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Who has had stage IV pressure sore

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  • #16
    Originally posted by SCI-Nurse View Post
    No ortho surgeon, Interventional radiologist can bx. the bone. IV Antibiotic Treatment is recommended by Infectious Disease or PCP or SCI MD. minimally 6 weeks usually. Plastic Surgery does Skin flaps. Need to stay off till healed in special bed. then when healed sitting program needed to slowly increase time up in wheelchair.
    CWO
    The wound clinic suggested Infectious disease and ortho surgeon. We met with Ortho surgeon yesterday and he wants to cut out a piece of bone (ischium) and send for biopsy then have Infectious Disease doc recommend antibiotics ..go home with picc line.. then have plastics dr do flap. He said in perfect world it will heal in a month. Is there a better way? I have no idea what the best options is....we had 3 drs (PCP, Wound, and surgeon) tell us no other ortho surgeons in our area like to deal with Osteomyelitis because the success rate is so low. There was an X-ray done 5 weeks ago showed no abcess or osteomyelitis...MRI was done 3 weeks ago and showed osteomyelitis. So should we just go to a plastics dr not ortho? This is first ever pressure sore in 16 years...thanks for help.
    Last edited by Aspen; 06-19-2019, 10:52 PM.

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    • #17
      Originally posted by McDuff View Post
      I had a 4 with osteo, I had a port put in and we did daily IV by using these pressurized little "rubber balls" that had the correct amount of antibiotic in them. Took about 1/2 hour for it to finish draining into the port. Cool little invention, allowed me to stay home and my wife hook me up. I was on it for quite a few weeks, don't remember exactly how long, sorry.

      After the course of antibiotics, it was flap surgery for me, and I was good with that. I had been fighting this sore for like 8-9 months and it wasn't getting better. At least with a flap, you know it is a 5-6 week stay, then you get to slowly get back to life again instead of bed-life.
      So did you have to have piece of bone removed or did they treat the osteomyelitis with just antibiotics? If bone removed was it your plastics doc who did it? This is why I am worried seems they are anxious to cut but if that is necessary...OK...just want to make sure its the best option. The dr did say the wound won't heal until Osteo gone.

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      • #18
        Originally posted by gjnl View Post
        For wheelchair seating pressure mapping in your area of Texas, check out Baylor, Scott and White Institute for Rehabilitation. They have RESNA (Rehabilitation Engineering and Assistive Technology Society of North America) certified Assistive Technology Practitioners (ATPs) and their website mentions pressure mapping. https://www.bswrehab.com/levels-of-c...chair-seating/
        Thank you

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        • #19
          Originally posted by SLIQNES View Post
          I see your from dfw im also in this area,do you know any facilities that does pressure mapping?
          My last mapping was done by guys from National Seating & Mobility when I was in flap rehab. The Rep that did the mapping is in a chair but I forget his name. The Rep I worked with that arranged it is Casey Stephens, casey.stephens@nsm-seating.com , he is a good and knowledgable guy.
          "a T10, who'd Rather be ridin'; than rollin'"

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          • #20
            Originally posted by Aspen View Post
            So did you have to have piece of bone removed or did they treat the osteomyelitis with just antibiotics? If bone removed was it your plastics doc who did it? This is why I am worried seems they are anxious to cut but if that is necessary...OK...just want to make sure its the best option. The dr did say the wound won't heal until Osteo gone.

            Yes, they scraped some bone off, no big piece they said, just the surface stuff that looked bad. It was done during my flap surgery and was not informed that there was any different surgeon there, and it was the Plastics Doc who informed me afterwards of what was done during surgery, so my "assumption" is that yes he did the bone scraping.

            For sure it won't heal until the osteo is gone. How you proceed after that is up to you. The Plastics Doc came and saw me in the Wound Clinic after the osteo was gone, and laid out my options in his opinion, he and I were in agreement that this wound was beyond healing. I was so tired of it by then, that having a true deadline was very appealing, as even trying to heal this was going to be *many* months with no promise of a different ending.

            I feel for y'all, these are "trying" things, and mind bending in the hassle of dealing with them.
            "a T10, who'd Rather be ridin'; than rollin'"

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            • #21
              Originally posted by McDuff View Post
              My last mapping was done by guys from National Seating & Mobility when I was in flap rehab. The Rep that did the mapping is in a chair but I forget his name. The Rep I worked with that arranged it is Casey Stephens, casey.stephens@nsm-seating.com , he is a good and knowledgable guy.
              Thanks

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              • #22
                Originally posted by McDuff View Post
                Yes, they scraped some bone off, no big piece they said, just the surface stuff that looked bad. It was done during my flap surgery and was not informed that there was any different surgeon there, and it was the Plastics Doc who informed me afterwards of what was done during surgery, so my "assumption" is that yes he did the bone scraping.

                For sure it won't heal until the osteo is gone. How you proceed after that is up to you. The Plastics Doc came and saw me in the Wound Clinic after the osteo was gone, and laid out my options in his opinion, he and I were in agreement that this wound was beyond healing. I was so tired of it by then, that having a true deadline was very appealing, as even trying to heal this was going to be *many* months with no promise of a different ending.

                I feel for y'all, these are "trying" things, and mind bending in the hassle of dealing with them.
                McDuff,
                Thank you for answering so many questions...just trying to make sure we are making the right choices. So if I read it right you had surgery followed by 4-6 weeks of antibiotics and then flap surgery followed by 6 more weeks in bed? I promise last question...really appreciate your help.

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                • #23
                  Originally posted by Aspen View Post
                  McDuff,
                  Thank you for answering so many questions...just trying to make sure we are making the right choices. So if I read it right you had surgery followed by 4-6 weeks of antibiotics and then flap surgery followed by 6 more weeks in bed? I promise last question...really appreciate your help.
                  No, only had the one surgery. Since my wound was open to the bone, after the mri showed osteo, my Wound Doc took this tool and jabbed and retrieved a piece of bone off my butt, they then cultured/biopsied(not sure which) to confirm infection for correct antibiotic. I was then on the antibiotic for some weeks. Then came the decision to flap or try to heal, chose flap. Then had the only surgery for that wound, and it was then that they scraped some bone off during the flap surgery, to leave only good bone.

                  Then came the 5-6 week stay in an LTAC(Long Term Acute Care) center, laying flat on my butt(which seems counterintuitive but works) on a Clinitron bed, a "fluidized sand" type mattress. Not really sand but feels like it, and it minimizes any/all pressure points on your body, so the flap can heal while you're laying down. Any body movement can/will rip the sutures, so you don't get to do sh*t for the first 4-5 weeks(ymmv with your Doc's orders). You can raise the head of the bed 30 degrees to eat, then you lower it back down. He will have a foley in, and all bowel routine is done in bed. Then you spend another week or more working towards getting back in your chair. First you sit on the edge of the bed for 5 minutes in the morning, then they check your butt and you lay down. Then you do 10 minutes in the afternoon, rinse and repeat, until you get to 30 minutes of edge sitting. Then he will get in his chair for the first time, and the timing clock starts over. Depending on Doc and how things are going, he will have to tolerate anywhere from 1 to 2 hours in the chair with no side effects before they consider letting you go home. And you have to *promise* to be a good boy, otherwise you will wind up right back where you started and get stitched up again from a failed flap.

                  All these numbers are what I went thru, they may/will be different for you and others.

                  Not a problem at all, ask as many Q's as you like, these are kind of scary issues to deal with.
                  "a T10, who'd Rather be ridin'; than rollin'"

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                  • #24
                    Originally posted by Smashms View Post
                    1st step id debriding the wound and removing the infected bone and culturing the wound to see what antibiotics will work on it. next step is IV antibiotics for a few months then closure either by suturing it closed or by doing wet to dry dressings 2x a day.
                    Thanks Smashms,
                    This clarification is helpful. What type of Dr removed your bone? Hav you had any problems sitting once healed? Appreciate your help.

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                    • #25
                      Originally posted by McDuff View Post
                      No, only had the one surgery. Since my wound was open to the bone, after the mri showed osteo, my Wound Doc took this tool and jabbed and retrieved a piece of bone off my butt, they then cultured/biopsied(not sure which) to confirm infection for correct antibiotic. I was then on the antibiotic for some weeks. Then came the decision to flap or try to heal, chose flap. Then had the only surgery for that wound, and it was then that they scraped some bone off during the flap surgery, to leave only good bone.

                      Then came the 5-6 week stay in an LTAC(Long Term Acute Care) center, laying flat on my butt(which seems counterintuitive but works) on a Clinitron bed, a "fluidized sand" type mattress. Not really sand but feels like it, and it minimizes any/all pressure points on your body, so the flap can heal while you're laying down. Any body movement can/will rip the sutures, so you don't get to do sh*t for the first 4-5 weeks(ymmv with your Doc's orders). You can raise the head of the bed 30 degrees to eat, then you lower it back down. He will have a foley in, and all bowel routine is done in bed. Then you spend another week or more working towards getting back in your chair. First you sit on the edge of the bed for 5 minutes in the morning, then they check your butt and you lay down. Then you do 10 minutes in the afternoon, rinse and repeat, until you get to 30 minutes of edge sitting. Then he will get in his chair for the first time, and the timing clock starts over. Depending on Doc and how things are going, he will have to tolerate anywhere from 1 to 2 hours in the chair with no side effects before they consider letting you go home. And you have to *promise* to be a good boy, otherwise you will wind up right back where you started and get stitched up again from a failed flap.

                      All these numbers are what I went thru, they may/will be different for you and others.

                      Not a problem at all, ask as many Q's as you like, these are kind of scary issues to deal with.
                      McDuff,
                      Thank you so much for this information...I feel like I have a better handle on what lies ahead now. Sometimes fear of the unknown can very stressful. I think we are concerned it will affect hi time in the chair even after all healing is done but we will take it one day at a time. Really appreciate you taking the time to help us out. I can't promise I won't have more questions but I think I am hanging in there for now. Well sort of..

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