Flap Success in 12 weeks

12 weeks after ischial flap surgery the wound site is healthy, and relatively pain free.  I notice 'burning pins and needles' type pain during stretching,but nothing that interferes with daily activities.

Suture Spitting-not flap failure

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Five weeks after surgery, the surgeon said the site was healed and I could resume my regular activities. This would be sitting in my wheelchair 11or 12 hours a day.  Everything I had read indicated a 4 to 6 month recovery period, so I was pleasantly surprised, yet hesitant.  The next day I went out for 2 1/2 hours, rested in bed for 2 hours, then went out for 7 hours.  The following morning during range of motion, blood came out of a staple hole that was situated over the old pressure sore.  The next day a small piece of string was coming through the staple hole-see picture #1 and #2.  Called the surgeon in a panic, and made an appointment for the next day.  Upon examination, the Doctor explained that the wound was healing fast.  The sutures (which I did not know were there) under the skin had not yet dissolved, and the healing tissue was 'spitting' the stitches out.  He snipped the visual piece off (picture #3), and gave me a kit to remove any other stitches  that might push out.  There were three other spots where the stitches could be felt.  The surgeon said everything was fine. The stitches would dissolve with time.  The dark red scar would take 6 months or more to become a skin-colored scar.

Is this Flap Failure? No

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So  10 days after stitch removal, some parts of the staple-line edge have a gap. The gaps have a red color skin filling in. This is o.k.  I sat in my wheelchair (Roho air cushion) for a 2 1/2 hours and my pants left wrinkle marks-first picture.  Insurance won't cover a Roho seat cushion for my shower/commode chair (using the bathroom is not medically necessary), but I did not want to risk sitting on the surgery site without one, so spent my grocery money, and plan on Top Ramen for a month.  Second picture is of roho commode cushion marks after 2 hours.

Flap Surgery Healing

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These are day-to-day photos of the flap site healing, for the 2 weeks after the staples were removed. Kept up protein in diet, and rubbing coco butter and vitamin E oil onto the scar site.  Began gentle range of motion on both legs.  Of course the left leg (surgery site) was sore.  The leg will extend completely straight. During range of motion the leg is tight when trying to bend knee towards chest, just be very gentle--want to stretch the new skin, not stress the suture site.  Photo #5 shows the ripples on the thigh where skin needs to stretch.

Staple marks and open edges

The day after staples were removed

the scar is uneven and lumpy.  The surgeon said to begin sitting on the edge of the bed for 10 minutes at a time, several times per day.  Then  gradually increase the sitting time over a  2 week period.  Some people experience low blood pressure (fainting) when sitting upright after 3 weeks in bed.  I did not. However, the loose and uneven nature of the scar made me hesitate to put much weight, or pulling on the area.  So I continued bedrest (turning every 3-4 hours) for another week. Began rubbing the surgery site with cocoa butter and vitamin e oil to soften and heal the scar. Kept up the 60 grams of protein per day.  The second week I sat up for 30 minutes twice, with no dizzyness. Stil stayed off the wound site--on my side, on the couch or in bed. Next visit with doctor soon.

Removed Staples and drain tubes

So 3 weeks post-operation and it was time to get staples removed.  There are two drains-literally, 2 tubes inserted under skin flap to suck blood and other fluids from site of surgery.  The tubes emptied into plastic airtight bulbs, which were emptied twice a day. After emptying bulbs, be sure and push the air out, in order to create suction.  When I left the hospital, the drainage was very blood-red.  The amount of liquid was 10 cc.  for drain#1(morning & night); and 5 cc for drain#2.  By the start of week 3, drain #1 was watery discharge, the amount 5 cc. or less; drain#2 was dry.   Counted 60 staples.  I was surprised that the edges of the wound still had gaps and puckered regions--the surgeon was not concerned.  

Recuperating at home--Important stuff

The two weeks following my return home were crucial to the healing of such a large wound.   Set the alarm clock, and Superman spent 14 days turning me from side-to-side, every 2 hours.  I was about 80lbs. and needed to put on weight.  Proper diet is crucial to the healing process--especially protein.  At least 60 to 80 grams per day, along with the proper balance of electrolytes, and extra zinc, iron, vitamins D &C.  I used liquid protein supplements along with powdered pea protein and powdered egg-white protein.  The liquid supplements made me urinate more.  For electrolytes, I like emergenC,  be careful not to overdo the zinc intake.  Soups with protein supplements, and milk (Lactade for my IBD) smoothies with egg-white protein added. The wound was covered and the surgeon said to keep the dressing on, so we did.  After a week we changed it.  At all times the wound was clean, dry, and had no weight put on it.

One week in Hospital-a new record!

Most post-operation care for flap surgery requires a 2 week hospital stay, followed by 4 weeks in a rehabilitation/long-term care unit.  One week hospital and unlimited long-term (institutional care-Not a good thing.) was covered by my insurance company. While in hospital the nurses turned me from one side to the other, every 2 -3 hours, keeping me off the surgery site. The drainage (from the 2 drains on the wound) must be charted every 12 hours for the 3 weeks the drains and staples are left in. I was on IV for antibiotics and saline and anti nausea drugs.  After 6 days, I had to leave the hospital, but I still needed to be turned every 2 hours  The hospital administrator/doctor wanted me to stay in the long-term care facility for at least one week.  He also wanted to put a feeding tube in me.  I feared that once in a facility I wouldn't get out, and my at-home benefits would be lost.   I went home, lucky my state has In Home Supportive Services and my caregivers actually care.  The hospital social services arranged for a hospital bed with air mattress to prevent pressure sores.  At home my food intake was better.  A body needs 60 to 80 grams of protien per day while healing.  Besides eggs, tomato soup made with milk and powdered Pea Protien is my favorite lunch.  Soup is easy to eat thru a straw, and that is easy for eating in bed.   Also used a Human Growth Hormone steriod (oxzanderlone?) for two months--this stuff works mircles.

Ischial thigh fasciocutaneous flap day 1 after surgery

took picture between dressing change. Very helpful to show nursing staff, so they understand how/why to get me on my side--especially with language barriers. There are two drains-literally, 2 tubes inserted under skin flap to suck blood and other fluids from site of surgery. The tubes emptied into plastic airtight bulbs, which were emptied twice a day. After emptying bulbs, be sure and push the air out, in order to create suction. At first the drains filled completly with blood.  The drainage eased up by day 4 post-op; about 15 cc per drain every 12 hours.  When I left the hospital, the drainage was very blood-red. The amount of liquid was 10 cc. for drain#1(morning & night); and 5 cc for drain#2.  Dr. orders : stay on side, turn every 2 hours. I wiegh 85 lbs. so had trouble with blood pressure dropping while on morphine (72 over ?) My normal daily meds include 20 mg baclofen, 2mg diazapam, .2 mg clonidine patch(time release), 5 mgs of oxycodone(2 per day), 10 mg time release oxy at bed, plus other stuff not related for uti.

Surgery on left Thigh to hip

7/23

7/23

Post-operation.  Surgery was about 2 1/2 hours.  I took a Spinal Anesthetic (needle), and had the option of staying awake to hear the surgery.  I slept  Now the real fun starts--recovery!

Left Ischial decubitus Ulcer Stage IV, The week before surgery

About 1 inch wide at the outside, the surgeon estimates a 2 inch diameter 'tunnel' wound under the skin.  Surgery scheduled.

Wound turns Black

Spending 14 hours in bed, 10 up in chair. Wound does not look  good.

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5/29

4th,5th,6th weeks wound

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The wound gets progressively wider and the tunnel more pronounced as continued sitting,-up in chair.  Spent 18 months sitting-up for 4 days; then in bed  (off wound site) for 10 days to recover.  Pressure mapping showed ischial points two inches from wound site; still have not figured that out.

Week 3 Tunnel Visable

After 3 weeks of sitting up 11 hours a day.   The dark pink spot is a tunnel going straight to bone-verified  by Plastic Surgeon. 

week two of ischial wound

One week later 4/18; a little deeper than last week, about the size of a q-tip.

First Stage of Wound

Location of wound: left ischial-- where the back of the left thigh meets the bum.  Very minute wound, about the size of a pencil lead, goes all the way to the bone.  This is after debridement surgery and wound vac. treatment. I am trying to maintain wound thru pressure relief and bandage.