Post-Surgery Recovery: Anal Fistula Healing Process - Surgery

Post-operative wound healing after fistula surgery?

---

Hello Dr.
Ke, I had a bit of a lapse in memory around the end of June when I developed an "anal abscess" due to frequent wiping from diarrhea.
Initially, I was unaware of the condition and visited a small clinic where I was prescribed painkillers and anti-inflammatory medication.
After about a week, the situation worsened, and by July, I was in severe pain.
I decided to take a leave of absence and went to a larger hospital for a consultation.
The doctor diagnosed me with an "anal abscess" and informed me that it had become quite serious due to the delayed diagnosis.
The swelling was significant, and if I had waited a few more days, it could have progressed to cellulitis and affected my sphincter.
The doctor indicated that this was an urgent situation and arranged for surgery that same day, which I underwent.
The surgical wound was very deep and open, and I was hospitalized for three days for observation before being discharged.
I was instructed to care for the wound with sitz baths four times a day, increasing to more if I had a bowel movement, with 10 minutes of rinsing and 15 minutes of soaking.
I had multiple follow-up appointments for the doctor to monitor the wound and assist with cleaning areas that my family was hesitant to handle.
However, the healing process was not going well.
I had two instances of silver nitrate treatment in the clinic, and the wound gradually began to heal, becoming smaller inside, but it was still difficult to clean.
"However, it no longer hurt" because the wound had shrunk, but it was not completely healed.
During my last follow-up in mid-October, the doctor noted that the outer layer was closing up, but the tissue inside had not healed properly and was still deep.
The doctor suspected that it might be due to the previous silver nitrate treatment or a recurrence of the anal abscess, potentially leading to an anal fistula.
The doctor asked if I wanted to proceed with a second surgery, explaining that having an anal fistula was problematic as it could easily lead to a recurrence of the abscess.
Upon hearing the word "recurrence," I promptly agreed to the second surgery to seek a definitive cure, which was scheduled for the end of October (second surgery - anal fistula repair).
After the surgery, the doctor explained that this time it was not a recurrence of the anal abscess.
Upon opening, there was no pus present; it was simply that the wound was too deep and the previous silver nitrate treatment had caused complications.
I felt much relieved after hearing this, but since the entire anal fistula was excised, the surgical wound was deeper than the first time, and I was again hospitalized for three days for observation before being discharged.
The wound care regimen was the same as after the first surgery, with sitz baths four times a day, increasing with bowel movements, and the same rinsing and soaking routine.
Since the second surgery, I have had four follow-up appointments.
My family helps me clean the wound, but it is still very deep, and there is a piece of white tissue that I do not know what it is.
It does not hurt when I touch it with a cotton swab, but it feels quite hard.
I have mentioned this to the doctor during each of the four follow-ups, but after examining the wound and performing debridement, the doctor reassured me that it was not a problem and that the white tissue would gradually fall off.
After that, the appointments concluded, and I was told to return in two weeks.
Today, I am posting to inquire, Dr.
Ke, that I am currently 43 days post-second surgery, with nine days until my next follow-up.
The external wound is slowly healing and shrinking, although it is still quite large and deep.
"However, it does not hurt at all." My family is concerned about the white tissue still being present and worries that if it does not fall off, it may prevent the underlying tissue from healing properly, potentially leading to a situation similar to the first time where the skin closes up and forms an anal fistula again.
Before each sitz bath, I observe the gauze, and there is almost no discharge left; most of it is just the anti-inflammatory ointment applied around the wound.
My family is very worried that if a third surgery is needed, it would be disheartening, especially after such a long time.
After each sitz bath, my family helps clean the wound with cotton swabs, and they have been gently trying to address the white tissue, but there has been no noticeable change or feeling that it will fall off.
Dr.
Ke, do you think the presence of that white tissue is normal?

---

Jerry, 20~29 year old female. Ask Date: 2017/12/06