Pressure wound not healing

[jw2189]

My son (C4-5 quad) has had a wound just in front of his IT for over a year, that started w/some maceration from a fungus infection. It was a stage 2-3 at that point, about 2x3 cm on the skin surface. After treating it ourselves for 5-6 months, we went to a WCC and he was put on the VAC in mid-February. The wound care doc found an 8 cm tunnel that went right under the IT (at what we're calling 6 oclock), and another 4 cm tunnel at 2 oclock.

He's been on the VAC since February (with the white foam in the tunnels and out to the surface, as the surface was getting smaller, and there was concern about it wanting to close over with the tunnel still present). Two weeks ago, the WC home health nurses (who have been wonderful!), decided to give him a VAC 'vacation' for 2 weeks. This Tuesday will be the end of the 2 week vacation. We've been using Promogran (at our suggestion, as we had used this in the past with other wounds with great success), along with a Silverlon strip of tape, in both tunnels. To date, the 2 oclock tunnel has 'opened out' so it's no longer a tunnel, but the actual wound bed/depth, and is still 4 cm. The 6 oclock tunnel under the IT is still at 8 cm.

The current plan is to put him back on the VAC on Tuesday, to see if it might 'jump start' the wound, which seems to have stalled.

My son is a vegetarian, who does eat eggs and cheese. His prealbumin was at the lower limits of normal - I'm pretty good with trying to pack protein in. He's been getting between 90-100 grams per day; we're using the Zone drinks @ 19 g each to supplement. He's also started taking arginine 1 gram, just started yesterday.

He's on an alternating air loss mattress; sleeps prone at night, and we position during the day w/2 hours sitting up at about a 45 degree angle (I can 'angle' his pelvis up so he's not putting pressure on the IT area), 3 hours on each side, and then up straight again for dinner. He's only gotten up about twice a week for about 4 hours, either for doc's appointments, or just a 'mental health' break. He does his bowel program in a commode wheelchair at night; we have a gel cushion for that chair. He is on a Roho Quattro wheelchair cushion in a Permobil wheelchair.

No wound culture has been done, but both docs and nurses have all said the wound is absolutely healthy-looking (I do understand about colonization). There is good granulation tissue at the wound bed, the wound bleeds when we irrigate or check depth; there is and has been a lot of drainage, mostly serosanguinous.

We're at our wits' end; my son is getting terribly frustrated, and is starting to talk about just doing a flap, to get it 'over with'. I would very much appreciate any comments, suggestions from all the great minds out there!

Thank you all in advance!

[traumaRUs, MSN, APRN]

Gosh - so very sorry for this issue with your son's wounds. We at All Nurses can't provide medical advice though. Could you obtain a second opinion from another wound care company? Someone that would be able to come to your house and see your son? Good luck.