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Pressure Sore That Won't Heal

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  • Pressure Sore That Won't Heal

    I have been dealing with a nagging pressure sore on my ischial for almost a year that has developed into osteomyelitis. I had a surgical debridement to remove a large chunk of it, spent nine months on bed rest, been on antibiotics to prevent staff infection, taking a Juven supplement, keeping up my protein, using electrical stimulation, and still can't seem to resolve it.

    My wound doctor has recommended hyperbaric oxygen treatments, which seem like a bigger hassle than they're worth. I'm tempted to just ask for a PICC line so I can treat it with IVs. I am sick of being stuck in bed and want to get back up in my chair for several hours a day, especially during the summer.

    Has anyone else had experience with a pressure sore that just won't heal no matter what you do? Anything that helped yield positive results? Kind of desperate and bummed out at this point.
    C3/C4. Complete

  • #2
    I did the sore thing for two three years what you're doing. Did all Iv's etc. I was scheduled for a flap but got sepsis two weeks before surgery. I went to ER; the surgeon met me there. He had to cut out the sepsis that tunneled in a matter of hours. Creating a much larger wound than before. If I had waited til the morning it would have been too late. After tests showed I was clear, he did the surgery. Did the bed rest at assisted living for six weeks; it went fast. It never really closed up at the corners, I was on anti-biotics etc. Came home where we did the once a week visit trying new remedies to no avail closing it up. It didn't get worse though. After 4 mos. of trying, Did a second flap with 6 week routine in AL. Came home for 4 weeks and one day my blood pressure dropped to below 40. Rushed to ER where ER doc worked trying to get blood pressure up. I was out of it. He said we'll try one more technique and if doesn't work, we'll let him go. I felt nothing but peace I was that close. Short story is it worked and was about to release me a few days later. I insisted having a MRI on my flap. Turns out I had an abcess under the reapair. I think that's what caused the whole mess and never found because they felt with all the anti biotics I was taking, no infection could survive. Blood tests and mri's showed I was clearTwo weeks later, I got out and haven't had a stitch of a problem with the area since. That 4 years ago. I have a colostomy. It was advantageous as we didn't need to do a BP program with possible contamination of the repair healing.

    If it's been a year with osteo forming. First thing is to ENSURE the infection is gone. Then think about a flap surgery. Time to get on with your life. Just you transferring into a chair to go to the wound clinic for Oxy treatment may destroy the previous time laying down. If it's not getting any smaller after all you've done, the chamber is going to take well over 6 weeks of treatment to heal and more than likely, not do much good. It may end up being a fragile, tender area prone to a sore again.

    After so many years of fighting to avoid a flap it was nice getting my life back. I was in the hosp. a couple weeks then went to an assited living for 6 or 7. Was in a Clinitron bed, essential if possible, for about six weeks and then did the gradual sitting periods then home to continue with the sitting schedule. I changed to a Ride cushion. They tried giving me a Roho but refused it. Worst cushion for me confirmed by a seating eval they did later. I'm four years post. Other than getting off my ass an hour before dinner I don't do anything special. I do pushups when I remember, ride my handcycles, stand in my stander, workout at the gym and see a masseuse and chiro. once a week. Back playing lead with a Bluegrass and ukulele groups. Out in the Sun and fresh air.

    I suggest you look at a Ride cushion never the less. It'll get you off your trochanters and butt. IMO Roho are not good cause there's still pressure there, even if they tie the cell off. The PT's recommend Roho cause that's what they've been taught by the DME's who visit them.

    One thing my plastic surgeon insisted on. Can't be a smoker; I wasn't. He said the failure rate for a smoker is greatly enhanced and he didn't want to have a failure cause of that. If you smoke; quit.

    I hear you on be down and desperate. The two months in a clinitron bed goes quick. Mine got pretty bad cause of the tunneling. Before it would have been a simple closure and 6 week rest. It is so nice having my life back and not down and desperate everytime my wife checked my wound. I'm here for support if needed. Can always PM me you e address if you prefer.

    IV's and anti biotics are not going to heal the wound. Onlt thing that's going to heal it is being off it 24/7; flap surgery or no surgery.
    Last edited by Patrick Madsen; 06-17-2020, 12:36 PM.


    • #3
      Flap surgery was originally recommended, but I have been trying to not go that route. If it ends up that I need to, perhaps doing it in the winter makes the most sense.

      How deep was your wound? What about the tunneling?
      C3/C4. Complete


      • #4
        Originally posted by Sfedor408 View Post
        Flap surgery was originally recommended, but I have been trying to not go that route. If it ends up that I need to, perhaps doing it in the winter makes the most sense.

        How deep was your wound? What about the tunneling?
        The wound wasn't that large or deep when struggling to close the first years. It was the sepsis debridement that did the major damage. Sepsis travels to the nearest artery to get into the blood supply. Mine was heading towards the femoral artery. Doc says it takes just hours in most cases for it to travel; like they have a mind of their own to get there.

        I had the same attitude, no matter what, I would not have a flap done. Was surely a waste of time that I could have been up and gone. The longer you wait, the more chance of infection setting in. I know guys who waited too long, got sepsis and ended up with amputation.

        Why wait if needed, it sounds like you're laid up anyway. If going to wait, ask the doc if you can get in your chair in the meantime. I did, it didn't get worse but didn't get better either.

        My sore started by hitting the wheel when transferring to the bed. We bought a new mattress that was a tad softer than the old one. My fist would go deeper lifting over the wheel, not knowing I was scraping my skin against the tire. Was 40 plus years post injury so won't complain.


        • #5
          Because I have a bone infection, I will probably be a candidate for a PICC line. Was hoping that once the bone infection clears up, the store would close up. Not sure, though.
          C3/C4. Complete


          • #6
            Good idea getting the infection under control. Perhaps time to have a heart to heart talk with the surgeon or whomever is handling it; about the best way, in their opinion to handle it. I always mention to them that I want to maximize my potential and what is their opinion doing that. It kind of shows them I am serious and willing to do the work to get there.

            Picc lines do their job for sure. Got to be careful with a bone infection that it is absolutely gone.


            • #7
              Despite being treated for osteomyelitis (bone infection) getting IV antibiotics, surgical removal of diseased bone; osteomyelitis can return. It lies dormant not completely removed if conditions exist that can reignite the bacteria in the bone. Pressure on the area can reignite the bacteria in the wound and in turn the osteomyelitis. It is frustrating that something treated can return. Is the wound clinic the original providers for the past osteomyelitis? I would get a repeat xray and MRI to look at the bone and surrounding tissue for infection.

              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.


              • #8
                Mr. Madsen is a font of great information regarding pressure sores and flap surgery. The SCIU at my VA attempted several avenues of medication, but realized that osteo was setting in. Flap surgery, five weeks on a Clinitron, rehab and now been sore free for five years. I have a three hour lay down following fours hours chair time—doctors orders. I do get back-in chair for another fours hours, then to bed for the night. Routine working for me at age 83.

                Pop Gunn

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