need advice on problems healing from APR and colostomy

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Mrs.C
Mrs.C Member Posts: 5
in Colorectal Cancer #1

In April I was diagnosed with T1 rectal cancer 1/2 cm from anal verge.  Had a transanal resection and path report came back as a T2 tumor and margins clean.  I was advised by 4 docs to have an APR surgery and permanent colostomy.  I had that surgery in June (T3 N0 M0).  All went well, but I am having trouble healing from the rectal surgery. I went back to work at 8 weeks out.  I am a teacher and am functioning well as the pain associated with drainage is minimal. It has been almost 5 months and the small hole left for the tube that allowed drainage (removed after 3 weeks) has not closed.  My doctor wants me to use a wound vac but wound doc says the hole is too small.  My doc is now looking for a doc willing to do this and if that doesn't work, he will have to open the hole big enough for the vac to work.  Has anyone ever used the wound vac with a small opening like this?  How was it and did it help?  Also, it was mentioned to me by my doctor that we have to consider reoccurence as a remote possibility with the small amount of drainage that won't go away and the opening that won't heal as the symptoms.  Of course this is all I can think about.  I would love to hear any similar situations and how they turned out. He is no hurry to check for cancer but will biopsy if he has to go in to make opening bigger.  Otherwise, watch and see for a month or so.  What do you think? 

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  • lp1964
    lp1964 Member Posts: 1,239 Member
    #2
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    Dear Friend

    I had the same surgery 2 years ago. I was offered an extra surgery to flap one of my abdominal muscles and bend it into the space where the rectum used to be. The also used the skin side of the flap to close the anal area. I was told that sometimes the radiated skin around where the anus used to be may not close without some healthy skin patch. 

    Did you have radiation prior to the surgery?

    Laz

  • Mrs.C
    Mrs.C Member Posts: 5
    #3
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    lp1964 said:

    Dear Friend

    I had the same surgery 2 years ago. I was offered an extra surgery to flap one of my abdominal muscles and bend it into the space where the rectum used to be. The also used the skin side of the flap to close the anal area. I was told that sometimes the radiated skin around where the anus used to be may not close without some healthy skin patch. 

    Did you have radiation prior to the surgery?

    Laz

    Thank you for your response.

    Thank you for your response.  I did not have radiation or chemo because there was no cancer in lympnoids.  They had me as stage 1 with no further treatment needed.  My doctor mentioned the flap surgery as a last case scenerio but has good luck with wounds vacs

  • Mrs.C
    Mrs.C Member Posts: 5
    #4
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    I just realized I wrote the

    I just realized I wrote the wrong tumor size in my original post.  Final path report has me at T2 N0 M0.

  • Helen321
    Helen321 Member Posts: 1,459 Member
    #5
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    I haven't had any experience

    I haven't had any experience with the hole, mine closed normally.  I'm surprised they left the drainage in for three weeks, mine was only in 3 days.  Could it be that they left it in too long? Did they mention if this is a common occurence? I can't imagine you are the only one with a tiny hole left, what is the protocol?  

  • lp1964
    lp1964 Member Posts: 1,239 Member
    #6
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    Mrs.C said:

    I just realized I wrote the

    I just realized I wrote the wrong tumor size in my original post.  Final path report has me at T2 N0 M0.

    In my opinion...

    ...when the drain is left there a little too long the skin can grow around it and when you remove the drain the hole won't close. After they checked for possible recurrence they should go back to cut around the hole a little and suture it with fresh margins. 

    Laz

  • Mrs.C
    Mrs.C Member Posts: 5
    #7
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    Helen321 said:

    I haven't had any experience

    I haven't had any experience with the hole, mine closed normally.  I'm surprised they left the drainage in for three weeks, mine was only in 3 days.  Could it be that they left it in too long? Did they mention if this is a common occurence? I can't imagine you are the only one with a tiny hole left, what is the protocol?  

    Thank you for responding. he

    Thank you for responding. he said it wasn't that unusual and sent a couple of patients to have wound vac with small opening.  He anticipates this procedure would take maybe 3 or 4 weeks to close it. The problem is, my insurance approved me for a different wound clinic and they say it is too small to vac.  He doesn't agree, so he is trying to get insurance to let me change clinics.  If not, he will consider opening it up enough for the clinic aim currently being seen at to put the vac on.  He and I both feel doing the surgery unnecessarily isnt right. I am just wondering if people had luck with vac and a small opening and if drainage and a little pain ended having recurrence?  By the way, I am 53.

  • Mrs.C
    Mrs.C Member Posts: 5
    #8
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    lp1964 said:

    In my opinion...

    ...when the drain is left there a little too long the skin can grow around it and when you remove the drain the hole won't close. After they checked for possible recurrence they should go back to cut around the hole a little and suture it with fresh margins. 

    Laz

    This is interesting.  I

    This is interesting.  I hadn't thought about that.  It was in there 3 weeks and it actually started coming out on its own ba couple of days before it was to be removed.  Doc just had me take it out all the way at home.  Since the wound doc's suggestion is to open it a bit to fit vac, maybe it would take of healing around the tube and kinda start over.  Something to think about.  How hard was the procedure you had with the flap? Recovery? Ability to work, etc?  He has ordered a MRI to check for recurrence because I am so worried about it.  Hoping and praying that it hasn't returned. Thanks for your response.

  • lp1964
    lp1964 Member Posts: 1,239 Member
    #9
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    Mrs.C said:

    Thank you for responding. he

    Thank you for responding. he said it wasn't that unusual and sent a couple of patients to have wound vac with small opening.  He anticipates this procedure would take maybe 3 or 4 weeks to close it. The problem is, my insurance approved me for a different wound clinic and they say it is too small to vac.  He doesn't agree, so he is trying to get insurance to let me change clinics.  If not, he will consider opening it up enough for the clinic aim currently being seen at to put the vac on.  He and I both feel doing the surgery unnecessarily isnt right. I am just wondering if people had luck with vac and a small opening and if drainage and a little pain ended having recurrence?  By the way, I am 53.

    The flap surgery...

    ...didn't seem like an extra procedure to me. It was just done at the same time. Sure, I have a 15 inch cut on my stomach that otherwise would not have been there. The plastic surgeon who did it tried to save my belly butto, but had hard time healing around that so he closed it up 6 weeks later.

    In my opinion unless there is some drainage (which obviously has to be addressed, they should close your opening surgically. If it hasn't closed by now, it never will. 

    Laz

  • km46den
    km46den Member Posts: 1
    #10
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    Mrs.C said:

    Thank you for responding. he

    Thank you for responding. he said it wasn't that unusual and sent a couple of patients to have wound vac with small opening.  He anticipates this procedure would take maybe 3 or 4 weeks to close it. The problem is, my insurance approved me for a different wound clinic and they say it is too small to vac.  He doesn't agree, so he is trying to get insurance to let me change clinics.  If not, he will consider opening it up enough for the clinic aim currently being seen at to put the vac on.  He and I both feel doing the surgery unnecessarily isnt right. I am just wondering if people had luck with vac and a small opening and if drainage and a little pain ended having recurrence?  By the way, I am 53.

    I had the flap

    I had the same surgery with a flap created during the surgery. It has been 4 months and I am still not quite healed, but feeling much better. No drain tube, either. My surgeon says it is doing okay, just sometimes takes a while. I have been stage 4 for 3 years now and now have  non removable tumor in my pelvic area after surgeries to remove tumors from my rectum, liver, and both lungs. Lots of chemo, which doesn't help healing. Hng in there and give it time. More surgery is not necessarily the best thing. The most important thing is infection inside, which they usually check with a scan. Good luck!

     

     

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