shearing wound to the rear that was closed surgically along with the 6 week stay in assisted living etc. Came home and it opened up again. The plastic surgeon tried various methods to heal it but due to it's position it's not doing it.

The plastic surgeon is going in Thursday and do a debridement and put on a wound vac. which i'll have on for 8 weeks. If it's worse than he last saw it, he'll do a flap and I'll have to do the 6plus weeks in bed etc. He's hoping that I will just need the wound vac. With the WV, I can do the rehab at home. With a flap I can't do at home. The good news is it's clean and not infected. My wife doesn't think it's any worse. God Bless the wives!

My question is, how active can I be with a wound vac.. Can I sit in my chair etc.?

A PT has been trying to get me in a power chair for over 25 years and I just can't do it. The DME dropped off a M300 to try and just the transfers in/out with a sliding board and wife is ridiculous. I absolutely hate and am not ready for one. She feels the tilt will help relieve some of the pressure but the wife thought it looked worse from me spending an afternoon/evening in it. I used a Roho Quatro cushion while in it.

[triumph]

Sorry to hear! Hope Nurse will chime in.
Our good friend has progressed from hospital to "specialty care" facility with two sores, and the plans reported to us are so different from the wound rehab. we have read here on CareCure. With our friend no precautions seem to be in place. He is allowed to sit in his wheelchair for up to two hours, yet he's still on antibiotic for infected bone under one of the sores. Has wound vac, don't know if it's still in place.
Discharge to home is imminent but no special mattress; what about transfers to bed; appointments twice a week for out-patient wound care, but how does he get there without sitting for a trip like this? One appointment is an 1 1\2 hours away, so with getting ready at home, transfer to vehicle, parking, it looks like more than 4 hours of sitting.
He's had only wound care from nurses, not specialist doctor in wound care - a gentleman who has been too busy to stop by.
This is 2017 folks! Aren't situations like this critical?

[nick]

I had a shearing wound to the rear that was closed surgically along with the 6 week stay in assisted living etc. Came home and it opened up again. The plastic surgeon tried various methods to heal it but due to it's position it's not doing it.

The plastic surgeon is going in Thursday and do a debridement and put on a wound vac. which i'll have on for 8 weeks. If it's worse than he last saw it, he'll do a flap and I'll have to do the 6plus weeks in bed etc. He's hoping that I will just need the wound vac. With the WV, I can do the rehab at home. With a flap I can't do at home. The good news is it's clean and not infected. My wife doesn't think it's any worse. God Bless the wives!

My question is, how active can I be with a wound vac.. Can I sit in my chair etc.?

A PT has been trying to get me in a power chair for over 25 years and I just can't do it. The DME dropped off a M300 to try and just the transfers in/out with a sliding board and wife is ridiculous. I absolutely hate and am not ready for one. She feels the tilt will help relieve some of the pressure but the wife thought it looked worse from me spending an afternoon/evening in it. I used a Roho Quatro cushion while in it.

Hi Pat, my name is Ed. T-10 complete here.
I have been battling a right trochanter sore, just a few weeks over one year now. I was on a wound vac for 4 weeks in beginning and zero success. Then flap done. It failed in an area on my incision about 1cm in length. hypergranulated tissue. My wound dr used a sulfate stick and burned it off and doing so he claims it was tunneled. I believe now he went to aggressively and burned deep into tissue. I was only 5 weeks out of surgery and back home at this point.
They used a wound vac only to have it make the sore monsterous on outside. Stage two apperaemce but 5cm x 6cm. Was not happy. Anyways we have tried since to get wound healed. Me staying off it the whole time practically. I was pressure mapped and had a Ride custom cushion made just last month. Started sitting, because map shows no pressure on trochanter. Well, I'm right back to where I was one year ago. A deep stage III right trochanter sore. Exactly the same sore. It now has a tunnel, and it's from a supposedly "miracle solution" of a cushion. Sat on Roho Quattro and have horrible mapping while on it.
I have an appointment set with the surgeon for possible debridement. Then try the dreaded vac again.

I will say this. I have had three pressure ulcers in 14 years. All flap required. I know, i know. Don't you take care of yourself? I certainly do. I'm in excellent shape. Not one other thing wrong except these damn wounds.
I have found if I sit, even broken up, 1 hour thru a day with wound vac on, it's defeating the whole purpose. As boring and as bad as it is, you need to completely stay off the wound. I GUARANTEE it will not heal with the vac. Especially if it's a hard place to get the dressing and drape to adhere. It's going to lose suction and infection sets in. I'm going to stay in bed for as long as it takes to avoid surgery again. I don't like being in that clinitron bed and I certainly don't want to deal with an ignorant roommate in rehab facility.
I also suggest you eat 1g of protein for every pound you weigh. Chicken, Eggs, Rices, Red Meats, iron is excellent in healing a wound. Take a supplement. You can take as much as 225mg a day. Get a protein supplement powder as well. But pay attention to its ingredients. If the first ingredient is whey protein isolate or hydrolized whey protein isolate then use it. It's because the isolated are the purest form of whey protein. Some being higher than 90% protein. Do some research and buy wisely. Some only have 35% and basically do zilch for the body.
I'd rather spend two-three months in bed again, than deal with it for an entire year like I have. I even had to resign my job because of this. I cannot sit, and would have high risk of infection working around so many others.
Best of luck. It's been a rough go this year for you and for I.
Ed

[fuentejps]

MAN pAT, THIS SUCKS. SORRY TO HEAR ALL THIS YOU'VE BEEN THROUGH.

[Jim]

Sorry to hear! Hope Nurse will chime in.
Our good friend has progressed from hospital to "specialty care" facility with two sores, and the plans reported to us are so different from the wound rehab. we have read here on CareCure. With our friend no precautions seem to be in place. He is allowed to sit in his wheelchair for up to two hours, yet he's still on antibiotic for infected bone under one of the sores. Has wound vac, don't know if it's still in place.
Discharge to home is imminent but no special mattress; what about transfers to bed; appointments twice a week for out-patient wound care, but how does he get there without sitting for a trip like this? One appointment is an 1 1\2 hours away, so with getting ready at home, transfer to vehicle, parking, it looks like more than 4 hours of sitting.
He's had only wound care from nurses, not specialist doctor in wound care - a gentleman who has been too busy to stop by.
This is 2017 folks! Aren't situations like this critical?

Sounds like a recipe for failure.

[SCI-Nurse]

We do not allow any pressure on recurrent pressure injuries at all or with wound vacs while healing.
CWO

[canuck]

Aw crap Pat, sorry to hear.

[Patrick Madsen]

Thanks guys, it is what it is. Either way, I'll get thru it.

Getting information for what is needed and what I can do to maximize the outcome gives some control over it.

I went out for a good last,for awhile, ride. A real blustery day. Filmed it with my GoPro to watch til I get back out there.

[josieand1]

I had a wound and a wound vac...doesn't work if you sit on it, doesn't have proper suction, leaks, etc. along with the pressure on the wound. You need to be off of it...until its healed. Did they originally check the bone to see if there was osteomyelitis or wasn't it that deep?

You'll get through it, it just takes a while...

[SCI-Nurse]

After a few weeks post -op. We use a prone stretcher- can lay on stomach and wheel front wheels.
CWO

[Domosoyo]

So sorry to read this. "Info Up" and keep moving forward.
(BTW those prone carts SCI-Nurse mentions can sometimes be rented or found on ebay etc..)

[ChesBay]

Thanks guys, it is what it is. Either way, I'll get thru it.

Getting information for what is needed and what I can do to maximize the outcome gives some control over it.

I went out for a good last,for awhile, ride. A real blustery day. Filmed it with my GoPro to watch til I get back out there.

Sorry you are going through this Pat. Your approach to managing it sounds smart.

Hoping for a fast recovery.

[triumph]

Very helpful information - thank you! Pat, your post raises important issues and hope the discussion continues and that you make progress.

Spoke to our friend last night. He's home now. Not on any special mattress. Reports wound vac messed up when transferred to commode chair for toileting. Planning 3 hour round trip to see specialist. As I indicated before this trip could have him sitting for hours, due to sitting in van, waiting room, doctor meeting, etc.
Will have to travel locally for wound check up twice weekly. Some days nurse will come to home.
Will let him know about rental of prone stretcher.

[lynnifer]

I'm so sorry to read this. I passed on my bad luck! Finally getting better here.

Those wound vacs are expensive and hard to arrange where I'm at. I'd invest the time and stay off of it.

Time to review some transfers too. I want back to a sliding transfer board 6yrs ago. Worth it.

I take a kajillion supplements now per day and believe it does help.

[baldfatdad]

Look into "flowable matrix" I spent 6 months on a vac and got no where. Had the flowable matrix done. One month on my stomach and I was done. Its been three month now and its fine. I'm back to driveing, working, etc.