Post-Surgery Granulation Tissue Issues After Anal Fistula Repair

Abnormal granulation tissue formation after anal fistula surgery?

Hello Dr.
Chang, I apologize for bothering you again.
Last week on January 16, I inquired about the healing time after anal fistula surgery (https://adoctor.tw/article/177648).
In your response, you mentioned that sometimes granulation tissue can grow excessively and cover the surrounding skin, requiring slight trimming.
However, even if left untreated, it usually grows back slowly.
In fact, during my follow-up on January 10, I had some bad granulation tissue removed, and an anoscopy was performed (the doctor said there was no recurrence).
The wound photo from January 9 shows that the proliferative granulation tissue had already covered the healing area (https://ibb.co/BgTB4Sy).
During the follow-up, I reported abnormal granulation tissue near the anal opening, and the wound photo after the doctor's treatment is as follows (https://ibb.co/rtG9tpk).
After that, on January 16, I inquired again about the healing time after anal fistula surgery, and a few days later, the abnormal granulation tissue that was removed near the anus started to proliferate again.
The proliferative granulation tissue even began to separate from the upper granulation (https://ibb.co/2SqGS6s), and the granulation tissue near the anal opening is separating (https://ibb.co/N7716xH).
During the follow-up on January 24, I reported that the area where the abnormal granulation tissue was removed had grown back.
After examining the wound, the doctor only mentioned that it would heal slowly and did not remove the abnormal granulation tissue again.
As of January 27, 78 days post-surgery, the wound looks like this (the abnormal granulation tissue is similar to what it was on January 9) (https://ibb.co/27dVD9y).

Finally, I would like to ask a few questions:
1.
Is it normal for abnormal granulation tissue to grow back within about a week after removal?
2.
You mentioned that even if left untreated, it usually grows back slowly.
Will this proliferative abnormal granulation tissue eventually fall off on its own?
3.
The wound has been producing yellowish-white discharge, as shown in the photos.
Should this discharge be considered tissue fluid? (https://ibb.co/fp9fcHh, https://ibb.co/YkDzXmg)

Tom, 20~29 year old female. Ask Date: 2022/01/27

Dr. Zhang Shuhao reply Surgery

The formation of granulation tissue is a normal step in the wound healing process, so its growth is a sign of healing.
It only needs to be trimmed if it grows excessively; otherwise, it will remodel on its own.
Based on the photo, your wound is actually getting smaller and healing well.
The yellowish-white color is a mixture of ointment and some tissue fluid, which is normal and indicates no infection after some time.
The surgeon who performed your operation did an excellent job, and you just need to return for regular follow-up appointments for monitoring.

Reply Date: 2022/01/27

More Info

After undergoing anal fistula repair surgery, it is not uncommon to experience issues related to granulation tissue, which can be a source of concern for many patients. Granulation tissue is a normal part of the healing process, but when it becomes excessive or abnormal, it can lead to complications. Based on your description and the images provided, let's address your questions and provide some additional context regarding post-surgery healing and granulation tissue.

1. Is it normal for abnormal granulation tissue to regrow within a week after removal?
Yes, it is relatively common for granulation tissue to reappear after being surgically removed. Granulation tissue is composed of new connective tissue and blood vessels that form during the healing process. While it is a sign that healing is occurring, excessive growth can occur, especially in areas of irritation or trauma. The regrowth of granulation tissue can be influenced by factors such as the surgical site’s moisture level, friction, and overall healing environment. If the tissue is not causing pain or other complications, it may be best to monitor it rather than remove it repeatedly.

2. Will the excessive granulation tissue eventually resolve on its own?
In many cases, excessive granulation tissue will eventually resolve on its own as the healing process continues. The body typically reabsorbs this tissue over time. However, if the granulation tissue is causing discomfort, obstructing healing, or leading to other complications, further intervention may be necessary. Your healthcare provider may suggest treatments such as topical steroids or other modalities to help reduce the granulation tissue if it becomes problematic.

3. Is the yellowish-white discharge normal, and is it tissue fluid?
The presence of yellowish-white discharge can be concerning, but it is not uncommon after surgery. This discharge can be a combination of tissue fluid, pus, and other secretions from the healing tissue. If the discharge is not accompanied by signs of infection (such as increased redness, swelling, or a foul odor), it may simply be part of the normal healing process. However, if you notice any changes in the discharge, such as an increase in volume, a change in color, or if it becomes foul-smelling, it is essential to contact your healthcare provider for further evaluation.

Additional Considerations:
- Wound Care: Continue to follow your surgeon's recommendations for wound care, including keeping the area clean and dry. Regular sitz baths can help soothe the area and promote healing.

- Follow-Up Appointments: Regular follow-ups with your surgeon are crucial for monitoring the healing process. Be sure to communicate any concerns or changes in your symptoms during these visits.

- Signs of Infection: Be vigilant for signs of infection, such as increased pain, fever, or a significant change in discharge. If you experience any of these symptoms, seek medical attention promptly.

- Patience in Healing: Healing from anal fistula surgery can take time, and it is essential to be patient with your body as it recovers. Each person's healing process is unique, and while some may experience complications, others may heal without issues.

In conclusion, while the presence of abnormal granulation tissue and discharge can be concerning, they are often part of the healing process. Regular communication with your healthcare provider and adherence to post-operative care instructions will help ensure the best possible outcome. If you have any further questions or concerns, do not hesitate to reach out to your medical team for guidance.

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