Post-Surgery Concerns: Managing Granulation Tissue and Discharge

Q: Post-Surgery Concerns: Managing Granulation Tissue and Discharge

Hello： New granulation tissue can be observed for 2 months.

Post-operative issues following fistula surgery?

I had surgery on April 14, and the condition of the wound at that time was as follows: [link to image].
After that, until May 24, the granulation tissue grew excessively and the wound was not healing, so I underwent electrocautery.
Before the electrocautery: [link to image].
Now, as of July 1, I still take a sitz bath once a day, but there is still a little bit of discharge: [link to image] [link to image].
It's about the amount that can be cleaned with two wipes of toilet paper; it's not a lot, just a little.
Last week, I went back for a follow-up, but the doctor said I didn't need to return.
The nurse also told me that I no longer need to apply the antibiotic ointment, as the wound inside needs to heal on its own.
However, it has been two and a half months since my surgery, and while the wound does not hurt, there is a small hard lump where the granulation tissue has formed (the doctor told me that this is normal for granulation tissue).
Is this really normal? Should I consider seeing another doctor for an examination? Given the current pandemic situation, I am very anxious.
I am afraid of a recurrence and delays in seeking medical attention.
I hope the doctor can help me.

Xiao Wei, 20~29 year old female. Ask Date: 2021/07/01

Dr. Yu Mingchang reply Surgery

Hello: New granulation tissue can be observed for 2 months.

Reply Date: 2021/07/01

More Info

Post-surgery concerns, particularly regarding the management of granulation tissue and discharge, can be quite common and understandably distressing for patients. Based on your description, it appears that you have been experiencing issues with excessive granulation tissue and some discharge from your surgical site for over two months. Here’s a comprehensive overview of your situation, along with some medical insights.

Understanding Granulation Tissue
Granulation tissue is a normal part of the healing process. It consists of new connective tissue and tiny blood vessels that form on the surface of a wound during the healing process. However, when granulation tissue becomes excessive, it can impede healing and lead to complications. This condition is often referred to as "proud flesh."
In your case, it seems that the granulation tissue was significant enough to warrant electrosurgery (cauterization) to reduce its volume. This procedure is typically effective in managing excessive granulation tissue, allowing the wound to heal more appropriately.

Discharge and Healing
The presence of a small amount of discharge, especially if it is not accompanied by pain, redness, or increased swelling, can be considered normal as the wound continues to heal. The discharge you describe, which is minimal and manageable with a tissue, suggests that your body is still in the healing phase. However, it’s crucial to monitor the characteristics of the discharge. If it changes in color, becomes foul-smelling, or increases in volume, these could be signs of infection that would require immediate medical attention.

Pain and Hardness
The hard area you feel beneath the granulation tissue is likely a result of the healing process. As granulation tissue matures, it can become firmer. This is generally a normal finding, but if you experience increased pain or if the hardness continues to grow, it would be wise to consult your healthcare provider.

When to Seek Further Medical Attention
While your healthcare team has advised that no further follow-up is necessary, your concerns are valid, especially given the duration of your symptoms. If you feel uncertain about your healing process or if your symptoms change, it is always appropriate to seek a second opinion or consult another healthcare provider. In the context of the ongoing pandemic, many healthcare facilities offer telehealth services, which can be a convenient way to address your concerns without the need for in-person visits.

Recommendations for Care
1. Continue Wound Care: Maintain your current wound care regimen as advised by your healthcare provider. If you are unsure about the use of topical antibiotics or other treatments, clarify this with your doctor.

2. Monitor Symptoms: Keep an eye on the wound for any signs of infection (increased redness, warmth, swelling, or discharge). If these occur, seek medical attention promptly.

3. Avoid Irritation: Be gentle with the area, avoiding any unnecessary pressure or friction that could irritate the granulation tissue.

4. Follow-Up: If you continue to have concerns about the healing process or if the discharge persists beyond what you consider normal, do not hesitate to reach out to your healthcare provider for further evaluation.

5. Stay Informed: Educate yourself about the healing process and what to expect post-surgery. This knowledge can help alleviate anxiety and empower you to take an active role in your recovery.

In conclusion, while some discharge and granulation tissue are normal during the healing process, your comfort and peace of mind are paramount. If you have any lingering doubts or if your symptoms change, seeking further medical advice is always a prudent choice. Your health and recovery should be your top priority, and it’s essential to feel confident in the care you are receiving.

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