Well... It's 4 weeks today since my surgery.... Doesn't time fly...NOT! Lol

Today has been a slightly better day, although I've had 2 bms. I put a big blob of Vaseline on before each bm and that really helped take the raw sting out of the fissure/ sore patch. I also took max dose of pain meds this morning.. So it's taken the edge off.
My husband says it looks like it's starting to scab over a bit.... So that's a step in the right direction I spose. The problem is the scab gets split or dislodged with every bm.

My anxiety level this morning was through the roof... I was so scared to poop... I felt just as anxious as I did way back in the early days. Not a nice feeling I can tell you.

I sent an email to mr w this morning, detailing what has gone on and the massive set back since the barbaric surgeon poked and prodded at my poor bum.... I'm going to have to wait and see if he gets back to me. If he doesn't I'll be getting my gp to write to him. I am very lucky in the fact that my gp is fantastic... Just a shame she is not a colorectal specialist!

OMB x

Hi, I'm so sorry you're still in pain. Your surgeon doesn't sound too nice. How many times has he seen you because after my surgery I had to see my doctor twice the first week, then once a week for a month and then ever other week after that until the flap took. Also try not to use vaseline. He told me not to use it because it's not water soluble. It's not easy to clean off and you don't want to get an infection, he recommended something called aquaphor instead. That lubricates but comes off easily. I feel so bad for you. I hope things start to improve soon. Fingers crossed, Suzy

Suzy,

Your doctor sounds like he was very on the ball. Would you share his name either in a post or private message? I wonder if he might be able to refer me to a colleague he knows in the area. I've not been impressed by the surgeons I've seen so far.

Hi, the surgeon name is Dr. David Ondrula 1 (847) 381-8161. I don't know where you are located so I don't know how much he'd be able to help but it might be worth a try. Good luck Suzy.

Suzy, over here you don't usually get follow up appointments for 6 weeks or so.... It all depends. Your after care was fantastic... Wish mine was the same. I feel I've been left to get on with it.

Not a great day for me today. It seems I have a scab forming, or trying to form on the sore patch ( so mu husband says... I'm not looking any more) is that a good thing? I used a bit of anusol with hydrocortisone on it today... Hoping the hydro will take some of the rawness down. I also have some wound honey that I may apply to the area in a couple of days.

I just want the healing to hurry up. I have run out of time to rest up now. My husband is going back to work, and school is starting again next week. God knows how ill be out the door just after 8 am.... It's taking me at least 2 hours after my morning bm to get the pain under controll.


Asdf.... How did your appt go???

Thanks Suzy. I'll give it a shot...maybe he can recommend a friend that's in the northeast. From your recommendation alone he sounds like a very nice guy and an excellent surgeon.

Hi OMB,

I would personally recommend laying off the topical applicants, especially the hydrocortisone. I'm sorry you're in so much pain, but if you are scabbing up, hopefully that is a sign that you're body is healing on its own. Topical applicants may just complicate things, or perhaps set you back a bit (possibly)...that's just my opinion.

I had my appt with the (2nd) plastic surgeon yesterday. He certainly seemed out of his element, but said he did help with one case like this during his residency. Basically he said he would read up and speak to my CRS and get back to me with a plan for a surgery. I personally don't see the value in having a plastic surgeon consulting during the operation, but if my CRS thinks it can help him make a better flap, then I guess I can't argue. In sum, I've been to many surgeons in the past month including 2 plastics, and 4 CRS, all of whom think that a flap is what I need. They just disagree on where to get the flap from. 1 CRS said to have an internal flap, like you OMB, because I already used the outside skin last time. 1 CRS said that I should have colostomy because I don't have any good flap skin left. 2 CRS said they would repeat the outside flap with a plastic surgeon in the room, and if it fails, I should be able to try the internal flap because that skin won't be touched (god help me if it fails). The two plastic surgeons didn't offer an opinion. I've also emailed some UK doctors that published papers on flaps to ask about the success of repeat flaps. 1 responded, and he said he does do repeat flaps, but it depends on the type of flap I had and how it healed...so encouraging news but not definitive. Otherwise, I am spiraling into bankruptcy waiting for the surgery. Sorry for the negativity...I send you only positive healing vibes.

Asdf... Don't be sorry for the negativity! If we can't come on here and express our sadness and frustrations to each other, what can we do!!!

Which uk drs did you write to?? There is one in Bristol that dent1 saw who is meant to be very hot on flap surgery.

How do you feel about your options?? Which one would you like to do?

Thanks for the advice on the topical s.... I've already wiped the hydrocortisone off... It was stinging like hell..... I just feel like I need some sort of barrier on it to take the sting out. I really don't want to set myself back any further than dr ' poke through to the bone' has set me back.

The Bristol guy is Tony Dixon I believe. He did not reply yet...

The doc who did reply was Giordano Pasquale of Whipps Cross University Hospital in London. He co-wrote this:
http://www.ncbi.nlm.nih.gov/pubmed/19225835

I don't feel good about any of my options, honestly, and am constantly wondering if I am just torturing myself worse by trying to heal. But I've tried too hard to quit. I think trying the outside flap again, but this time doing an island flap (house or diamond) sounds reasonable if I can stand the horrific pain. Also, trying a weird alternative flap that might twist in tissue from the sides somehow, like perhaps an S flap on the flap diagram Suzy posted...sounds better because I could avoid reusing the same spot for flapping skin. Otherwise I can do the internal flap, but I am inclined to save it in my back pocket if this surgery fails. If the outside flap does fail though, I don't know if I will have the mental ability to hold myself together long enough to wait for the next surgery... I can also opt for an LIS which would be much easier pain-wise even though no doctor has recommended it. I'm scared of the colostomy idea, and so far all but the one surgeon who suggested it have laughed it off. I'm scared that even if I get the bag and survive the surgery, my wound still won't close or will rip open as soon as I poop again. That will be such a horrifying feeling I don't know if I could bear it. So I think I'll pass on that for the time being.

Why can't synthetic skin be used?? It's used in other skin grafts on other parts of the body... Why not on an anus??

Asdf.... How soon did you realise your flap had failed... And what symptoms drew you to that conclusion??

Ok...I've been researching this quite a bit...So skin grafts are different than flaps. Skin grafts are just skin, no fat, no blood vessels...just skin. They require a clean area with a good blood supply to be useful. I have read one case study online of a surgeon who used it successfully on a patient in Pennsylvania. Synthetic skin, or cadaver skin (gross I know), has the similar drawback of not having any blood supply or supportive tissue as is the case in a flap.

Flaps have a fatty vascular cushion of tissue, and can be local or distant, of many different shapes, sizes, and orientations. Plastic surgeons do flaps mostly everywhere so they are good at making them supposedly, albeit not in the anus. I asked both plastic surgeons about a distant flap, like from skin from my leg or belly, and they told me that distant flaps require you disconnecting the tissue from it's blood supply, and then finding a new artery to reconnect using a microscope. They said that is a very extensive procedure, and on a flap this small, it's not worth the effort. I still think it is an option though and am going to research it further if all else fails. There are also flaps called interpolation flaps, where they use skin from near, but not adjacent to the defect, and jump over the unusable skin. This one looks weird, as you literally have a flap of skin hanging and bleeding which is connected at one end to it's donor site, and the other end to the defect. The hope is that new capillaries form to provide blood from the defect, and then the bridge to the donor site is cut in a subsequent surgery. This would be very hard if not impossible in the anus because you couldn't sit on it, let alone poop on it. I'd imagine it would get infected very easily as well.

At my 10 day follow-up my CRS told me the right suture line was open. He said just a tiny bit open, and said it should heal up anyway. I waited till about 5 weeks to decide I better start getting ready for backup plans. That's when I started with the HBOT, and then the Kenalog procedure. I never really knew it wasn't going to heal...I'd just keep going back to his office and he'd keep saying give it a few more weeks...just like last time and the time before. Now it's 3 months since Kenalog, and over six months since the flap. I had a fairly sizable but healthy and smooth poop this morning and I'm still in pain 7 hours later. My butt still bleeds and aches and hurts when I sit in a hard chair. Now I KNOW without a doubt that this wound will not be going away without a surgical intervention, and possibly even with one...