Wound Healing vs Flap Surgery

[Broken Doll]

I would appreciate some advice on wound healing versus surgery.

I’ve been bedbound now for over a year almost 24/7. I got an ischeal wound in 2019 during my colostomy surgery and have been hospitalized and with home IV antibiotics countless times. My wound care doctor is Dr. Schecter, Palmor health who coordinates care with Dr. Antoine Hallak, plastic surgery. Both determined a year ago that I should let the wound heal itself.

For the most part the wound has stayed infection free. It did respond well to porcine collagen matrix, however, I was only able to get five treatments. Every two weeks I go to the wound clinic and the doctor looks at it and I continue with a Vache wash, gauze, Quick and Mepilex. The tunneling is getting deeper and I feel like nothing will happen until I end up in the hospital again.

Could you recommend another wound care doctor or surgeon in San Diego county that I could see for a second opinion? and, what is involved with the second opinion? Do I need to get all my medical records from my current wound doctor?

I’m petrified about the after care of a flap surgery. Dr. Hallak sends his patients to kindred Hospital where I had a hellish nightmare experience and will never return. I also live all alone so it’s hard having consistent care especially at the level I would need coming home from surgery. I talked to a friend that said he went home after his flap surgery, but he was in the hospital for three weeks.

I’m concerned my healing is affected because I’m critically low in iron, (saturation 4) and my doctor ordered iron infusions -200mg for 8 weeks but haven’t been able to coordinate with the home health care agency that will do it. And if I go to an infusion center, I’ll have to be discharged from home health.

[HACKNSACK44]

How big is the wound?

[SCI-Nurse]

If you have a stage 3 or 4 pressure ulcer, it is very unlikely to heal with any topical measures to the degree that you can sit on it again. A flap is most likely needed. For the San Diego area, I can recommend Rick Bodor, MD and Kevin Broder, MD, both at UCSD. I worked with them both for years at the San Diego VA.

If you are on Medicare or Medicaid (Medi-Cal) it is unlikely you will be approved for more than 10 days in an acute care hospital, so probably will have to spend the remaining 5 weeks of bedrest (on an airfluidized bed like a Clinitron) in a sub-acute facility similar to Kindred. You may be able to get a short (2-3 week) stay in an acute rehabilitation center like Sharp Rehab for your sitting program after that.

(KLD)

[McDuff]

I would definitely try to find a 2nd opinion. I unfortunately have had a few isch wounds, and like KLD said, if they reached the 3-4 stage, they never healed. I spent almost a year on a wound vac once, and it never got better. My wound Doc and Plastics Doc, always concurred after that, that mine don't heal, even though my iron and overall health was good, straight to flap.

I would only be in the hospital for 2 days after surgery, then they took me, literally, across the street to an LTAC center. I spent 5 weeks there, flat on my back in a Clinitron type bed, but mine was a hybrid, fluidized lower half, and low air loss mattress on top half. This allowed for getting head raised for eating and such, but never more than 30 degrees, and not for long, but it was so nice to have the option.

Good luck, been a bunch of us in your spot, and it sucks. I'm in Dallas area, so no help on Docs, sorry.

[SLIQNES]

Hello im also in the DFW area had flap surgery a year ago,how long did it take for your wound to completely heal? I ask because despite my wound still being covered with gauze and me doing weight shifts ive seemed to have sheard the skin and am back in the bed until it heals.

[Podkane]

I really hope you follow up with the flap surgery advice and docs KLD suggested. My experience was that until I took action to find a surgeon to do the flap (Craig in Denver) there was no change.I was in a Kindred facility for the post op, and it was no picnic but as long as you are vigilant about your care you can survive it. You kind of have to tough it out and decide you will get thru it. Prayers and positive energy to you.

[SCI-Nurse]

Agree with KLD above if your wound has not completely healed and closed in one year you need a plastic surgeon consultation for surgical flap

BTW Craig Hospital in Colorado does not perform flap surgeries they are outsourced to the adjacent/ nearby hospital Swedish Hospital

SCI-Nursepbr