Perianal abscess - Packing Wound

[tulip78]

I had surgery for the drainage of a perianal abscess. It was a large abscess which was extremely painful. I was admitted to hospital as an emergency and had surgery to drain the abscess. The wound has been left open to heal and I have been attending the hospital on a daily basis to have the wound packed and the dressing changed.
It is now 4 weeks and on my appointment today the nurse told me although it is almost healed on the outside, there is still a 2cm depth inside the wound and that the outside is healing faster than the inside. She said if the wound closes too early I will be left with a pocket which could cause the abscess to re-occur.
She called a consultant who examined my wound (ouch) and he said I will have to come in for further surgery under anaesthetic to open the wound up as the opening is now too small, so packing can be inserted and also to examine the wound to check for 'tracking'.
Is this necessary? Will it damage my wound further? Is packing slowing the healing process? Why is it being packed when some surgeons don't pack the wound?
I'm devastated as I thought I was doing well, the wound is tiny on the outside but the nurse said it's still about 2cm deep.
Any advice or comments would be appreciated as I feel it would be undoing all the good work. I'm so worried incase it makes things worse, I don't know if I should let them re-operate.. I'm thinking I should cancel as I don't want the wound any bigger and it could get infected or cause damage whilst they look for tracking and disturb any granulation tissue forming.:sign0085::sign0085:

 

[Jennifer]

Hello and welcome to the forum tulip78!

I'm sorry you have to deal with this, I know it's not fun. When I had my resection the wound didn't heal properly and had to be reopened so it could heal from the inside out. I wasn't put to sleep for this because my skin didn't have any feeling at the time so I was awake when they cut the skin back open. I had it packed for about 5 weeks until it fully healed. The packing was changed twice a day (this was over a decade ago so I'm not sure how often people are told to change the packing these days). It was packed until the wound was mostly closed and on the surface and was originally about 2 inches deep and 4 inches wide.

If your skin is mostly closed but it's still that deep then opening it back up to clean it out and pack it properly will help reduce the risk of infection and help keep the wound from getting deeper (that's what they mean by tracking/tunneling). If the skin closes on top with that opening left untreated then it will get infected and you'll likely deal with more problems and it will take longer to heal.

I'm going to move your thread to the Fistulas, Fissures and Abscesses under Surgery to try and get more replies for you. Keep us posted.

 

[CarlyL]

Hi Tulip, I had a perianal abscess two years ago and I had packing of the wound for 9 weeks as it was 13cm deep. My surgeon and nurses told me that the tissue has to heal from the inside out in order for the whole area to regenerate effectively.

The problem is if they don't pack it, the granulation tissue can form way quicker nearer to the surface leaving the rest of the tissue with gaps and can lead to more problems. I unfortunately did develop a fistula a few months later but I don't believe this is related to the packing.

The surgeons know best in my opinion and if they feel it still needs packing and draining, I would let them. I don't think it would make things worse, it could avoid further problems.

I hope this helps, sending you all the best with your recovery. xx

 

[Sef0912]

Hi Tulip-
I have had multiple fissures and fistulas and I have had a surgeon who strongly believed in packing the wound and one who didn't. I think it depends on the surgeon and how deep the wound is. I had a wound that also didn't heal properly. It was reopened due to the inside being deep and not healing as fast as the outside did. This really did not hurt and was done under local anesthetic. It took about 3 months to heal (sorry if this is discouraging.) One of the wound care nurses and doctors suggested that if I have another fissure that heals this way in the future, to suggest a wound vac. Although it is not pleasant and is hard to use with anal fissures, it helps to heal the inside of the wound rapidly. The only thing I have noticed with the wound that was packed versus the wound that wasn't is that I have more scarring from the one that was packed and have had to have some granulation tissue that has developed around that scar removed. I would just say hang in there and it will get better, even if it gets worse first. Sending you lots of hugs and hopes for a fast recovery.