 |
 |
Nikki, I read your post with interest. What type of cushion is she sitting on? Is it fluid (Jay2 type) or air (Roho type)? The air cushions don't offer the most optimal positioning, but they are the best for overall pressure relief. Since the sore is over her ischial tuberosity, I would guess that seated pressures are more the problem rather than lying ones. If the tilt is adequate with the chair (somewhere around 60 degrees), the pressures over the tuberosities should approach zero in full tilt. If this is the case, then more frequent and longer duration pressure relief may be necessary. Unfortunately, many sores are stubborn and unrelenting enough not to tolerate any pressure whatsoever. In these cases, the patient has only two choices: stay off of it until it heals (months and months), or opt for skin flap surgery. If you exhaust all options, I'd ask her physician to counsel her to seriously consider the surgery. Depending on the person's upper extremity function, many have found at least some independence in mobility pushing a prone cart. It's not the best means of mobility, but it's better than nothing. There are also many new advances in wound care available. Each option has varying levels of success with individual patients. There is the medication Regranex, which works well when there is 90% or more granulation tissue in the wound (although it is expensive). Other options include dressings attached to a vacuum machine (negative pressure therapy), dressings with heating pads (thermotherapy), electrical stimulation (galvanic and microstim), pulsed lavage (alternative to whirlpools), etc, etc. I hope you find what works for the benefit of your client. Pressure sores are probably one the most tenacious and frustrating problems we deal with in our profession. Warm Regards, Geoff Mosley, PT, NCS MRC Mount Vernon, MO