Newly Healed Pressure/Shearing Wound, looking for care advice

[Sythellri]

Hello again,




I posted a week or so ago about a pressure and sheering wound. It’s now healed and has been closed for a few days already so I have been slowly easing back into my routine of sitting up in my power wheelchair. My local area does not have a health network with spinal cord injury or pressure sore specialists so I was hoping I could ask for some advice from the community here:




The wound is located right behind my scrotum in the perineal area. What kind of dressing should I get to prevent it from tearing? I have seen some recommendations for silicone gel, hydrocolloid dressings, and Topigel but I don’t really know the pros and cons of each. My problem area has dozens of folds in the skin too.





I have no medical knowledge besides Google. Is this an atrophic scar? I have read that these are much more prone to future skin breakdown due to the loss of structural integrity. If it is an atrophic scar, is there any nonsurgical way to help it fill in naturally?




I used Medihoney to help the wound heal. Now that it’s finally closed, should I continue using Medihoney or use something else? I am currently applying lotion to keep it moisturized but that’s it.

[SCI-Nurse]

First of all, you should have a seating re-evaluation with a computerized interface pressure device to determine if you need a different cushion or revision of your current cushion. You are lucky that you got this to heal, as wounds in this area in men frequently develop fistulas with the urethra, and that makes them very difficult to heal.

My recommendation for this area would be to stop the Medihoney. It is only appropriately used on broken skin.

If you think that friction (such as from doing weight shifts or sliding transfers) is a part of how this developed, and your cushion re-evaluation looks good, then I would recommend using an adhesive pure clear silicone gel dressing on this. Cut to size (about 1/2" wider on each side as the scar area), spread the skin to eliminate wrinkles and apply. No need to tape it in place. Remove once daily to better inspect and clean the skin.

Once you have a pressure injury that has healed by secondary intention, you will have scar tissue there. Short of plastic surgery, there is no way to make scar tissue go away, and indeed it will always be more fragile than normal skin.

Go very slowly with your re-seating program and stop sitting if you see any indication of the scar breaking down.

(KLD)

[SCI-Nurse]

I myself used a self-adhesive silicone gel dressing to treat a closed burn scar last year. While this was a different brand than I used at work, it worked just the same and I was happy with it:

https://www.amazon.com/gp/product/B0...?ie=UTF8&psc=1

(KLD)

[6 Shooter]

My son had an open stage 3 pressure sore about 3" by 2". He got the sore while on a fishing boat without a Roho cushion that he forgot. It took almost 6 months to skin over. It has taken another 6 months for the skin to thicken which felt as stiff as leather and a semi-dark grey color. We tried a number of things to speed up the healing (closure) process. What finally worked was red LED light, about 5 minutes per treatment, twice per day. The red LED light caused the skin to add collagen and thicken. The light will get a little warm to the touch, but not hot enough to cause skin burning. The LED box is about 1/3 larger than a pack of cigarettes. It has about 14 lights in the case. Will say that his open wound could have easily become infected during that 6 months covid time frame, but he upped the vitamin C to 6000 mg per day and never got an infection. Will also say that you could supplement with Live Conscious Collagen daily, which is type I and III and has a 5-star rating. We did not know of that product at the time, but have been taking it daily for about 9 months now and his pressure sore skin is now back to normal. If you wish, send a message about your interest in the red LED light. They cost about $400. And, I do not sell them. One other point is that he has added Roho cushions to his truck seat and his hand cycle seat. His manual wheel chair also has a Roho cushion. No subsequent pressure sores 1year post total healing. He is a C-6 quad.

Look here and read first: Chronic Wound Healing - Red Light Therapy (lighttherapyoptions.com)

Now here for the product, with price dropped since our purchase: 120 LED Array Red (660nm) - Elixa