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Pressure wound - please help now!

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    Pressure wound - please help now!

    I am a quad seven years out and have now developed my first major pressure sore. I have had it months and this is the first one that has not healed with just weight shifts and silvadene dressings. It is on my left ischium, 4 by 2 cm, and is probably a deep stage 2 or, more likely, a stage 3. It has a central eschar (2 by 2 cm) which has been sharply excised, treated with papain and collagenase for enzymatic debridement, covered with duoderm bandages, Hydrophilic bandages, and none of these has had a notable effect on the size or depth of the ulcer. The eschar remains. I am also staying off the sore in the bed about nineteen hours a day. None of the above is having a significant effect on healing. I have recently increased the protein in my diet and am not loosing weight.What in the world should I do now?

    #2
    Is the wound tunneling? Has it been swabbed for bacteria? Staying off it 19 hours won't do it, especially with an ischial wound, because virtually the entire weight of your body is sitting on it. Any healing that starts to happen while you're off it gets destroyed when you sit on it for 6 hours a day. What cushion are you sitting on? Have you seen a wound care doc or nurse? How much have you increased your protein - are you getting at least 100 grams a day?
    _____________

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      #3
      Get it check for infection. Also until the necrotic stuff is gone, you won't know just how big it really is. Also won't see any progress until it's gone too.

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        #4
        i had one 4 three months. Used colodium silver and stayed off wound. corn flour will help to keep wound dry. try to get into sun if possible

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          #5
          If you have eschar, it needs debridement, and is at least a stage III, but cannot be staged until the wound is cleaned of all eschar and dead tissue. It will also not heal with eschar in place. Are you seeing a good wound care specialist?

          Surgical debridement is fastest. Enzymatic debridement may be possible if there is only a little and it is not very thick.

          (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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            #6
            Sounds as if you are under care of a wound care specialist? If you can find one with SCI experience it makes a difference. The SCI Nurse here is helpful, and will surely tell you to keep all pressure of the wound. I am recovering from a stage 4 wound on my right Ischia, just had it debris and 8 weeks on a Wound V.A.C. which has made a substantial increase in my healing rate, along with a good experienced SCI wound care Nurse. I am a C-7 quad and live on my own. I have to get up to eat and tend to minor tasks but I try to sit for no more than one hour at a time, frequent weight shifting, total up time 3-5 hours a day. The biggest problem I have is keeping the V.A.C. sealed when I get up (Anyone have ay tips on keeping the drape sealed would be welcome). I have help with shopping and only drive to see the Dr. Keep your protein high. I believe the recommended protein intake for wound healing is 1.5-2 gram’s of protein per kilogram of body weight. Or 150 lbs body weight divided by 2.2 kg equals 68.2 x 1.5 = 102 grams of protein daily minimum. Good luck, it takes time to heal so don’t rush it.

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              #7
              Get checked for osteo via xrays and bone scan.
              Roses are red. Tacos are enjoyable. Don't blame immigrants, because you're unemployable.

              T-11 Flaccid Paraplegic due to TM July 1985 @ age 12

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                #8
                ChipD, I was just using a wound vac on a sacrum wound and to get the extra seal needed in certain spots we used stomata adhesive. But I'll tell you what, that thing will never heal if you get up on it at all, especially on your ischium. That's where all your weight goes when you're sitting up. I had a flap done on mine a few years ago and now it looks like I need another one because I wouldn't stay off of it and thought getting up for an hour at a time would be okay. I don't know about you but my butt is literally skin and bones. I don't sit anywhere for any more than a few minutes without a cushion anymore, which doesn't matter much right now because I'm in a nursing home on a Clinitron bed. It's just and necessary evil to get the new flap healed up and ischium healed up properly. Good luck with it.
                C-5/6, 7-9-2000
                Scottsdale, AZ

                Make the best out of today because yesterday is gone and tomorrow may never come. Nobody knows that better than those of us that have almost died from spinal cord injury.

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                  #9
                  You probably need to have it debrided like KLD said. You really don't know what is underneath. You said that you are sitting 5 hours a day- it may not be realistic but the more you can stay off of it, the better.
                  Are you getting any drainage? If so, what does it look like and smell like? (sorry)
                  Have you been seen by a Wound Care Nurse or surgeon?
                  CKF
                  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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                    #10
                    Rybread,
                    Thanks for the tip on sealing the wound. I’m having good success with the V.A.C. The wound is filling in beefy red from the inside-out. The base over the bone is now covered by muscle. My nurse just dressed the wound and is very pleased with my healing rate, undermining down to one small spot she couldn’t get a q-tip head under it, started at 1.5-2cm undermining from about 12:00-6:00 position. Over all, open area is down to 2.4cm x 1.4cm from 3.5cm x 2.5cm 8 weeks ago after debridement. I know sitting is not helpful but I have no choice, I do use a high profile Roho. I also have carefully watched and adjusted my diet over the past 6 months and put on weight, high protein 80-100gm daily, my nurse has noticed the difference. Good luck your self, the Clinitron is great for pressure relief, but the vibration drove me crazy.

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                      #11
                      I am now seeing a wound care specialist at the Shepherd Center. Since I have changed to the collagenase and alginase, I have seen amazing progress. The eschar has almost disappeared in one week. The base granulation tissue is also looking better. Yes, I have increased my protein intake and I think it is helping. . I hate to admit this, but I rarely did weight shifts before this happened. I knew better, what stupidity. If I can heal this, I hope I learned a lesson.
                      Thanks to all of you.

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                        #12
                        We all learn some things the hard way- sorry you have to go through this, but I have had more than a few guys tell me that they learned their lesson this way.

                        If we can help in any other way, let us know
                        CKGF
                        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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