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Problems During Healing

Most people have no problems healing, but the process can be a real challenge for some people. Below is a list of the primary reasons a wound isn't healing or is healing far too slow.

  1. Lack of Oxygen: The natal cleft is not just a place where the sun doesn't shine, it's also a place that gets very little oxygen. Lack of oxygen creates an environment where anaerobic bacteria thrive and that bacteria can bring healing to a full stop. The lower the surgical wound, the less oxygen it will receive - which is why many people have difficulty healing surgical wounds deep in the lower cleft. In a perfect world, your surgeon did most of their cutting "out of the ditch" to keep the suture line or open wound in an area where it will get oxygen.

    If you were not so lucky as to have a surgeon who kept your wound off the midline, you can help yourself during healing by exposing the wound area to oxygen as much as possible. This will sound a little odd but we must do what we must do.... Some forum members have used techniques of sitting in the jackknife position twice daily (bottoms up!) to keep the cheeks spread apart and get oxygen into the cleft. Some have even used tape to keep their buttocks apart.

    Our surgical advisory group is working on a "cigar" vent to use in the area that can left in place all day during normal activities. This is an easy-to-make at home way of providing a break in the air seal of the buttocks so that air can get to the wound. Getting oxygen to the wound is the first place to look if you are having a healing problem.

  2. Poor nutritional habits or poor general health:
    • Eat right and take vitamins. No Fast Food!
    • RELAX! It has been proven that stress impairs your immune system and slows down healing.
    • CHILL OUT! Research has shown that anger slows healing. Those who control their anger heal faster than those who have a short boiling point.
    • Avoid using antibiotic ointments (Neosporin, Bacitricin, etc.) These are proven to frequently cause allergic reactions and contact dermatis with regular use.
    • Try doing sitz baths with Epson Salts in the water.
    • Make sure you are getting at least 60 grams of high quality protein daily.
    • Breathe. Deeply and slowly. Healing uses a lot of oxygen from the bloodstream. Try an exercise of doing 5 minutes of deep breathing, three times a day.
    • Make sure you are changing your packing at least twice daily.
    • Try some of the high-tech dressings and ointments to speed healing.
  3. The third thing to look at is infection:
    • Is the wound inflamed, painful, or draining a bad smelling fluid? See a doctor ASAP, especially if you are running any kind of fever.
    • It could be hair or debris getting into the wound and causing irritation.
    • It could be that a sinus or a section of the cyst was missed during surgery.
    • Any surgical wound infection is serious business. If you think for one minute that you might have an infection, get to the doctor ASAP. Left untreated, wound infections can turn into Sepsis (infection moves into the blood) which will require hospitalization and can be fatal.
    • Closed incisions are infamous for infections. Once the swelling starts to go down by day 4 or 5, keep a close watch on the incision for redness, pain and discharge. See above notes on surgical wound infection....
  4. Do you possibly have undetected diabetes or an immune system disorder? One of the symptoms is slow healing wounds. Levels of diabetes have been skyrocketing in the general population, a simple fasting blood test should tell you if you are at risk.

  5. Unhealed Wound Areas Low in Cleft: It is not at all uncommon to have a small section at the bottom of the incision fail to heal, usually it is because this section gets less oxygen due to location. Advanced care products such as Multidex Powder can help. Also try the recommendations above in #1 for getting more oxygen to the wound. Extra cleaning of the area with Hibiclens might also help lower the bacteria level.

  6. Wound Healing Centers: Once you have ruled out the above possibilities, it is time for a Wound Care Center. Most major cities have one, just check the phone book or call the hospital to ask. Wound Care Specialists are the SWAT team of healing, all they do is treat wounds and they are far more knowledgeable than your surgeon. Your surgeon has gone through extensive training in cutting and sewing, a Wound Care Specialist has gone through extensive training in wounds. Surgeons frequently are not the best at things like aftercare and wound healing, which is why we recommend that if it has taken longer than 4 months to heal your wound, it's time to bring in the professionals...
  7. Other things that can go wrong: These are fairly rare occurrences, but they do happen.
    • Hematomas - a pocket of blood, or clot, in the wound. More likely to happen in closed wound incisions. These need to be opened up to drain or removed since they can become infected.
    • Seromas - this is an accumulation of fluid in the "dead space" of the surgical wound. Unlike an abscess, this is not an infection, just a pooling of fluid. More likely to happen in closed wound incisions or in an open wound that has closed over at the top too quickly, leaving "dead space" open underneath. Some of these may resolve themselves, but most need to have the fluid drained and the "dead space" needs to be closed, either by deep suturing or by re-opening the top of the wound and packing until it heals from the bottom up.
    • Wound Breakdown (dehiscence) - this is a softening of the wound tissues that can happen in the deep layers or the top skin layers. In a closed incision, this means that the sutures can't hold and the patient needs to resort to open healing. If you are hearing the words "wound breakdown" from your doctor, get a referral to a Wound Care Center ASAP. Do not ask your doctor to go this one on his/her own, no matter how great or competent they are. Wound breakdown is a disruption and bursting open of a surgical suture line.
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Consider a Wound VAC:

Vacuum-assisted closure (VAC) is a non-invasive technique whereby negative pressure is delivered in a uniform manner to a wound. This encourages the arterioles to dilate, so improving blood flow, promoting a moist environment and assisting in the proliferation of granulation tissue. A foam dressing is cut to the shape of the wound and then applied over the wound. Suction tubing is inserted into the foam dressing and the foam and suction tubing covered with an occlusive film dressing, prior to connecting the tubing to the suction pump. The negative pressure can be either continuous or intermittent, and can be administered at between 50 mmHg to 200 mmHg depending on patient comfort (Baxandall, 1996). The use of the VAC system has resulted in progressive wound closure in cavity wounds, and is now often used on patients in the community as well as in the hospital setting.

Read Cathy's experience with a Wound VAC

More info on VAC

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This page last updated: 11/10/2010

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Dehiscence

Dehisce...wound may partially or completely burst or break open after surgery, depending upon whether some or all of the layers of tissue come open. The noun is dehiscence. From the Latin dehiscere (to split open).