Post-Surgery Concerns: Fistula Recovery and Healing Process

Post-fistula surgery

Hello Dr.
Chang, I underwent minimally invasive surgery to remove a fistula on January 3rd of this year.
My recovery had been going well, and I currently have no drainage of tissue fluid, with minimal bleeding or discomfort.
However, during my follow-up appointment today, the surgeon mentioned that there is some skin breakdown at the surgical site and prescribed me a penicillin ointment.
He also noted that granulation tissue is forming at the wound, and if it continues to grow, it may need to be debrided.
I would like to ask: 1.
Does this indicate a potential recurrence of my fistula? 2.
I read online that the presence of granulation tissue is a normal part of the healing process; why would it need to be debrided? 3.
I have heard that surgical wounds from fistula procedures typically heal within a month; is my recovery taking too long? 4.
A colleague suggested that I take traditional Chinese medicine and purchase health supplements to increase zinc intake to aid in wound healing; is this advisable? 5.
The doctor advised me to sleep early, but I find it difficult to fall asleep before midnight.
If I use sleep aids to help me sleep, will this have any effect on my wound healing?

Joey, 30~39 year old female. Ask Date: 2023/01/31

Dr. Zhang Shuhao reply Surgery

1.
There is no swelling, pain, or discharge, which does not resemble a recurrence, and it is unlikely to have recurrence issues shortly after surgery.

2.
Granulation tissue that grows beyond the necessary range for wound healing can lead to poor healing and is prone to bleeding from friction; it can be treated in the outpatient setting with silver nitrate cauterization to aid healing.

3.
Healing is not too slow; for fistula wounds, a recovery period of six to eight weeks post-surgery is considered normal, depending on the extent of the wound.

4.
Yes, dietary supplements generally have no adverse effects, but medications should be used under a physician's guidance.

5.
As long as there is adequate rest and minimal stress, there is usually no need for special sleep aids.

Reply Date: 2023/01/31

More Info

Post-surgery recovery, especially after a procedure like fistula removal, can be a complex process that requires careful monitoring and management. Based on your concerns, I will address each of your questions in detail.

1. Signs of Recurrence: The presence of broken skin at the surgical site does not necessarily indicate a recurrence of the fistula. It could be a normal part of the healing process, especially if the area is still recovering. However, it is essential to keep an eye on any changes in the wound, such as increased redness, swelling, or discharge, as these could signal an infection or other complications. Regular follow-ups with your surgeon are crucial to monitor the healing process.

2. Granulation Tissue: Granulation tissue is indeed 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, excessive granulation tissue, often referred to as "proud flesh," can impede healing and may need to be removed to allow for proper closure of the wound. Your surgeon's recommendation to scrape away the excess granulation tissue is likely aimed at promoting better healing and preventing complications.

3. Healing Timeline: While many surgical wounds, including those from fistula surgeries, can heal within a month, individual healing times can vary significantly based on several factors, including the extent of the surgery, your overall health, and how well you follow post-operative care instructions. If you are concerned about the speed of your recovery, it would be beneficial to discuss this with your surgeon. They can provide insights based on your specific situation and may suggest additional interventions if necessary.

4. Supplements for Healing: The use of traditional Chinese medicine and supplements like zinc can be beneficial for wound healing, as zinc plays a crucial role in cell division and protein synthesis. However, it is essential to consult with your healthcare provider before starting any new supplements, as they can interact with other medications or conditions. Your doctor can provide personalized advice on the best approach to support your healing process.

5. Sleep and Healing: Sleep is vital for recovery, as it allows your body to repair itself. If you are having trouble sleeping before midnight, consider establishing a calming bedtime routine to help you relax. While sleep aids can be effective, they should be used cautiously and under the guidance of a healthcare professional, as they can have side effects and may not address the underlying issues affecting your sleep. Improving your sleep hygiene—such as reducing screen time before bed, maintaining a consistent sleep schedule, and creating a comfortable sleep environment—can also enhance your overall recovery.

In summary, while your recovery seems to be progressing well, it is essential to remain vigilant about any changes in your surgical site. Follow your surgeon's recommendations closely, and do not hesitate to reach out to them with any concerns. Healing is a multifaceted process that involves not just physical recovery but also emotional and psychological well-being. Taking care of your overall health, including nutrition, sleep, and stress management, will contribute positively to your recovery journey.

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