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Heal a wound over tunneling?

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  • #16
    Originally posted by Patrick Madsen View Post
    I'm so sorry he's going thru this SC. It seems the docs spend more time concerned about what insurance will pay than doing the necessary steps to get it over with.

    What really helped me was the Ride Java Cushion. The hole in the center offloaded all the pressure that was on the wound. Forget ROHO, IMO, they are the worst thing a person can use, esp. women. The rubber holds in heat and moisture more trouble. If he's using one. you may want to tie off the nodules under his wound so there is no pressure on the wound.

    Yep, ER, different doc.
    The Ride cushion looks interesting. He recently had pressure mapping done and his current cushion is not optimal. He tried a verilite and that was even worse. I will suggest this one to him.
    Last edited by Sugarcube; 12-26-2018, 12:01 AM.

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    • #17
      I don't use the custom one. I hear they're much heavier than the regular Java.

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      • #18
        Originally posted by Patrick Madsen View Post
        I don't use the custom one. I hear they're much heavier than the regular Java.
        Yes, they have some good videos on their website. The Java looks like the ideal one for my friend. I'm no expert though, but I will tell him about it. Thank you so much for taking the time to respond. Big thanks to everyone else as well.

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        • #19
          Originally posted by Sugarcube View Post
          Yes, they have some good videos on their website. The Java looks like the ideal one for my friend. I'm no expert though, but I will tell him about it. Thank you so much for taking the time to respond. Big thanks to everyone else as well.
          Is he still sitting with this sore?

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          • #20
            Originally posted by TheRainman View Post
            Is he still sitting with this sore?
            Unfortunately, yes. He is off it most of the time, but has to get up to prepare food and for some chores around the home. He lives alone and has no regular day to day help.

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            • #21
              Originally posted by Sugarcube View Post
              Unfortunately, yes. He is off it most of the time, but has to get up to prepare food and for some chores around the home. He lives alone and has no regular day to day help.
              I think we need the nurse advise here. Because I think he is playing a dangerous situation with him doing transfer and some pressure on it.

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              • #22
                You can’t sue, he didn’t cause the pressure ulcer and they are hard to heal. You may think it is superficial and not deep but they start where the bone meets the underlying area. No one has a flap without trying dressings, biological and staying off the pressure area. We don’t let our is goal flaps turn.. they have to lay flat on the special bed for 6 weeks. We might let them raise the head of bed 30degres to eat... only if they can’t eat lying flat. Because we don’t want to stretch the flap area. We are a little less stringent with sacral flaps. Then we have a very slow sitting program. Of course we are a VA so this is allowed. To prevent pressure ulcers research shows pressure shift e wry 15 minutes and pressure relief e wry hour. And of course pressure mapping for the right cushion. This person will have to pretty much start over but the tunneling must heal first then the wound base up by granulation. He needs a PET scan and/or bone biopsy by IR. Or atleast make it smaller so flap won’t be as extensive. Sed rate , CRP should decrease but if infected will be very high. CWO
                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.

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                • #23
                  Originally posted by SCI-Nurse View Post
                  You can’t sue, he didn’t cause the pressure ulcer and they are hard to heal. You may think it is superficial and not deep but they start where the bone meets the underlying area. No one has a flap without trying dressings, biological and staying off the pressure area. We don’t let our is goal flaps turn.. they have to lay flat on the special bed for 6 weeks. We might let them raise the head of bed 30degres to eat... only if they can’t eat lying flat. Because we don’t want to stretch the flap area. We are a little less stringent with sacral flaps. Then we have a very slow sitting program. Of course we are a VA so this is allowed. To prevent pressure ulcers research shows pressure shift e wry 15 minutes and pressure relief e wry hour. And of course pressure mapping for the right cushion. This person will have to pretty much start over but the tunneling must heal first then the wound base up by granulation. He needs a PET scan and/or bone biopsy by IR. Or atleast make it smaller so flap won’t be as extensive. Sed rate , CRP should decrease but if infected will be very high. CWO
                  Thank you for this response. To be clear, he has no intention nor has he thought about suing anyone. Someone else, who was trying to help, brought that up is this thread. He only wants to get well.

                  He was uncomfortable with some of the decisions, which is why I am here and also why he is thinking about having someone else look at it. Mainly, he was concerned about letting the wound heal over before the tunneling and undermining are healed. He had been diagnosed with ostemyelitis and sepsis with this wound. Both were treated with IV therapy in the hospital, followed by antibiotic infusions at home. That therapy has ended. His sed rate is still high, somewhere in the mid 60s at last check.

                  There are a couple of wound clinics near him that have some treatments that are not available where he is now. He is wondering whether or not he may be a candidate for some of those types of treatments.

                  Recently, the wound was reopened by his doctor and it is being treated for the tunneling and undermining. The tunneling is 7cm currently and there is also undermining. He has thought about the possibility of a flap, but will only do so if these other methods fail. His doctor hasn't mentioned that as an option as yet.

                  I hope this clears it up some. Your input is welcomed and much appreciated.

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                  • #24
                    Does anyone have any recommendations for wound care in the eastern states? Specifically, a place that knows a lot about spinal cord injury and a possible flap procedure or alternative treatment. It has been treated for more than a year now with little success. Last week there was 5.1 cm tunneling, which has pretty much been the case since the beginning. An MRI measured 7.8 x 1.8 and another that measured 4.5x2.5 in February. A doctor at the wound clinic yesterday said it is now down to 2cm. Is that even possible in 4 day's time? They are content with it and want to continue to let it heal over the top. He's frustrated. He has an appointment with a plastic surgeon, but now they are saying he doesn't need to go and to cancel that appointment. He asked for some more imaging to see what is going on, but was told that it won't show anything. They said to watch for signs of infection and get back to them if he notices anything. I think he is about ready to give up. Any suggestions, please?

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                    • #25
                      With a flap you must be on special bed on bedrest and also not elevated the HOB -either at 9 degrees or may allow 30 degrees to eat then go flat. Once healed which can take months, a slow gradual sitting program is done. Pressure mapping for cushion of wheelchair will be tested first time up.
                      Very strict requirements in order for someone to have a successful flap.

                      CWO
                      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.

                      Comment


                      • #26
                        Sounds to me like the Doc missed the tunnel on that last measurement, don't think there's anyway for things to heal up that quickly. If you've been trying to heal this for a year, think it's time to throw in the towel and get a flap. Yeah, it sucks having to lay flat for 5-6 weeks, but, it's a known entity, when it's over it's over. As you well know, y'all been on a wound treadmill for far too long, with no end in sight. I took the known entity for sure. I had a buddy bring up my Xbox and I played the time away, the tv was mounted high so I could play easily with just a little head raise.

                        I'm in Tx so can't help with facility. But I definitely suggest to "not" cancel the plastics Doc appt, at least get his opinion. Just remember a surgeon "likes" to cut.
                        "a T10, who'd Rather be ridin'; than rollin'"

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                        • #27
                          Originally posted by Sugarcube View Post
                          Does anyone have any recommendations for wound care in the eastern states? Specifically, a place that knows a lot about spinal cord injury and a possible flap procedure or alternative treatment. It has been treated for more than a year now with little success. Last week there was 5.1 cm tunneling, which has pretty much been the case since the beginning. An MRI measured 7.8 x 1.8 and another that measured 4.5x2.5 in February. A doctor at the wound clinic yesterday said it is now down to 2cm. Is that even possible in 4 day's time? They are content with it and want to continue to let it heal over the top. He's frustrated. He has an appointment with a plastic surgeon, but now they are saying he doesn't need to go and to cancel that appointment. He asked for some more imaging to see what is going on, but was told that it won't show anything. They said to watch for signs of infection and get back to them if he notices anything. I think he is about ready to give up. Any suggestions, please?
                          I have had nothing but success with my three- 4th stage decubiti, using a " forward thinking" plastic surgeon who made her bones in would care. Can't say enough about her. She has offices in LI and Staten Is.
                          PM me and I will forward you info.
                          Regards & best

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                          • #28
                            Did the doctor biopsy the bone? Interventional Radiology can bx it and antibiotics can be started from that. Might be a repeat of before. When he stopped the antibioitcs di the sedrate go down and the CRP or still elevated?

                            CWO
                            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.

                            Comment


                            • #29
                              Originally posted by McDuff View Post
                              Sounds to me like the Doc missed the tunnel on that last measurement, don't think there's anyway for things to heal up that quickly. If you've been trying to heal this for a year, think it's time to throw in the towel and get a flap. Yeah, it sucks having to lay flat for 5-6 weeks, but, it's a known entity, when it's over it's over. As you well know, y'all been on a wound treadmill for far too long, with no end in sight. I took the known entity for sure. I had a buddy bring up my Xbox and I played the time away, the tv was mounted high so I could play easily with just a little head raise.

                              I'm in Tx so can't help with facility. But I definitely suggest to "not" cancel the plastics Doc appt, at least get his opinion. Just remember a surgeon "likes" to cut.
                              I'm in the DFW area was admitted to kindred last year.I still going for outpatient treatment this wound is stubborn hope it heals soon.

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                              • #30
                                Originally posted by McDuff View Post
                                Sounds to me like the Doc missed the tunnel on that last measurement, don't think there's anyway for things to heal up that quickly. If you've been trying to heal this for a year, think it's time to throw in the towel and get a flap. Yeah, it sucks having to lay flat for 5-6 weeks, but, it's a known entity, when it's over it's over. As you well know, y'all been on a wound treadmill for far too long, with no end in sight. I took the known entity for sure. I had a buddy bring up my Xbox and I played the time away, the tv was mounted high so I could play easily with just a little head raise.

                                I'm in Tx so can't help with facility. But I definitely suggest to "not" cancel the plastics Doc appt, at least get his opinion. Just remember a surgeon "likes" to cut.
                                I agree there has been no improvement on the depth but the outside has been closing around it. Now the skin has started and almost completely covered the top. There is a small pinhole left, which is basically how this whole thing started. I'm concerned that the cavities below will eventually fill up with fluid again, become infected and some time in the next several weeks or so he will be septic again. I think he needs to get a referral in order to get the flap. I doubt he will get that from this doctor. The depth has been measured on a weekly basis from visiting nurses. Four days prior to it being measured a 2.5 cm, it was 5.5. The other tunnel, which showed on the mri in Feb has not been treated at all, I guess because it is not an open wound yet.

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