My husband is a T3 sci (1994) and up until 2007 had been decubitus ulcer free. Since 07 however, we have been on a roller coaster ride trying to treat a sacral stage 4. We just finished a month long stay at a hospital in WI where our plastic surgeon unsuccessfully attempted repair of this wound. It was our 3rd surgery on the area. I can say that the previous 2 surgeries may have not resulted in long term repair due to my husband being a bit too over eager to get back in his chair to return to work. At this time however, we have had him planted in a low air loss mattress since November 18th – his last surgery date. His wound was not closed this last surgery by the dr – he came out surgically debrided with a wound vac in place. We continue to use this approach at this time. At our first follow up appt our surgeon stated that we were facing living with this opening the rest of my husband’s life. I am mid 30s my husband mid 40s, we have a 5 year old and we want to live life. Do we need to just come to grips with this wound and accept it, or do you think there are surgeons/procedures out there that could help us?
There are a few things that pretty much doom pressure ulcer surgery to failure or recurrence. One near the top of the list is non-compliance. Pressure ulcer surgery takes a motivated patient to have a good chance of success. The patient must stay off the wound after surgery sometimes for months to allow it to strengthen to the point that it can withstand the pressures of daily life without breaking down. This is just a fact.
I would say that while I completely understand your desire to get on with life, an ulcer that has been there for years will have a very high chance of recurring even assuming that there is tissue available to attempt to close it.
Wound vacs are helpful but in very large wounds very rarely obtain closure by themselves. I would say have a long talk with your husband about what you are both willing to do to get closure of the wound. Then if he seems willing to stay off of it long term, I would seek the opinion of another good plastic surgeon with experience closing these types of wounds for options as to what might be possible. Do not be dismayed if the surgeon is unwilling to provide assurances of success. With your husband’s long wound history I would be suspect of one who didn’t. Tests might be needed before additional surgery. Go in with an open mind.
Good luck to you both. These wounds try the patience of your surgeon just as they try yours believe me.
John Di Saia MD
Originally posted 2012-02-03 07:30:51.