Post cleft lift, bottom opened! Need advice please


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Hello! This may be a long post, so I apologize in advance. I’ve gotten such good advice and research through this website, it ultimately lead me to my cleft lift surgeon Dr. Caplan in Philadelphia. I can’t thank everyone enough for sharing their stories and experience!!

Little background, I’m a 29 year old female, not overweight or hairy ;) I had a previous surgery to remove my first Pilonidal cyst almost 9 years ago. Aside from a minor infection post op- it healed nicely and I never thought about it again. Within th last year, I had 2 flare ups. I decided it was time to do some research on what to do next. From this website, I found a surgeon closest to me (still 2 hours away in Philadelphia) but decided that the cleft surgery and ultimately a cure were worth the travel.

1/11/18- I had my cleft lift performed by Dr. Caplan. Everything went smoothly and I was very happy with all the nurses and Dr. Caplan. He even went out to talk to my mom when I was in recovery! He was the only doctor she saw do that on that day. He did not place any drain at this time, as he said it wasn’t that bad and I didn’t need it. I was placed on 2 antibiotics daily.

I was in some pain, but was able to make the 2 hour trip home. For the next few days, I relied on the pain meds he prescribed. I thought I was tough, but I was very sore! I had some tape on that was to be left on until my follow up but I was able to shower etc. I had a BM without issue, thankfully .

Day 5- I no longer needed pain meds and I saw Dr. Caplan in the office. He removed the tape and said it looked good and sent me on my way. He also said I could stop the antibiotics.

Day 7- started to see some blood after I sat to pee. I called the office and they said that was normal at times. However, it got worse and I had some increased drainage. I sent pictures and they said it looked as though it had come apart at the bottom slightly but I was to follow up in the office in 2 days so to take it easy and try cleaning it as best as I could.

Day 10- today I just saw Dr. Kaplan, and he said I had a small opening at the bottom. He said my incision had started to drain some, creating the opening. He removed some tissue and put one small stictch back in. He doesn’t want to close it up all the way as he wants to allow it to continue to drain. I was told to do wet to dry dressings twice daily and follow up with him again next week. He put me on Bactrim as a precaution for infection and said it should close in about 2 weeks. He removed the top stitches and said things looked okay. While he would’ve liked me to have progressed a little more and not have this opening, he still had faith it will heal without issue, just a little longer.

MY QUESTION- is this normal? I read so many success stories and I am so disheartened. I’ve also read some experiences of this happening, and am sad I have fallen into this category. Is there anything I can do to help this heal as quickly as possible? He came highly recommended for the cleft lift surgery and I respect his opinion. I’ve babied this incision post op, haven’t sat- laid around on my stomach and sides. I’ve done everything right, and am just super bummed

Any advice would be greatly appreciated
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I replied on the other post, but will add a little more here regarding my son's cleft lift with Sternberg:
My son had a passive drain in for 12 days. I pushed fluid out of it, per surgeon's instructions, 3x a day by rolling rolled up gauze from the bottom of incision to the drain opening. It was to be removed at day 9 but he still had a lot of fluid coming out when I rolled it so the surgeon had me wait a few extra days. We were over 2000 miles from surgeon so I was taught how to care for his incision and I kept in constant contact with surgeon via texting and phone calls. I am not a medical professional, but maybe your incision opened from fluid pressure. The fluid was normal for my son.
My son had 3 places where the incision split. Each was about 1 cm in length and all were just on the top surface of skin, not deep enough to bleed.
He also had a stitch abscess near the bottom of the incision that required one application of silver nitrate. He is completely healed now:)

I know that it is easy to put too much pressure on yourself to do everything perfectly. Relax, follow the surgeon's instructions, and take care of yourself. Eat as healthy as possible and rest. You will know by the 6 weeks mark if you are healed. If you are not, as I mentioned in earlier post, send some photos and info to Dr. Sternberg and/or Dr. Bascom for a second opinion. You will be healed, be encouraged.
I can’t thank you enough for replying! I tend to be a worrier and while only a little over 2 weeks post op, I guess I still expected to be further along healing wise. I’m finding this is pretty normal what is happening. While I don’t wish it on anyone else, it’s nice to not feel so isolated in all this. It’s embarrasing to talk about, and most friends/family have no idea what this even is. So it’s hard to have conversations regarding it.

This past week I’ve seen some improvement with swelling, drainage, etc. It’s still draining some so I can’t expect it to close yet but I’m seeing some improvement, so I know I’m heading in the right direction I follow up again with Dr. Caplan tomorrow and will get his verdict as well!
I truly understand. While I am not the one who physically suffered with this, my son did, I walked with him for over 6 years in it. I understand, to an extent, the embarrassment and inability to talk about it with anyone. No one can see your wound so that just adds to the lack of understanding. It seems very common for fear and worry to be a part of this as well. My son had 4 previous failed surgeries and the slightest hint that it might be getting infected would put me back in a place of fear and pain. I would send his surgeon a picture and describe my concern. Dr. Sternberg would pretty quickly text back or call and he always relieved my fear. I am so glad that you are going to your surgeon tomorrow. Post what he says, if you feel comfortable doing that. I know myself, and others on this thread, would like to know.

I saw Dr. Caplan yesterday, I’ve officially graduated to seeing him in 2 weeks rather than weekly! YAY LOL

Overall, he wishes I was further along in healing but he is happy that the swelling and redness has gone down greatly. It is still draining some sero-sang draininage from that opening at the bottom. He said due to fluid pressure and build up, that’s why it opened. As the draining starts to subside in the next few days, he’s confident it should start to close on its own. It’s pretty superficial, looks clean and healthy, and only about an inch opening. It’s off the midline (thankfully).

He’s released me to be as active as I can tolerate, within reason (obviously no squatting ;) ) while I’m not going for a run or to the gym anytime soon, it’s a huge relief to be able to be given the go ahead to walk my dogs, drive and try to get back to “normal”.

I’m cleaning it and changing the gauze about 2 times per day (unless I get sweaty or something, then more often) doing the cigar method to keep it dry and get some air. I’m doubling my protein and Vitamin C, holding my nose and chugging bone broth to get vital nutrients LOL I will close this damn thing!!!
That is great news!!! Good news too that the opening is off the mid-line! My son used the cigar method to keep air to the bottom area where he had split stitches and later a stitch abscess. You are doing all of the right things with caution in getting back to working out and the essential nutrients to heal as quickly as possible. Thank you for keeping us updated on your healing!
Hi Hopeful

You are in the exact same position as I was about 5 months ago. I wouldnt worry about it too much, apparently according to my surgeon (one of the best in europe) its really rare to NOT have a split near the bottom post cleft lift, which is what mine did. My recovery took 3 months to fully heal but was painless and didn't cause me too much bother. I'm back at the gym and work.

I've almost forgotten I ever had PS.. but I like to come back onto the forum and give support back as this forum was here for me when I needed help (Susan Stanford being one of them), the forum actually guided me to cleft lift surgery.
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Hi Luke!

Thank you for your response! :) Not that I want to hear of others who took an extended time to recover, but I’m happy to hear that what I’m going through isn’t uncommon. The fact that you are back to work and the gym and living life like you never had PS gives me hope I’ll get there too :) I’m starting to see it might not be as quickly as I would have hoped, and sometimes I have a “woe is me, this will never heal” moment, it’ll just take a little longer.

Any special things you did that you think helped it to heal? I asked my surgeon about medi honeh, aquacell etc and he said just time and air etc.

Thanks to this forum and folks like you and Susan, I’m sure it gives others lots of peace of mind!! I hope to do the same once I’m all healed also :)
Hi Hopeful

I found there are a few things I did that I believe helped.
Here are the things I did to heal the cleft lift split:

  • Aquacell, this kept the area dry and and made me feel more comfortable as the exudate can cause some minor irritation if left a whole day, aquacell pretty much solves this problem. I stopped using this when my wound was about 1cm by 1cm and relatively dry looking. I think its important to not use it if you appear to be dry without it.
  • Hibiscrub, Antimicrobial skin cleanser, I cleaned the area with this twice daily, not too much as it can become sticky and cause irritation, dilute with water and use a cotton bud.
  • Blow dry, use a blow dry after cleaning the area and also after showering after pooping. Imperative you keep the area clean and dry.
  • Air, your surgeon is right you should air it when you can, I used to air it for about half hour after showering, lay on side and position in a way to expose the area. legs tucked up seemed to work for me.
  • Gauze, lay a small gauze to fit over the area just for added protection and comfort. tape it.
  • Table Salt, at the very last stage of my healing I experienced some slight over granulation, about 1cm by 1cm. I did have silver nitrate applied to the area but found it wasn't helping much. After some research I found table salt sprinkled on the over granulation worked for me. It did hurt at first and made it bleed a bit, but after 3 days or so it was gone.
  • Sitting, sit in a position where you are putting pressure on the side of your rear instead of the middle. If you can lay down, lay instead.
  • Multi-vitamins, I took multi-vitamins the whole duration of my healing, I'm not sure if they helped or not but it was another thing I was doing which I felt positive about.
This was pretty much my routine and I think it helped :)
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I agree with everything that Luke advised. One thing that my son did to help with getting air to the area during the day was to roll a couple of pieces of gauze, like a cigar, and place that between the butt checks near the anus.
Thank you thank you!!

I’m going to ask the doctor about the aquacell when I go back next week. I have a feeling while it’s still draining, he’s just going to want gauze and air. Could be worth shooting an email though just to ask.

I do the cigar thing too! Talk about a weird feeling trying to waddle everywhere with this thing between your buttcheeks! LOL And the blow dryer too! I’ll have to let it get some air each day after my shower though, I usually dry it and put the cigar in and move along.

I’m definitely in the first stages of wound healing, it’s a nice healthy red with no infection so there’s promise! It’s frustrating when you choose cleft lift and still have an open wound to heal by secondary intention :(
Definitely get the aquacell, once gauze is wet it will stay wet, Aquacell allows the area to stay dry - which is key.

Your last point - it is frustrating but you gotta look at it this way - You've had a certain skilled procedure done that takes the pressure off the mid cleft which will allow it to heal up in no time. If you had open wound excision it probably would not heal as the gravitational pressure in the middle of the cleft is constantly pulling apart. Trust the Cleft Lift :wigglebum:
I would like to share my story. I just had a cleft lift done 5 weeks ago by Dr. Brand in Chicago (excellent doctor btw) and I also have an open area near the bottom of the incision, pretty close to my anus. It is fairly sore when I sit and it's about the size of a quarter. My doctor keeps reassuring me this is normal and expected from some cleft lifts. My case was more difficult as well because I already had a failed surgery last year. So anyway, it is more common than you think and the best thing to do is be patient and keep the area dry and clean. Hope it is a quick recovery for you.
I appreciate you sharing your story :) mine is also really close to my anus. I’m still showering after #2 just to make sure everything stays clean! Mine is a little bigger than a quarter, it’s a little more long in length than round though. Did your surgeon say he will eventually close it or let it heal from bottom up? I’m heading down healing from the bottom up round. Dressing changes are a pain in the ass (literally! Lol) but I’m hoping in 2-3 months it should be closed. I’d like to go to the beach without any worries!
I appreciate you sharing your story :) mine is also really close to my anus. I’m still showering after #2 just to make sure everything stays clean! Mine is a little bigger than a quarter, it’s a little more long in length than round though. Did your surgeon say he will eventually close it or let it heal from bottom up? I’m heading down healing from the bottom up round. Dressing changes are a pain in the ass (literally! Lol) but I’m hoping in 2-3 months it should be closed. I’d like to go to the beach without any worries!
So my doctor is not going to close it, he is going to let it heal from the bottom up. Dressing changes are painful for me as Well, the gauze sticks to the wound and I have to sort of tug it off every time and it usually drips a bit of blood after. But it already looks like it is shrinking,I hope it'll be gone in a month or so. I'm also treating it with silver nitrate sticks weekly. Hope you are making progress as Well! My goal is to go to the beach too without worry
I haven’t had to do any silver nitrate yet, I’m surprised honestly! The nurse that works with Dr. Caplan says he does it quite frequently. Does it hurt??

The past two weeks have shown some pretty good progress, thankfully :) mine is about roughly half the size it originally was? I’m hoping about a month too for mine!

Sending lots of healing thoughts :)
I've had some pain with silver nitrate but it's tolerable. It's usually sore after and drains more for a couple days. My wound is actually almost all healed up, it really healed faster than I thought. The key is keeping it dry and clean. Good luck to You!
Sharp sting for a couple seconds, not pleasant but not the end of the world. I used table salt instead of silver nitrate to heal a small area of over-granulation, worked first time.