Surgery No.3 – Wide excision and reconstruction with z-plasty [Private]

Surgery: 06/12/07

The quick summary
My z-plasty experience with my new surgeon was quite different to the previous two surgeries. This time I was in hospital overnight, my surgeon used methylene blue prior to the surgery. I had very little pain after the surgery compared to what I had expected. Everything went well, better than expected for the first three weeks. After which all hell broke loose. Out of the blue I had a massive infection with an abscess which had to be aspirated and a drain installed. I was re-admitted to hospital and put on IV antibiotics for 48 hours. After that the lower section of the wound refused to stop draining, and eventually given the chance to heal my newly remodeled buttock decided it wasn’t going to, so as of March ‘08 I was en-route to surgery No. 4

The detailed account
My experience with the my new surgeon was quite different. He took more time to explain to me what he was going to do and why, he warned me that the z-plasty he planned to do was quite a major surgery and that I would be left with z shaped scar rather like the mark of Zorro, and a large part of my natal cleft would be obliterated, in other words, the crack of my bum would be flattened out. I was prepared for what was going to happen, but even so when I first saw the wound I was a bit shocked, it was quite dramatic. The advantage of a flap closure is that more tissue can be removed without leaving a large open wound which would take a very long time to heal. It also moves good tissue into the mid-line and eliminates the cleft where hair most often enters causing a recurrence. My new surgeon also used Methylene Blue just prior to the surgery which stains the infected tissue and makes it easier to see how far the diseased tissue extends.

Again I was admitted as a day case but told I may have to spend the night. I had a general anaesthetic and when I came round I had very little feeling in the area. because there was a local anaesthetic in the wound and also nerves in the tissue that gets displaced and moved are severed in the process, it often takes several weeks to regain full feeling in the area. I’m not going to go into detail about the mechanics of the z-plasty if you google it you can find out exactly what it involves.

I had a drain which was left in the wound and there was quite a bit of bleeding from the drain, enough that the duty doctor on the ward suspected I may have a haematoma, and that they should keep me in overnight. They duly did this and in the morning it seemed to have stopped bleeding, so the drain was removed and I was allowed home. Of all my surgeries I think the z-plasty was the most comfortable, this could be because there is little tension in the stitches compared to the simple closure, or it could also be simply because the area had a long lasting anaesthetic in it. All my stitches including the ones on the outside were the dissolving variety this time, and when I went in to see the nurses, this time at the hospital, again they commented on how neat and tidy it looked. I must have skin that is easy to stitch up! My healing progressed really well and everyone was delighted by my progress, I was told I was obviously doing the right things. Again I tried to eat well, lay on my side, took my laxatives and got lots of rest. It wasn’t hard since it was Christmas time and that was pretty much what everyone was doing around me! After about 3 weeks I was sitting down for short periods and I was told I was pretty much healed and could bathe and no longer needed a dressing. I was chuffed, this had been pretty easy.

A few days later the wound started to get a bit sore, at first I assumed it was just that I had been more active, but it got progressively worse to the point that I was convinced something was seriously wrong. It was new year’s eve and the outpatients department at the hospital was closed, so I headed off to my GP’s surgery who took one look at it, said it was infected and gave me some antibiotics. Over the next couple of days it got worse and started to bleed and discharge. By the time I next saw my surgeon, a week since I’d last seen him, and he’d pronounced me healed, it was looking pretty awful. He was amazed. I had an ultrasound scan of the wound there and then, that revealed a large abscess in the wound, which the radiologist drained and I was admitted back to the ward that evening for IV antibiotics for 48 hours. That was a horrible 48 hours, I felt awful. I had a drain installed in my bum with a bag attached to it that I had to carry around with me every time I wanted to get up to go to the toilet or eat. I also had the IV attached to my arm most of the time, so moving around in itself without strangling myself, or tripping over a tube was an artform. Added to that, the large dose of antibiotics gave me diarrhea and made me sick. So I was glad that after 48 hours they were happy enough that my infection was under control, and they would let me go home with oral antibiotics.

Although everyone was staying positive for me at that time, I got the feeling that wasn’t going to be the end of it, and sure enough it wasn’t. The wound continued to heal ok but it also continued to drain constantly from the hole where the abscess was drained by the radiologist. This went on for a few weeks, with the nurses (this time at the hospital outpaitents dept) applying a bit of pressure the wound every few days and keeping the hole from closing over to allow the wound to keep draining. Eventually the discharge slowed down and the consultant decided that we would see how it went, if it started to drain or bleed again then that would be that, and it would need some more surgical intervention, he suspected perhaps some hair had entered the wound at the base where it was impossible to shave due to the shape of the suture line. He seemed fairly confident it would be just a clean up operation on a small area which could probably be stiched up. So a few weeks later – the beginning of March ‘08 it was still bleeding and discharging. Surgery No. 4 was beckoning.

I wrote a sort of diary in blog format about the process of healing from my fourth surgery which you can read here (scroll to the bottom of the page for the first entry)