What to Expect during My Post-Op Recovery from the Pilonidal RAF (Rotation and Advancement Flap)/Cleft Lift Procedure
Most patients experience a routine post-operative recovery, which looks as follows:
- Mild discomfort for around a week or two
- Drain output meets drain removal criteria around post-op day 8 (less than 15 ccs/day x 2 days)
- Able to start to exercise a day or so after the drain is removed
- Able to return to full activity around 1 month after the drain is removed
Some patients, however, hit some bumps in the post-op road which can delay their complete recovery. So, what are these bumps? What can go wrong and how can one handle them? Most importantly, if you feel something is going wrong, please contact Dr. Sternberg to discuss it.
Wound Infection
This is a rare occurrence as you will be on an antibiotic for 2 weeks after surgery. Some patients, however, are already infected with bacteria that the prescribed antibiotic may not cover. If a wound infection develops the flap may become red, or the fluid in the drain may become cloudy. You must contact Dr. Sternberg as your antibiotics may need to be changed. On rare occasions this can lead to some wound separation. Also, if there is a significant amount of fluid draining through the incision (enough to soak through a few layers of gauze pads) please get in touch with Dr. Sternberg.
Odd Change in the Color of the Drain Fluid
The fluid in the drain is most commonly red for the first few days following surgery. It then may become pink and eventually have a “straw” coloration and may appear “oily”. It is expected to see string-like solid material and particles in the fluid. However, should the fluid start to become milky, brownish, greenish or have a foul odor it may indicate an infection that is not covered by the antibiotic that you are taking. If this occurs, please get in touch with Dr. Sternberg.
Wound Separation
This problem occurs in around 20% of patients. The following factors appear to predispose some patients to develop this post-op problem:
- Previous pilonidal surgery, especially if a moderate or large amount of soft tissue had been removed during the prior surgery
- Significant infection at the time of surgery
- Being overweight, particularly around the hip area
If there is a wound separation, it often occurs anywhere from 1-3 weeks after surgery when the skin sutures begin to dissolve. It may progress for a week and then stabilize. Sutures that take longer to dissolve can cause other issues, so using sutures that dissolve more rapidly seems to be a better compromise. Usually, if there is some skin separation, it will occur in the lower third of the incision close to the anus. This likely happens for the following reasons:
- There is more tension in that portion of the incision
- Wiping the area after a BM irritates that area more
- That skin is naturally more fragile
- It’s exposed to less air
What else can lead to wound separation:
- Falling on your wound in the early postoperative period
- Developing a clogged drain that leads to seroma (fluid) collection
- Premature drain removal
- Wound infection
What should you do if you develop some degree of wound separation?
1) DON’T PANIC! Most of the time, this does not threaten the eventual excellent outcome of the operation.
What can I expect if I develop some post-op wound separation?
Once the wound separation stabilizes, it should heal, which may take 1 to 2 months. Please stay in contact with Dr. Sternberg during this process and he will advise you about activity. Often after a week or 2 you can exercise. Applying a wound hydrogel to the wound often speeds healing. We recommend Medihoney Gel, which is available at Walmart.com or Amazon (it’s worthwhile spending $50 and buying the 10 tube box as you will go through the 1/2 oz. tube very quickly). You should shower and wash the wound well with soap. After showering, dry the area well, apply the Medihoney directly to the open wound, and cover with gauze. Please keep a piece of folded gauze in the remaining buttock crack to promote air circulation. You don’t need to shower twice a day but do apply the Medihoney twice a day. If you cannot order it, Manuka honey (available at Whole Foods or a health-food store works, it’s just a bit more goey).
A few other post-op pointers:
- Please don’t dry the open portion of the incision with a hair dryer anymore, as you want to prevent a scab from developing. Should a scab develop, please stop using the Anacept and apply Vaseline petroleum jelly twice daily until the area appears healed.
- We will want you to update us weekly until the healing appears to be headed in the right direction.
