Announcement

Collapse
No announcement yet.

deep tissue injury

Collapse
X
 
  • Filter
  • Time
  • Show
Clear All
new posts

    deep tissue injury


    Hello everyone,
    I am writing this because I am beside myself right now with worry. My son has had his spinal cord in jury for 11 years. I am his caregiver and have done a pretty great job taking care of him according to all the nurses and doctors. He has had several issues with pressure sores but they were manageable.
    Over the years, we have taken several trips and cruises, partly for family fun and also so David could see he can enjoy life still with spinal cord injury. Everything has always gone well until last week.
    We took a trip to Disney World for the first time in 5 years. We drove down taking several breaks where he could do pressure relief as we always have done. When traveling, I take a air mattress overlay and use a memory foam pad on top of it. Always worked so I had no reason to feel differently this trip.
    One night, in our vacation home, my husband and I turned David over to clean him up and I see all this black eschar on his butt.
    Took him to wound care yesterday and they want his surgeon to debride it before they start caring for it. They said it came from pressure and it was there before it showed on the outside. I keep going over and over it in my head and the only difference is that he got a new chair with his first roho cushion. I wonder if there wasn't enough air in it or what it could be. they didn't really explain how much air should go in other than you should be able to put 2 fingers under his butt and cushion.
    needless to say, I am so upset right now, thinking I did something wrong,
    anyone else ever deal with this and how do I prevent it from happening again?

    Thanks, Davesmom, Diane

    #2
    I assume he is doing weight shifts by tilting his wheelchair using a tilt-in-space wheelchair seating system?

    One of the downsides of doing weight shifts this way is that while it significantly unloads the ischiums, it does so by putting the weight on the sacrum. How long was he tilting back for? Beyond 5 minutes is not recommended. A Roho cushion is going to provide pressure reduction for the ischiums, not for the sacrum, unless the person is doing an extreme amount of sacral sitting. Is that the case for him?

    Was he turned in bed or did he lay supine (flat on his back) the entire time?

    Also, to be clear, a deep tissue injury appears as purple or very dark skin, and does not have eschar (scab) on it. That would be an "unable to stage" wound that cannot be staged until the eschar is removed. Then is is nearly always a stage III or IV. Surgical intervention is not appropriate for a deep tissue injury unless it evolves into a stage III or IV.

    (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.

    Comment


      #3
      Gosh, DavesMom, I'm sorry to hear this but urge you not to be hard on yourself. Life surprises us, as you know. All we can do is learn fro our experiences and solve the problem that arise. Overall Dave is so fortunate that you and your hubby are able to care for him.

      I periodically berate myself fr a number of things I've done and risks I took. It has never helped m one bit.

      Comment


        #4
        Hi all. After feeling so bad about my son's latest issues, we found out what caused the problem. We have been traveling with David for the last 10 years with his spinal cord issues and never had a problem. I kept telling him that the only thing different is the chair. He always tells me, things happen mom and you need to stop worrying. Yeah, as if that will happen. The day we took him to the surgeon to find out about surgical debridement, we found out what happened. My husband put air in the Roho cushion and just before we put Dave in, heard air coming out. Long story short, Roho has had a problem with faulty valves which was slowly allowing air to leak out. That meant that David was basically sitting on the metal of the seat. The mobility place ordered him a new Roho with the new valves and we are waiting for that. As it turns out, no surgical intervention was needed as I use Dakins and it debrided all the dead skin and he is on his way to healing now. They hae totally changed the valves now so if anyone has a problem, contact them.
        DavesMom, Diane

        Comment


          #5
          So sorry. This is a problem with Roho and other air-filled cushions...they are high maintenance and require constant vigilance to assure they are properly filled, not leaking, etc.

          I assume he is not sitting at all right now, nor laying on his back in bed. How deep is the wound now? Stage? What are you using for treatment?

          (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.

          Comment


            #6
            What a relief!

            Honestly, this is the best possible outcome you could hope for. There was a clear cause. It is fixable. And his wound is healing with your great care.

            These things have to happen every once in awhile, and now you are aware of what to double check in the future. And since you have had your one bit of bad luck, you have earned another 10 years wound free for your son!

            Comment


              #7
              Good job! Dave is lucky to have you for his mom.
              "Never turn your back on fear. It should always be in front of you, like a thing that might have to be killed." - Hunter Thompson
              T5/6 complete

              Comment


                #8
                You did what you needed to do. Treat the sore and figure out what caused it. Sometimes despite your best efforts shit happens.
                Last summer somehow we got a bath bomb down the back of my daughter's chair during an afternoon hair wash. (I think it was in a bath towel that we used to dry her hair.) Finally noticed it when she transferred to bed and was so bummed. It did heal but left a mark.

                Comment


                  #9
                  Thank you everyone for the kind words. It really had me upset but I will definitely watch out for things like this in the future. You are all so amazing and I am so happy I found this site early on in his spinal cord injury.

                  Comment


                    #10
                    I never could use a Roho. IMO, worst possible cushion out; for me. I could never really feel secure sitting on one; especially when transferring.

                    Had a seating eval with it coming close to last for choice. Especially a 4". Since my flap and second to fix it again, turned out it was caused by and abscess, the Ride Java cushion has been wonderful for the last 4 years. Before I used the Varalite rear two chambered that was good for twenty or so years. Only worse cushion for me was the old Bye Bye Debucibye; an all air cushion that would propel a person out of their chair everytime the sat forward. We could always tell who was using one in sports. Especially the javelin thrrow. I think the cushion threw the person farther than we did the javelin.

                    Congrats mom, You and Dave sure have gone thru the ringer.

                    Comment


                      #11
                      Patrick, have you ever used a Gel cushion? The Ride java seems to have one seeting position that suspends your pressure areas? Doesn't it get uncomfortable not being able to shift around on the cushion all day?

                      Comment


                        #12
                        So far never had a problem with that Crispy. No red spots nothing. I only press up if I remember and that is rare. I found the gel cushions sucked me into it too much. The Ride is best I've had for comfort and getting off the trochanters. The deep well in the center was a challenge at first but no big deal now.

                        Comment


                          #13
                          I use a roho elite hybrid it has a form fitted front and sides with just the air cushion just under the but. They have a new version that has a dual chamber . So you can fill watch side with different amounts of air. To take pressure off only one side. Iv have been on the original one for 5 years. I love roho patch kit they work so well and so quick no waiting for the g!our to dry.

                          Comment


                            #14
                            Patrick Madsen,
                            It is so nice to see you on here. David has gone through a lot but he is a trooper. Since I talked to you last, he lost both of his legs above the knee. It seems like its aways something but I am right there fighting for him. By the way, he goes to wound care and healing nicely from the deep pressure injury. I did want to ask if anyone else on here slides while sitting on the Roho. David has to keep pulling himself up and he should not have to do that. Is there something anyone knows of that I can put it on top of the Roho so he doesn't slide like that? The cover is what makes him slide down in his chair so any ideas would be appreciated.
                            Thank you all,
                            DavesMom, Diane

                            Comment


                              #15
                              Everyone’s different. Unlike Patrick I like Roho cushions and never had any serious skin problems for 40 years. I tried a Ride cushion For a couple of months recently to deal with some scoliosis issues and developed a skin injury. We did pressure map but all I had to do was move slightly and if I wasn’t placed just exactly right we would get a hotspot. ROHO‘s aren’t for everyone but I never had skin issues while using one. Everyone’s different.

                              Comment

                              Working...
                              X