Stoma reversal surgery reattaches the bowel after a temporary colostomy or ileostomy, restoring normal digestive function. Understanding the surgical wound healing process is important for recovery.
Understanding the Healing Process
After stoma reversal, surgical wounds heal primarily through two mechanisms: primary intention or secondary intention. Primary intention healing occurs when wound edges are surgically brought together and closed, often with sutures or staples. This method is commonly used for the main abdominal incision, resulting in faster healing with minimal scarring.
Secondary intention healing involves leaving the wound open to heal from the bottom up. This is often used for the former stoma site due to infection risk. This process takes longer, as the body must produce new tissue to fill the wound cavity.
Regardless of the closure method, all surgical wounds progress through natural healing stages. The initial phase is inflammation, beginning immediately after surgery and lasting about 1 to 5 days. During this period, the body sends immune cells, nutrients, and oxygen to the wound for repair, often causing redness and swelling. This is followed by the proliferative phase, where new granulation tissue forms and new blood vessels develop, lasting from day 4 to a month post-surgery. The final stage is maturation or remodeling, where new tissue strengthens and reorganizes, continuing for months or even years.
Caring for the Reversal Wound
Proper care of the stoma reversal wound prevents complications and promotes healing. Wounds should be kept clean and dry. If left open to heal by secondary intention, daily dressing changes may be required, often involving packing the wound with gauze to ensure inside-out healing. Wet dressings may promote healing and reduce pain during changes.
Maintaining good hygiene is important. Patients are advised showering is allowed, but they should gently pat the wound dry afterward. For the anal area, especially with frequent or loose bowel movements, thorough washing with warm water, patting dry, and applying a barrier cream helps prevent skin irritation.
Physical activity should be limited initially to avoid straining the healing wound, with heavy lifting restricted for 6 to 8 weeks. Patients should also avoid twisting or bending at the waist. Gentle activities like short walks are encouraged for circulation and recovery, with gradual increases as tolerated and advised by a healthcare provider.
Nutrition is important for wound healing. A balanced diet, rich in protein, is beneficial for tissue repair. Patients may start with liquids and gradually progress to a soft, low-fiber diet, then slowly reintroduce other foods as their digestive system adapts. Drinking plenty of fluids is important for hydration. Managing pain as prescribed by a healthcare provider helps ensure comfort during recovery.
Recognizing Healing Progress and Concerns
Observing the wound regularly helps recognize normal healing signs and identify potential problems. A normally healing wound gradually reduces in size, shows healthy pink or red granulation tissue, and experiences fading redness. Mild itching as the wound contracts and new nerves regenerate is a normal sensation during healing. The wound may be fully closed within 8 weeks.
However, certain signs indicate a complication requiring medical attention. These include increased redness, swelling, warmth, or pain around the wound site. The presence of pus or foul-smelling discharge from the wound is a warning sign. A fever of 100.4°F (38°C) or higher, or chills, should prompt a call to a healthcare provider.
Other concerns include a wound that opens (dehiscence), excessive bleeding, or delayed healing. Abdominal pain that worsens or is not relieved by medication, persistent nausea and vomiting, or inability to pass gas or stool, may suggest an internal issue like a bowel obstruction. Any of these symptoms warrant prompt contact with the surgical team or healthcare provider for assessment.