Not great news. My healing progress has plateaued.
There is granulation tissue coating most (but not all) of the wound surfaces, but as far as the surgeon can see the cavity hasn’t closed up at all over the last couple of sponge changes. After such an auspicious start that’s really disappointing. The trouble is, there are probably lots of reasons why this could be happening. The obvious ones, none of which are very easy to resolve:
- the physical configuration of the cavity is such that the sponges don’t fit well, which means that the vacuum probably isn’t pulling the wound surfaces together very effectively
- the back surface (in particular) of the cavity is very inflexible due to all the scarring from previous surgery, making it even less amenable to being pulled into place by the vacuum
- the cavity is quite large for a single sponge, but trying to get two sponges in is likely to tear the join in the bowel apart
- the old chestnut that the tissue just isn’t healing as well as it ought to, thanks to the radiotherapy that I had to get me over my bowel cancer
So the question is, what to do?
The surgeons preliminary thinking is to stop the vacuum treatment now that it’s not helping me to make progress. He’s also wondering if the sponges are now being counter-productive, and actually preventing the healing from continuing. Consequently he’s planning to take out the sponge on Saturday or Sunday; at that point his thought is to see if we’ve actually done enough to allow me to continue to very slowly heal “naturally”.
He’s working on the principle that there is now extremely good drainage from that cavity, so there should be no reason for the infection to return, and that when we last improved the drainage (nowhere near as well as this!) last year, I did heal steadily for nearly 3 months before it ground to a halt. This time we have significantly better drainage and have already got the healing off to a head-start; so maybe we’ll continue to make progress. And there’s no fundamental reason why (if it would be helpful in the future) we couldn’t even put me back on the vacuum treatment for a time too.
So for now we’re still not giving up. I’ll be discharged, get over all the surgery, return to work and “normal” life, and we’ll arrange some regular radiological examinations to monitor my progress.
But I think I need to be under no illusions here; a permanent colostomy is starting to look like the most likely and effective resolution to my problems. And at some point we need to make a clear decision that “enough is enough”, and actively plan that to ensure that I end up with the best possible result.
Because if I’m forced into it without enough planning I’ll get a much less good final result, and I’m planning to have to live with it for a very long time to come!