Pain After Flap Experiences

[casey.n.brown.]

Good evening from Indiana! So I am 5 weeks post op, about to head into my 6th week from having a small flap procedure from a problem area I was having that wouldn’t heal (you can look up my previous posts about it). Everything is healing beautifully and I have zero complaints, surgeon is very happy etc etc. My incision is about 8” long and coincides with a prior bigger flap surgery I had back in 2008 that I’ve had zero issues with. This new incision runs closer to my groin area. Since recovering, I have this hard to explain tingling pain (kinda sharp at times) in what feels like my lower shin down to where my foot starts…could this all just be post op related and nerve pains? All I’m taking is Tylenol when it seems more bothersome than normal. I’ve been a T11/T12 paraplegic for 18 years now and have never really had an issue with pain or nerve pains so this is a “new feeling” after having my surgery 5 weeks ago. Just looking to ease my mind a bit and see if pain after a flap big or small is common and if with time it will get better. I know it’s only been 5 weeks but I’m an anxious one and always have been. Thank you in advance!

[SCI-Nurse]

Yes, I would imagine it is neuropathic pain. Are you currently on any meds for this (Neurontin, Lyrica, etc.)? If not, talk to your primary care physician about trying a low dose. (KLD)

[casey.n.brown.]

Yes, I would imagine it is neuropathic pain. Are you currently on any meds for this (Neurontin, Lyrica, etc.)? If not, talk to your primary care physician about trying a low dose. (KLD)

Yes, I am taking a low dose of gabapentin(300mg twice a day) but I dont really notice a difference. I’m in my 7th week after flap and everything is remaining closed and has healed beautifully incision wise. This is hard to explain but when I sit in my chair, I get a tingling sharp pain that consumes my entire left leg but specifically my shin and ankle “hurt” the most. I have also noticed that my hip and femur are particularly sore (I broke my femur 5 years ago and had a rod put in). Nothing is swollen or red or hot to the touch but when I push on my hip and top of my femur it’s very sore like a massive bruising feeling. I did make an appointment to see my Ortho surgeon who fixed my femur when I broke it just to make sure nothing else is going on to make my femur so sore and my hip very sore. Do you have any suggestions on why I’m feeling all of this? I’m trying to be patient because I am only 7 weeks post op but it’s frustrating feeling like I’m in more pain after my surgery than before. I’m hoping a lot of it is nerve related and just part of the process. I have my last follow up with my plastic surgeon who did my small flap on the 25th, do you have suggestions on anything I should bring up to him about how I’m feeling? I’m just assuming he wouldn’t know with being a plastic surgeon. He’s a very brilliant man and has been happy with everything so far as far as my healing process has been.

[SCI-Nurse]

Yes, you definitely should tell the surgeon. It could be a combination or nerves are irritated from surgery and neuropathic pain. You are on a very low dose of Gabapentin. Max dose is -900 mg every 8 hours. You can ask the doctor who ordered but you can slowly increase. Several options-add 100 mg as a third dose, take every 8 hours. In 10 days to 2 weeks-if no side effects, add 100 to 200 mg more to that third dose. When you get to 300mg -3x a day then if needed increase by 100 to 200 each dose. If you can take Ibuprofen or Naproxen and ok with surgeon, try dose of those. These meds called NSAIDS reduce inflammation( non-steroidal anti inflammatory agents) and Tylenol doesn’t. Take with one glass of water and food. Your kidney lab functions must be normal. CWO

[casey.n.brown.]

Yes, you definitely should tell the surgeon. It could be a combination or nerves are irritated from surgery and neuropathic pain. You are on a very low dose of Gabapentin. Max dose is -900 mg every 8 hours. You can ask the doctor who ordered but you can slowly increase. Several options-add 100 mg as a third dose, take every 8 hours. In 10 days to 2 weeks-if no side effects, add 100 to 200 mg more to that third dose. When you get to 300mg -3x a day then if needed increase by 100 to 200 each dose. If you can take Ibuprofen or Naproxen and ok with surgeon, try dose of those. These meds called NSAIDS reduce inflammation( non-steroidal anti inflammatory agents) and Tylenol doesn’t. Take with one glass of water and food. Your kidney lab functions must be normal. CWO

so I had my last follow up with my plastic surgeon and everything has healed and he’s happy with it. I do have less padding in that butt cheek since this surgery because he did the flap from my butt cheek vs the back of my leg because I’ve had a prior flap on that same side using the back of my leg. I brought up the pain I’m having and from what I was describing to him he thinks it might be my sciatic nerve…thoughts on this? It still hasn’t gotten any better. When I sit after a couple of hours my leg from the knee down just kills me and feels like it’s going to explode, along with my foot. I also have an extremely sore hip, upper femur and inside of my thigh, sitting and laying down. Could he have damaged it when he did the surgery or because I have less padding in that butt cheek now I am feeling all of this? I figured it’s either sciatic or I need a new hip. I still plan to see my ortho surgeon who fixed my broken femur on the same side back in 2017 to make sure all is well with that and plan to bring all of this up to him. I am leaps and bounds better than I was prior to flap surgery but definitely didn’t anticipate this after the fact.

[SCI-Nurse]

You can also see a neurologist to be evaluated for sciatica.

(KLD)

[Sue Pendleton]

I had all the normal signs of sciatica, thankful for almost normal feeling, and my physiatrist at Walter Reed way back then asked to treat it with accupuncture. Let's just say I thought that was quakery even with hundreds of hours experience behind him. I had stayed away for 6 humongously painful months assuming the only cure was morphine and sleeping 24/7. He said to call him in the morning and if there was no change my husband could pick up a reasonable dose of something he hated prescribing that a courier would deliver to Fort Meade. I understand it does take a lot of hands on work before using this to treat pain by itself. He did use a TENS machine attached to what is actually non-rigid very thin screens that are guided by his thumb or finger on one hand and tapped inward with the other hand. I apparently made some small noise as he inserted the needles into my lower left back so he stopped. He thought it was hurting. I turned around and was giggling. It tickled. He hooked the TENS instead of only being able to treat one patient at a time as he would if he tapped them as the Chinese still do. He told my husband which door to just knock on if I started feeling any discomfort at all. I felt a slight and thin line of heat starting from my lower back and slowing followed my sciatic nerve down the back of my left leg until it got to the bottom of my foot. That took a good 20 maybe 25 minutes then I told hubs to go find him. He was coming back as hubs opened the door and the heat feeling was just beginning to get too hot as he came back in. It was hurting more as we drove home then I got in bed, ate something and as the pain went away I feel asleep. With many who do not have my degree of touch and feeling sensation you may need imaging or a TMG (?) to be diagnosed but the flexible screws work.

[relative]

Sorry for what you’re going through -I am a T7 complete 20 years out. 10 years after my injury I started to get pins and needles in my shins and the feeling worsened to be more like shin splints (they ran me a whole bunch of tests on my legs to make sure that there wasn’t an issue with any of the blood flow, And everything came up negative. So I’ve been chasing that phantom pain (in addition to a bunch of neuropathic pain that I feel at my injury level (Indirect pain)) for quite a while. I am on on a lot of meds to try to deal with Indirect and phantom pain. We Did a trial with a Spinal cord stimulator (SCS) and it looked positive, so I
had the surgery in June 2022 (They put in two sets of electrodes in my spine) and just after a new program was put in recently by one of the clinicians, and We turned up the power quite a bit, and I am finally having some relief from my Phantom pain in my shins. I hope this information is helpful to you (and/or others)