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gracilis flap for Protocolectomy Wound Healing  


Joined: 1 month ago
Posts: 1
September 24, 2020 1:54 pm  

Wondering if anyone has had any experience with the gracilis flap reconstruction surgery for failed wound healing after a proctocolectomy.

Here is the back story since July.

I had my protocolectomy July 23 as planned, JP drains and stitches removed by August 10th and wound was 8cm deep. Homecare was coming once a week but my wife was packing twice a day. After the stitches were out the packings became more painful and by 8/19 I couldn’t stand the pain of them anymore and the wound now measured 11cm deep.  A CT scan on 8/20 confirmed infections in the base of the wound, and surgery to drain and clean the wound on 8/22 left parts of the wound as deep as 19cm, and a Wound VAC was put in place.

I spent 11 more days in the hospital with wound VAC changes every 3-4 days in the OR, and since I was discharged on 8/31 I have continued to go each Mon and Thurs to the OR for Wound VAC changes as with the depth, I cannot stand them being done bedside/awake. 
There has been slow healing, new healthy granulation tissue each wound vac they say, but only a mm or 2 of healing a week - still around 10cm deep - at this rate due to the required OR visits to change and the amount of pain I am in and pain medicine I am on, 
Last week my surgeon consulted plastics - regarding doing a skin flap in an attempt to fill and heal the wound sooner with less pain.
I am now scheduled for a “gracilis flap reconstruction” hopefully using only 1 leg, but most likely both with the size of the wound, and possibly some fat cells from my abdomen to attempt to completely close the wound.
This procedure is scheduled for Oct 2nd.
The goal is full closure of the wound but if they can’t be accomplished, their goal is it will be so much less deep of a wound that if still needed a wound vac chance could be done at home, or hopefully it would be shallow enough for just gauze packing again for final healing. 
Thanks for any advice anyone can offer - or past experience if anyone has had it done?

Joined: 1 year ago
Posts: 628
September 24, 2020 5:56 pm  

Hi Befink and welcome to the forums. Oh boy, have you been through a lot!!

I have some similarities to you, but also some differences. Here is my background. My surgery was over 2 years ago. I went to the hospital by ambulance, so my surgery wasn’t planned and I was very malnourished. My colon was perforated in 2 spots so they removed it and gave me an ileostomy. They put a wound vac on the wound. After 11 days in the hospital I was discharged and had home health coming 3 times a week to change the wound dressing. The pain was very intense and my nurse started using topical lidocaine to help. After several months, the wound was closing, but there were tunnels going down from the wound, so the didn’t want it to close until the tunnels were gone. 

After 6 months, the surgeon cut me back open and cleaned things up, hoping to move things along with healing. I still had the wound pump at this time, and still had nurse coming to change dressing on pump three times a week. 

In May of 2019 (11 months after original surgery) the dr said maybe the pump was why the wound wasn’t healing, so we removed the pump (what a relief) and went to packing aquacel in the wound and covering with gauze at home (which my husband is still doing 16 months later). 

At one point, my surgeon referred me to a plastic surgeon, thinking a skin graft, very similar to what you are describing, would help things heal. I met with the plastic surgeon and he did not think it would help in my case, because of the tunnels. But he did say skin grafts are often helpful in wound healing. 

In my case, they discovered there is a fistula from my rectal stump into my wound, so the constant source of infection is keeping the tunnels from closing. The wound itself is once again closing up, so not it is very small and almost to the point of just being a couple tunnels. But it is still draining enough that I need to have the dressing changed daily. 

I know my situation is unusual. I hope that the skin graft works for you and you can get rid of that pump. I know what a hassle it is to lug that thing around wherever you go. Please feel free to ask any other questions you may have and let us know how the skin graft works. Best wishes to you!!

Ileostomy 6/18/2018
“May your day be bright and your bag be light.”

LK liked
Joined: 3 years ago
Posts: 856
September 25, 2020 5:35 am  

befink...Welcome to VO! You have been thru so much , I really hope this graph works well for you. I came out of my second to  last surgery with a large wide & open wound, no stitches, right down the center of my tummy from under the ribs to on top of my pubic bone.  For 6 months & the Wound Vac was my buddy! It was certainly a love hate relationship. But it did what it was to do & kept further infection clear. 

I never required the graph in the end, but I know that once in place healing is accomplished quicker! You  have  been thru so much & are very strong to have endured it all.  Do not loose courage. I certainly  wish you all the best of health & healing as you face this big surgery!! Be sure & update so we can continue to cheer you on!!