What to expect During My Recovery from the Cleft Lift Procedure/Pilonidal RAF (Rotation and Advancement Flap)
Most patients experience a routine recovery which looks as follows:
- Mild discomfort for around a week or two
- Drain output meets drain removal criteria around postop day 8 (less than 20 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 drain was removed
Some patients, however, hit some bumps in the 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 that something is going wrong, please reach out to Dr. Sternberg to discuss.
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 may not be covered by the prescribed antibiotic. If a wound infection develops the flap may become red, or the fluid in the drain may become cloudy. It’s important that you contact Dr. Sternberg as your antibiotics may need to be changed. On rare occasions this can lead to some wound separation.
This problem occurs in around 10% of patients. The following factors appear to predispose some patients to develop this problem:
- Previous pilonidal surgery
- Significant infection at the time of surgery
- Being overweight
If there is a wound separation, it often occurs around 2-3 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 on 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 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.
2) contact Dr. Sternberg.
What can I expect if I develop some wound separation?
Once the wound separation stabilizes it should go on to heal, and this process may take 1 to 2 months. Please touch base 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 Anacept gel which is available at many pharmacies and on Amazon. You should shower and wash the wound well with soap. After showering, dry the area well and apply the Anacept directly to the open wound. 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 Anacept twice a day.