Pushin' On: UAB Spinal Cord Injury Model System Digital Newsletter Volume 36 | Number 1 | Page 3

•
nutritional evaluation, and all of
your current medical conditions.
• Involuntary muscle spasms
are common for people with
SCI, so spasms must be
well controlled to prevent
movements from damaging
the wound.
Infection – An infection can
change the plan for surgery.
• Urinary culture or urinalysis
may be needed to check for
urinary tract infection.
• Redness at the wound edge,
foul odor, or pus are signs of
a wound infection.
Preparing for discharge after surgery
Your recovery plan will be made
when you’re preparing for surgery. It
will include getting the equipment you
need and how to best care for your
wound while it’s healing.
• Pressure-Reducing mattress
(such as a low air loss mattress or
air fluidized bed).
• Pressure-Reducing cushion.
• Pressure mapping should be
done for wheelchair users
to ensure the best possible
pressure-reducing seat
cushion setup is used.
• Educating family members on
at-home wound care, setting up
home health care, or setting up a
stay in a skilled nursing facility.
What happens during the surgical
and reconstructive treatment?
Surgical treatment
The wound is first surgically
cleaned (debrided) to remove any
dead or infected tissue. This creates
a larger wound, but the remaining
tissue is healthy and more likely to
heal. In many cases, a small amount
of bone will also need to be removed.
In some cases, a joint will need to be
removed.
Reconstructive treatment
Muscle/skin flaps are the most
common reconstructive treatment
and usually done in one of two ways.
1. A section of healthy skin and
tissue nearby the wound is partly
detached and moved to cover
the wound. This allows the blood
vessels from the original flap site
2.
to stay attached to that healthy
skin and tissue now covering the
wound. The blood supply helps
nourish the tissue around the
pressure injury.
A section of healthy skin and
tissue is completely detached
(harvested) from the back,
buttocks or thigh and moved to
cover the wound.
• Larger wounds may require
that a leg be amputated if
a lot of skin and muscle is
needed from the leg to fill the
wound.
What if I have more than one
pressure injury?
It all depends on the number and
size of the injuries, but more than one
surgery is usually needed if there’s
more than one wound.
What are the risks?
There’s always a risk for
complications during a surgical
procedure, and surgeons are required
to meet with you to explain the
surgery and the risks you’re taking.
This is called “Informed Consent.”
It allows you to choose whether or
not the potential rewards of surgery
outweigh the risks.
• Informed Consent usually
happens sometime before the
day of the surgery to give you
ample time to weigh the risks and
rewards.
• Treatment cannot restore normal
sensation in areas without
sensation.
There’s also a high rate of
complications with skin/muscle
flaps that can occur after surgery.
Here are a few of the more serious
complication.
• Injury Recurrence – the wound
comes back.
• Wound Dehiscence – the wound
either doesn’t close properly
or breaks open along the row
of stitches holding together the
edges of a wound.
• Infection – harmful bacteria gets
into the body through an opening
in the skin.
• Flap Necrosis – the skin and
tissue used for the flap dies.
• Bleeding – bleeding can occur
under the skin and tissue and
may require emergency treatment
to drain.
What is the standard of care for
healing?
There’s only one standard of care:
ALWAYS follow the advice of your
medical team. Each injury is different,
and each patient is different. And
even with the best care plans,
complications can develop that can
alter those plans.
It’s certain that your care plan
will center on taking all measures
to promote healing and prevent
complications. Here are the most
common practices during recovery.
• Bed rest – You lie on an air/fluid
bed to reduce areas pressure.
• Sitting protocol – You slowly
begin sitting once the wound has
had time to heal. It’s common to
first sit for short lengths of time,
maybe 15 minutes, for only a
few times per day. If the wound
continues to heal, the sitting
periods are increased over time.
• All pressure relief movements
must avoid bumping,
shearing, and other stresses
to the wound.
And finally…
It’s impossible to answer all
questions about surgical and
reconstructive treatment of pressure
injuries, but this article offers a basic
understanding of what to expect if
you’re considering the treatment.
• Ask your doctor to explain
anything you don’t understand.
• Ask for information that
specifically details the procedure
you are considering and all of the
possible risks and benefits that
you face.
Editor’s Notes:
*National Pressure Injury Advisory
Panel changed terminology and
updated the stages of pressure injury.
Views and information found in this
article are not meant to replace the
advice from a medical professional.
Consult your health care provider
regarding specific medical concerns
or treatment.
UAB Spinal Cord Injury Model System
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