Tuesday, October 19, 2010

Patient feels uneasy about cleft lift


Sounds like you feel uneasy at the prospect of an unmet surgeon chopping on your rear end, right?  Natural.  You hope that this solves the nuisance quickly and permanently, correct?  We do, too.  We both hope the cigar works to avoid surgery (see prior blog post), right?


Thanks!  I will try wearing the "cigar" for a few weeks and see how it goes.  If this doesn’t work and I still have the open wound I plan on coming to Oregon to see you. Our plan also.
Since I will be coming so far to see you how would the appointment situation work?  Would you be able to look at my wound and see what needs to be done one day and then do a procedure on the next day?  
If you agree with our proposal after we see the unhealed Z-plasty, probably surgery the same day. 

  I would like to stay in Oregon during this entire time so I don’t have to be flying back and forth.  Since my z-plasty surgery a couple years ago the top 2 inches or so of my butt crack is gone.  I am left with a short butt crack (only about 2 to 2.5 inches worth above my rectum) with the z scar right above it.  Would I still be a good candidate for a cleft lift since my wound is only about a half inch above my rectum and extends up for about an inch?  
Yes, the operation is designed to solve that kind of problem.

Since the wound is right in the mid line of my crack and right at my rectum it worries me that it can’t be fixed.  How many cleft lifts have you performed and what percentage of them have been successful?  

Maybe 200.  As far as we know they are all healed.  Maybe 5-10 required repeat operations.  Maybe 3-5 patients three operations as we learned how to solve and teach these problems.  We are still learning.

How long would I need to take off from my job (it is a sit down office job)? Also, when could I go back to jogging and playing sports?
Tell your boss three weeks.  You have permission to back to both when you feel like it.  He will be surprised when you show up at 10d-2 wks
 

Sorry for so many questions, just trying to prepare myself for what may be to come.  Thank you for your time and have a good day!

Monday, October 18, 2010

A "CIGAR" TO GIVE THE FINAL PUSH TO HEALING







Subject: Vent cigar A patient describes an almost healed surgical wound in the cleft--no symptoms aside from minimal moisture. He wants final healing.

The buttocks, like lips, seal pus in the cleft. You might improvise around this idea and see if it helps. Minimal risk carrying this open wound for years. Surgery practically guaranteed to cure it if a Cleft Lift is used.

MD, from Seattle, wrote, "Photos, both of the products, the assembly process, and the final product, both on the table and in situ, would be an enormous help. I think I understand it, but could always improve my understanding." As soon as I learn to post photos I'll add photos to this blog.

This may interest you. The message includes three pictures that may not come through. If you don't see them, tell me. I'll try again.

The aim of this device: To let air reach non-healing wounds trapped in a cleft. I used this sort of device to heal one challenging patient with Crohn's and a non-healed wound from top of cleft to vagina where the proctectomy had fallen apart 2 years before. Plus, she had, between the coccyx and the back edge of vagina, an open cavity 7 cm deep!

A cleft lift healed almost all. However, a 2 cm skin defect refused to heal at the posterior edge of the vagina.

The defect remained open for months. Then I realized the problem! She sat with her legs together all day and lay all night with her legs together . I drew a "rim trail" on the line of contact of the thighs, down the front of the thighs from pubis to knees and up the posterior side from knees to the top of the cleft. I spread thighs to examine. The defect lay in the center of the huge airless area. She kept the cigar against the raw area day and night and it healed.

Details of construction:
Screen is soft fiberglass window screen or "fly screen". Orange is plastic kitchen scrub sponge everted by patiently pulling out the center. The steel scrub sponge is included for comparison. The thread is common cotton. A monofilament might be better.

Details of use:
Insert the "cigar" in the cleft with the side of the "cigar" against the wound. Wash the wound and cigar 1-2X/day.

Concerns expressed:
Irritation of the wound or discomfort. Falling out. Sharp ends of broken fiberglass.
Experience: The patient did not experience them. I wore the above device for a night and for several hours in a day. I found it comfortable. It did not fall out with walking despite my slack form. It did fall out with large steps or stairs. Tight briefs or other inventions should solve that.

The fiberglass is so fine and soft that I found no ends even after hours of wearing.

My interest:
I want to hear of experience of others. I will share any experiences I have or hear of. The "cigar" seems a low risk preliminary step for patients to use or doctors to recommend. It can be discontinued if uncomfortable, useless or irritating. In theory the "cigar" should help all forms of persistent pilonidal disease.