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Dr. David
Dr. David, Board Certified MD
Category: Medical
Satisfied Customers: 45945
Experience:  Board Certified Physician
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I had a perineum repair and the top of the wound did not heal

Customer Question

I had a perineum repair and the top of the wound did not heal at all well
6 weeks on my surgeon recomended a re stitching of the wound edges, he did this under general and used various stitches and also tissue adhesive, he also used a large v shaped anchor stitch, thing is I'm in agony in my left bum cheek, near my ands, no where near the actual repair
Is this to do with the anchor, also lumpsin Bh of glue everywhere, driving me crazy. Amanda xx
Submitted: 3 years ago.
Category: Medical
Expert:  Dr. David replied 3 years ago.
Dr. David :

This is Dr. David

Dr. David :

this sounds like a messy surgery

Dr. David :

there is really no need for an anchor stitch

Dr. David :

there should not still be tissue adhesive in the area.

Dr. David :

tissue adhesive should not be used in the perineum since you are sitting on that area frequently

Dr. David :

why did you have the wound there?

Customer:

I had a traumatic birth with my first child 14 years ago and had my perineum cut and stitched. The stitches never held and after an infection the wound was left to heal open, it's always bothered me and after developing a small recteceol I decided to have a posterior repair and my old perineum scar made good, all went well, but the perineum repair did not hold at the top of the wound (dehisence) my surgeon decided it was best to revise the wound and re stitch, I'm in more pain this time than when I first had it done, and have pain in my anul area and bum cheeks which is excruciating, kinda thinking it's from all the hard crusty glue that's round this area, although can't bear to look. Ax have attached most recent letter.

Dr. David :

I see.

Dr. David :

sounds like there could be some nerve damage to cut nerves in the perineum area from all of your trauma and surgery there.

Dr. David :

you might need to see a pain management doctor

Dr. David :

or be started on some nerve pain medication like neurontin (gabapentin) or lyrica (pregabalin)

Dr. David :

sometimes increasing protein and vitamin C intake can help the area heal.

Dr. David :

you might also need more advanced wound healing treatments as well like hyperbaric oxygen chamber therapy.

Dr. David :

specialized wound care, medihoney cream, silvadine ointment, etc.

Customer:

Where would my surgeon have anchored the large v 2/0 sutre.?

Dr. David :

where? or why?

Customer:

Where, as I'm wondering if this is where the new pain in my but cheeks is steming from? X

Customer:

P's, have been advised about high protein so trying to eat loads of steak!!

Dr. David :

that is good you are trying to eat more protein.

Dr. David :

egg whites are a good source of complete protein as well.

Dr. David :

the large V shaped anchor stitch could very well have cut into nerves and muscles in your butt cheek area.

Dr. David :

and this could be causing pain.

Dr. David :

I think your surgeon tried to do this to try to keep the perineal wound area closed as much as possible.

Customer:

2nd surgery done on Friday, and he said I'd be back to work Monday, it's now Tuesday and I've not been able to get put of bed or go down the stairs!!

Dr. David :

but this can be a very tricky area to keep closed because of all of the movement with walking and sitting and standing.

Dr. David :

sounds like your surgeon didn't make the right prediction.

Dr. David :

I would go back to see him as soon as possible.

Dr. David :

and ask about where you go from here.

Dr. David :

and if you need nerve pain medications.

Dr. David :

and if you need hyperbaric oxygen chamber therapy to help the wound heal.

Customer:

Seeing him on Friday so hopefully get to the bottom!! Of things then, thought this was going to be a straight forward procedure so I'm disappointed he's not given me the cold hard facts up front

Dr. David :

me too.

Customer:

He seems to have glued my entire bum and vaginal open, feel like a craft project. Did you manage to view the letter? Would he have used a bioderm tape along with the glue?

Dr. David :

I don't see the letter.

Customer:

It's amazing the stuff you can find out on the internet these days, turning into quite the expert on tissue glue

Dr. David :

here are instructions to upload a word or document file.

Dr. David :

type a word in the textbox and highlight it

then select the "chain" icon above the textbox or the paper clip icon to upload a jpg

this opens a window where you can click next to the text box to select the jpg or pdf file on your computer to upload into JustAnswer

http://ww2.justanswer.com/how-do-i-send-photo-or-file-expert

Customer:

Oh sent it as an attachment,

Dr. David :

do you see the paperclip and chain icon above the text box you are typing in?

Customer:

Yes, did from there. I'll try again.

Customer:

Letter.

Customer:

Any luck.?

Dr. David :

no, I didn't see it yet.

Dr. David :

type a word in the textbox and highlight it

then select the "chain" icon above the textbox or the paper clip icon to upload a jpg

this opens a window where you can click next to the text box to select the jpg or pdf file on your computer to upload into JustAnswer

http://ww2.justanswer.com/how-do-i-send-photo-or-file-expert

Customer:

Letter

Customer:

It basically says, she was found to have a minimal separation of the wound edges. The edges were trimmed and freshened. A number of interrupted 2/0 vinyl sutures were used to approximate the deep tissue. Interrupted 3/0 sutre were used to sutre the skin edges. A large v 2/0 was placed as a fixation sutre and tissue adhesive to immobilise the wound edges. PR normal.

Customer:

On my mobile so that may be the issue

Dr. David :

I see.

Dr. David :

thanks for typing that in.

Dr. David :

it can be hard to impossible to upload files on mobile.

Dr. David :

see your surgeon this friday

Dr. David :

and talk about those issues I brought up.

Dr. David :

I hope your wound gets better.

Dr. David :

thank you for your patience today.

Dr. David :

I am seeing patients in the clinic.

Dr. David :

let me know if you have other questions.

















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