Advancement Flap surgery for fistula

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Regular Member

Date Joined Feb 2017
Total Posts : 32
   Posted 8/18/2017 7:00 PM (GMT -7)   

2 weeks ago I had surgery for a high fistula. I'd already had an I&D on an abscess but after not healing they found a fistula. I had a seton placed but it fell out after 3 weeks and I found it super uncomfortable so the colorectal surgeon decided to do the flap. It's been 2 weeks now. I still drain, mostly pink serous fluid but also a bit of wheat colored fluid. I thought it was pus but the nurse who packs my wound says it's serous fluid. I've read that this surgery has about a 70% success rate and you can't tell until 6 weeks or so.

- My questions are, today the nurse put packing in and my wound, which is 4cm deep, bled a bit. Not hugely but enough to be noticeable. It looked like fresh flood mostly. Is this normal after 2 weeks? My wound doesn't hurt and the nurse said it looks clean. I'm terrified it's from the flap somehow. Secondly,, I don't know how deep the wound was after surgery but can't imagine it was much more than 4cm. Since it hasn't really gotten shallower is this a bad sign or is 2 weeks way too early for a wound that deep to fill in?

I don't have much pain or swelling. I do have a bit of pain after a bowel movement but I suspect thats because the inside of my rectum was cut and stitched and that era takes a long time to heal.

- My other question is this, is it common to get a swollen vein in your anus after surgery down there? I have a tender small lump on the anal verge (it's on the bottom of my anus, and nowhere near the original fistula and fistula opening). It looks like it might be a hemmeroid but it's hard to tell. Its a bit achey, especially after a bowel movement.

Any responses would be really appreciated, especially those who have been through advancement flap and the first month or two of recovery.

Veteran Member

Date Joined May 2012
Total Posts : 3313
   Posted 8/19/2017 2:31 PM (GMT -7)   
I haven't had flap, but I've had two abscesses and a fistula. The bleeding has me a bit hesitant, as does the lump. I think it's worth calling the CR surgeon. The lump could just be scar tissue, but it also could be the formation of another abscess if the fistula diverted.
"For this thing I besought the Lord thrice that it depart from me. He said, My grace is sufficient for thee: for my strength is made perfect in weakness. Most gladly therefore will I rather glory in my infirmities; I take pleasure in infirmities, reproaches, necessities, persecutions, distresses, for when I am weak, then am I strong" 2 Cor

Regular Member

Date Joined Feb 2017
Total Posts : 32
   Posted 9/5/2017 7:14 PM (GMT -7)   
Thanks for your reply. The small bump has calmed down a lot. It doesn't feel like an abscess (I certainly know what that felt like!). It looked a bit like an external hemmeroid (slightly purple) so I got some cream and it's been OKAY since then. I do get weird aches in my lower abdomen though, or maybe it's in my rectum? It lasts for about 3-4 minutes and happens every once in a while. Kind of builds up a bit over half an hour then spasms and is awful for a few mins and then totally cals down, goes away. The flap procedure is pretty brutal on the inside of your rectum so might be related to that.

Regular Member

Date Joined Nov 2010
Total Posts : 268
   Posted 9/5/2017 8:19 PM (GMT -7)   
I had a grascillis flap procedure for an abscess in June. I'm about 9 weeks post-op. I still have blood coming from the 'hole' above the flap. Nurse calls it a bloody return and says it's a good sign for healing. I still also have drainage. It's hard to measure because the depth varies in different spots, but today's measurement was about 1.5 cm.

Sorry I couldn't answer any more of your questions. But ask away if there's anything else you can think of smile
Sarah, 27 y/o
June 22, 2017 Flap procedure for abscess
June 23, 2014 Total proctocolectomy w/ perm ileo
Thyroid Cancer, Crohn's Disease, Autonomic Dysfunction, Heart Shunt, Chronic Kidney Stones

Current rx: Celexa, Remicade, Synthroid, Multivitamin, Calcium w/ D, Dilaudid, Birth Control, Zofran, Lansoprazole, Metoprolol, Benadryl, B12 Shots, Probiotic, Allergy Med, Xanax, Ambien, Loperamide

Regular Member

Date Joined Feb 2017
Total Posts : 32
   Posted 9/5/2017 9:27 PM (GMT -7)   
Hi RiddleMeThis,

No, thank you so much for your input. I feel so alone at the moment so it's a relief to know others are going through similar journeys!

My flap procedure was the musocal flap, which is using the skin on the wall innside the rectum (where the internal fistula opening was) and stretching it down over the opening like a manhole cover, then using stitches to keep it in place till it takes by itself. That might be a little different to yours?

Can I ask what kind of drainage you are getting? Mine is a kind of straw colored drainage. I always think its pus but my nurse says its serous fluid, which can be yellowish in color. It's similar to the drainage I was getting prior to the flap surgery, hence why I'm worried that drainage is still occuring after 4 weeks. I've read that after flap drainage can occur anywhere from 3 weeks to 3 months after surgery. Such a nightmare!
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