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Who has had stage IV pressure sore

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  • Who has had stage IV pressure sore

    Can anyone share their treatment and post sore experience with me. Pressure sore has been treated by wound clinic for 5 weeks and they say it looks healthy but every week getting larger and now tunneling. Recommending ortho surgeon...but can't get in for weeks...just want to know what the treatment options are...I have researched online and see stem cells, Epiflo oxygen, Hyperbaric chambers, and bone scraping all in researching treatments but have no idea success of any of these...could someone who has experienced successful treatment please share? Someone with experience might calm me down.

  • #2
    Flap surgery then 2 months in bed.
    But it worked!
    69yo male T12 complete since 1995
    NW NJ

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    • #3
      Definitely get a second opinion and stay off it.

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      • #4
        you need to be completely off of it i was off of mine for the better part of 6 months with 1 failed flap and 1 flap which took but it was months of recovery. i had a month or more in the hospital 1 week in ICU another 3 weeks on a unit in a clinitron bed. and another few months at home on a clinitron, home air fluidized bed. And now i sleep on a memory foam mattress. and turn myself every 2-3 hours while i am in bed.
        T6 Incomplete due to a Spinal cord infarction July 2009

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        • #5
          Just coming off three, finishing my third.
          Go get a wound vac. Flaps don't work until almost healed.
          Use portable wound vacs , debriediings, and ACELL treatments.
          Start now .

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          • #6
            Strongly recommend you see a good experienced board-certified plastic/reconstructive surgeon who has done many flaps. Orthopedic surgeons and general surgeons should not be doing these surgeries.

            NPWT (negative pressure wound therapy, the VAC being one brand) can help prepare the wound bed for surgery, but rarely will they heel a stage IV. In addition, since by definition a stage IV extends to bone or joint, 90% of these wounds also involve osteomyelitis. This must be treated before a flap is done (and does not necessarily require removal of bone tissue).

            Have you had a CRP level drawn (blood test)? Sed rate? Elevations of either or both are associated with osteomyelitis.

            I hope you are not using any tobacco products (smoking, dipping, chewing, vaping). All would remove you from consideration as a flap candidate in the SCI Center where I worked.

            As above, you must stay off it completely, 24/7. You need to get your nutrition in line too...our plastic surgeons would not do flap surgery unless you can keep your pre-albumin levels at 25 or better. You should be eating a minimum of 100 gm. of protein daily. Also take a multivitamin with minerals, and have your zinc level checked. Take a good zinc supplement if your level is low.

            (KLD)
            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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            • #7
              Originally posted by Tim C. View Post
              Just coming off three, finishing my third.
              Go get a wound vac. Flaps don't work until almost healed.
              Use portable wound vacs , debriediings, and ACELL treatments.
              Start now .

              Thanks for info... What are ACELL treatments? When you say third were they stage IV in the same area?
              Appreciate the input.

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              • #8
                I had one on sacrum, ischium and my stubborn trochanter.
                There's no way I could think to stay in bed 6 mos.
                The wound vacs allowed me chair time.
                ACELL is actually a porcine derivative that promoted fresh tissue growth following a debriedment. If performed in hospital it should be covered by insurance.
                I'm happy to answer any questions,
                My best

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                • #9
                  Originally posted by SCI-Nurse View Post
                  Strongly recommend you see a good experienced board-certified plastic/reconstructive surgeon who has done many flaps. Orthopedic surgeons and general surgeons should not be doing these surgeries.

                  NPWT (negative pressure wound therapy, the VAC being one brand) can help prepare the wound bed for surgery, but rarely will they heel a stage IV. In addition, since by definition a stage IV extends to bone or joint, 90% of these wounds also involve osteomyelitis. This must be treated before a flap is done (and does not necessarily require removal of bone tissue).

                  Have you had a CRP level drawn (blood test)? Sed rate? Elevations of either or both are associated with osteomyelitis.

                  I hope you are not using any tobacco products (smoking, dipping, chewing, vaping). All would remove you from consideration as a flap candidate in the SCI Center where I worked.

                  As above, you must stay off it completely, 24/7. You need to get your nutrition in line too...our plastic surgeons would not do flap surgery unless you can keep your pre-albumin levels at 25 or better. You should be eating a minimum of 100 gm. of protein daily. Also take a multivitamin with minerals, and have your zinc level checked. Take a good zinc supplement if your level is low.

                  (KLD)
                  Thanks for the reply... so now we know there I osteomyelitis via MRI...we don't know if it is new or old..or if that matters regarding treatment options. I just want to understand treatment options. Is Osteomyelitis treated by a Ortho surgeon? do they have to make the pressure sore larger to access the bone (undo the healing?) If they scrape or remove bone do you have to have flap surgery? Just trying to understand.

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                  • #10
                    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.
                    T6 Incomplete due to a Spinal cord infarction July 2009

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                    • #11
                      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.
                      a few MONTHS of iv Antibios?
                      wow, that not typo?

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                      • #12
                        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.
                        "a T10, who'd Rather be ridin'; than rollin'"

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                        • #13
                          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 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


                          • #14
                            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.
                            I see your from dfw im also in this area,do you know any facilities that does pressure mapping?

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                            • #15
                              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/

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