The End is Nitrate the nitro help with the spams about two weeks after I started, but didn't heal the fissure right away, it wasn't until 4 months later and pushing that I got spams free, my doctor told me to use it as long as needed.
Now after 4 months I developed a rash that then blistered so I had to stop, plus a yeast problem, thats when I started to blow dry the area also, you will find as you read threads and post that members here had tried almost everything to get this problem under control. :D
I developed my own care after trial and error, plenty of Vaseline before a BM, to ease the irritation and pain, then after the BM, sitz bath, after the sitz bath I use and still use a Carlson suppository and another before bed.
This is how I have been healing since month 6 when my doctors manipulation of the fissure and sentinel pile caused me my last major retear, keeping the area lubricated has been the major factor on making the all day pain and irritation better.
And after talking with my doctor about surgery in Feb, he said that he will not remove the skin as it's just skin, some doctors have not problem removing it, I opted for more time to see if the fissure heals by itself and so far so good, my next app is on June.
Now I have to say that mine has receded a lot and that my anal area looks almost normal again.