The chances of recovery depend on how the coccyx fistula operation was performed or how it was performed. There are roughly 2 different methods of treatment: the open and closed method. These different forms of treatment also influence the course of healing.
In principle, it can be said that surgery for coccyx fistula can be performed both on an outpatient and inpatient basis, but the open method is usually chosen for inpatient treatment. Regarding open treatment, it can be said that the wound usually heals well. Normally, the healing process takes six to eight weeks.
However, healing can sometimes take up to half a year. It can therefore be a lengthy process, since the tissue has to grow back up from the depth and close the wound. Nevertheless, most surgeons prefer the open method of treatment, as the recurrence of coccyx fistula is better prevented.
With the closed treatment, on the other hand, the wound is closed with sutures at the end of the operation. Occasionally, antibiotics are administered to the wound beforehand to prevent infection. In closed treatment, it is important for the wound to heal by preventing sweating and stretching of the wound.
If the course of treatment is without complications, healing can usually be expected after 2-3 weeks. The closed treatment usually heals much faster than the open variant. In principle, the fistula has to be removed completely, down to the connective tissue layer above the sacrum.
In this case the chances of healing are very good and the risk of relapse is low. Another factor for healing and frequency of regression is whether it was possible to form the gluteal fold less deep. However, this is not guaranteed in open wound treatment.
This is because in the case of coccyx fistula, the wound is usually located in the depth of the gluteal fold. Because the buttocks lie against each other, a closed moist environment is created, which promotes bacterial growth. In addition, hair can grow into the wound, which leads to irritation.
This makes open treatment of fistulas deep in the gluteal fold extremely difficult. This can also lead to unpleasant drafts and repeated fistulas above and below the wound. The area is therefore very unstable due to its location in the gluteal fold.
Therefore, the following procedure should be followed. The fistula is cut asymmetrically, then deeply removed and sutured. The suture is done in such a way that the suture is not in the depth of the gluteal fold.
This was first described by KARYDAKIS. One also tries to set the seam as laterally as possible by a moon-shaped cut. This is called Scarpa-Moon-Flap.
A lateral suture can also be achieved by using full skin flaps or a KARYDAKIS operation with skin-subcutaneous flaps. With these methods, the chances of healing fistulas in the deep gluteal fold are significantly better, but nevertheless, infections of the wound and wound healing disorders can still occur. During the KARDAKIS operation the drainage of wound secretion is ensured by a suction pump (drainage).
Within the first 2-3 weeks after the operation, the wound area should be strictly protected. It is allowed to take a shower, but swimming and bathing are not allowed. The sutures are normally self-dissolving.
Close meshed and regular wound care should be ensured. What is also important for a decent healing is the separation of the connective tissue deep in the gluteal fold. In addition, the wound should be flushed with antibacterial agents before closure and the sutures should be treated with an antibiotic.
In addition, the drainage of the wound should be guaranteed for about two days by a suction bottle. A further point in the healing of a coccyx fistula is the treatment of pus and acute abscesses. In the case of acute abscesses, the pus must be drained as soon as possible.
This can be done through a small incision with local anesthesia. In addition, treatment with an antibiotic can improve healing. In contrast, surgery can be better planned for chronic fistulas than for acute abscesses.
If, on the other hand, a circumscribed small fistula is involved, it can be removed locally with a small incision and minimally invasive surgery. For this purpose the fistula is indicated with the help of a dye. Such small defects heal on their own within a few days.
In contrast, the relapse rates of a new fistula are higher with this therapy than with a deep major operation. Other minimally invasive procedures are the BASCOM operation, which is also called pit picking operation.Here the complete hair root, inflammable material, dead material can be removed via a small incision. An abscess will only be opened, but a sanitation must take place after 2-4 weeks.
Due to the small wound, the wound healing is much better than in complex operations, but the method can only be used in case of slightly pronounced fistula systems. In the pit picking procedure, however, accumulations of wound fluid (seroma) have been observed in large numbers, which impairs wound healing. Seroma formation is attempted by operating on the skin and subcutaneous flaps on the superficial body fascia (scarpa).
This method spares blood and lymph vessels and ensures better wound healing with less seroma formation. The pit picking method is modified with lasers. It is also expected that this method will lead to better wound healing through fistula sclerotherapy with the help of lasers.
Usually, the healing time of the pit picking operation is about eight weeks. In the course of healing, the wound may bleed or wet slightly or show yellow fibrin coatings, which is completely normal. In general, the following principle appliesIf the fistula formation of the skin and its appendages is a benign disease, but without the subcutaneous fatty tissue, a radical excision of the fistula is not necessary. In general, incisions in the midline of the gluteal fold heal poorly and deeper incisions can be made outside the midline, as these heal much better.
