Post-Surgery Care for Fistula: Is Wound Cleaning Necessary?

Is it necessary to clean the wound after a fistula surgery?

Hello Dr.
Ke,
1.
My father underwent a fistula surgery three days ago (with two incisions).
It appears to be a tunnel-type surgical procedure.
The doctor instructed that he needs to insert his finger into the wound (the holes) for cleaning every day, going almost to the depth of his entire index finger.
I couldn't find any similar cases online that mention the need to probe the wound.
Is this action really necessary?
2.
Additionally, the clinic doctor emphasized that no topical medications should be applied, stating that it is to prevent the wound from healing too quickly.
However, I found that most people do apply medication.
What is the difference in this approach?
3.
Many people online have shared that adding Epsom salt during warm sitz baths is beneficial.
Is this really helpful?
Thank you, Dr.
Ke!

Hua Hua, 20~29 year old female. Ask Date: 2017/11/17

Dr. Ke Fangxu reply Surgery

1.
I personally use the tunnel technique less frequently due to its higher recurrence rate.
However, having to poke your finger into the wound every day can be quite painful and may lead to accidental injuries or infections.
Generally, a warm water sitz bath is recommended, but whether it is necessary should be discussed with the surgeon.
2.
The reason for avoiding the application of medications is to prevent incomplete drainage of secretions, which can cause irritation or inflammation of the wound.
If ointment is to be used, it can be applied around the wound as long as it does not seal the wound completely.
3.
Adding povidone-iodine to a warm water sitz bath can help with disinfection and sterilization.
However, if the concentration is too high or the soaking time is too long, it may lead to skin inflammation, so it should be used with caution.

Reply Date: 2017/11/17

More Info

Post-surgery care for a fistula, particularly after a tunneling fistula surgery, requires careful attention to wound cleaning and management. Here are some insights based on your questions:
1. Wound Cleaning Necessity: The instruction to insert a finger into the wound for cleaning may seem excessive and uncomfortable. Generally, the primary goal of cleaning a surgical wound is to prevent infection and promote healing. While it is essential to keep the area clean, the method of cleaning should be gentle and not cause additional trauma to the tissue. In many cases, using saline solution or warm water to gently clean the area is sufficient. The need for deep cleaning with a finger may depend on the specific surgical technique used and the surgeon's preference. It is crucial to follow the surgeon's advice, but if you have concerns about the necessity or safety of this method, it would be wise to seek a second opinion from another healthcare professional.

2. Use of Topical Medications: The surgeon's recommendation to avoid topical medications is likely aimed at preventing the wound from healing too quickly, which could trap bacteria and lead to infection. In some cases, keeping the wound open allows for proper drainage and healing. However, many patients do use topical antibiotics or ointments to help with healing. The key difference lies in the type of wound and the surgeon's assessment of the healing process. If the wound is producing excessive drainage or showing signs of infection, a topical treatment might be warranted. Always consult with the surgeon before applying any medication to the wound to ensure it aligns with their treatment plan.

3. Warm Water Sitz Baths with Iodine: The practice of using warm water sitz baths can be beneficial for post-operative care, especially for anal or perianal surgeries. Adding antiseptics like povidone-iodine can help reduce the risk of infection. However, it is essential to use the correct concentration, as too strong a solution or prolonged exposure can irritate the skin and delay healing. Sitz baths can help soothe the area, promote blood flow, and assist in cleaning the wound without causing trauma. It is generally recommended to limit the duration of the sitz bath to about 15-20 minutes and to ensure the water is not too hot.

In summary, post-surgical care for a fistula involves a balance between keeping the wound clean and allowing it to heal properly. Gentle cleaning methods, careful consideration of topical treatments, and the use of sitz baths can all contribute to a successful recovery. If there are any uncertainties or if the wound shows signs of infection (such as increased redness, swelling, or discharge), it is essential to contact the healthcare provider for further evaluation and guidance. Always prioritize communication with the surgical team to ensure that the care plan is tailored to the specific needs of the patient.

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