Post-Surgery Complications: Changes in Fistula Wound Healing

Abnormalities in the wound after fistula surgery?

In August, I underwent a LIFT surgery for anal fistula, and on November 1, it recurred (pus formed at the previously healed wound site), requiring another surgery.
Currently, it has been 11 days since the operation.
I've noticed that the wound looks different compared to the previous days; it was previously a smoother wound, but yesterday I discovered a deep red-black spot inside the wound.
Initially, I thought it was residual feces, but when I cleaned it with a cotton swab, I realized it was another wound within the original wound.
After I poked and ruptured it, a small amount of blood came out, but it doesn’t continuously bleed.
However, I feel like there is a small circular indentation (approximately 0.1 to 0.2 cm in diameter).
The image link is: https://ibb.co/v11VHwP.

Today, when I changed the dressing, I noticed that the indentation appears deep red (it looks like a condition after blood has coagulated), and it still bleeds a little when poked.
My questions are: What could this situation be? Is it normal? Since poking it makes it look like the image at the bottom, should I leave it alone and not poke it again? Or should I poke it to let the blood flow out? The area above the wound is near the anus, which makes it prone to residual feces.
Can I use a cotton swab dipped in saline solution for cleaning? Would excessive cleaning damage the mucosa? I am a bit worried since my follow-up appointment is still a few days away.

Nìmíng, 30~39 year old female. Ask Date: 2021/11/12

Dr. Zhang Shuhao reply Surgery

The image shows an open wound following a repeat fistula surgery, with granulation tissue beginning to form at the base of the wound, which is a normal postoperative condition.
The hole beneath the wound is a cavity formed by the original fistula extending subcutaneously (considered the distal end of the fistula).
As long as it is not too deep, there is still a chance for gradual healing.
Since granulation tissue is relatively fragile, vigorous rubbing may easily cause bleeding.
If there are secretions, you can gently press around the area during dressing changes to expel them before applying ointment.
If you are concerned about residual feces in the wound, you can rinse it with clean water, but avoid vigorous rubbing.
Continue with regular dressing changes and return for follow-up appointments as scheduled; there is no need to worry excessively.
Wishing you a speedy recovery.

Reply Date: 2021/11/12

More Info

Post-surgery complications, especially following procedures like the LIFT (Ligation of Intersphincteric Fistula Tract) surgery for anal fistulas, can be concerning for patients. Your situation, where you have noticed changes in your wound healing, is not uncommon, but it does warrant careful attention and management.

Firstly, the appearance of a deep red or black spot within the wound that you described could indicate several things. It might be a sign of granulation tissue, which is a normal part of the healing process, or it could be indicative of a developing abscess or necrotic tissue. The fact that you noticed a small indentation or a "pocket" in the wound, especially if it is accompanied by bleeding, suggests that there may be some underlying issue that needs to be addressed.

In terms of whether this is normal, it is essential to understand that while some changes in wound appearance can be expected as healing progresses, any new or worsening symptoms should be evaluated by a healthcare professional. The presence of blood, especially if it is not just a small amount, can indicate that the wound is not healing as it should. It is crucial to avoid picking at the wound, as this can introduce bacteria and lead to infection or further complications.

Regarding your question about cleaning the area, maintaining hygiene is vital, especially in the anal region where fecal matter can easily contaminate the wound. Using a cotton swab with saline solution to gently clean the area can be appropriate, but you should avoid aggressive scrubbing or over-cleaning, as this can disrupt the healing tissue and the delicate mucosal layer. It is best to follow the advice of your surgeon or healthcare provider regarding wound care, as they can provide specific instructions tailored to your situation.

If you are concerned about the wound's appearance or if you experience increased pain, swelling, or discharge, it is advisable to contact your surgeon or healthcare provider before your next scheduled appointment. They may want to assess the wound sooner to ensure that there are no complications such as infection or improper healing.

In summary, while some changes in wound appearance can be part of the healing process, any new symptoms, especially those involving bleeding or unusual coloration, should be evaluated by a medical professional. Maintain good hygiene practices without over-cleaning, and do not hesitate to reach out to your healthcare provider with any concerns. Your health and recovery are paramount, and proactive communication with your medical team is essential to ensure a smooth healing process.

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