Although my goal is to have all my cleft lift patients heal their incision quickly and uneventfully, sometimes there are problems. The most common problem is a slight separation of the lower portion of the incision, just as it curves inward toward the anus. This web page discusses this problem.
It is not always predictable who will have some wound separation, but the things that seem to predispose to this are:
In my series of patients this occurs about 10% of the time. You can read my recent article which details my results in 700 patients over several decades of collecting data. Most surgeons do not have this kind of data, and really have no idea how often this happens in their own patients. You can not assume this number applies to other surgeon’s patients. Although I wish this number was lower, it turns out that this isn’t as big an issue as it seems (read more below)
With any operation, the cleft lift procedure included, healing of the incision has to occur. In general, this is a six week process after which wounds are at about 95% of their full strength. It gains that last 5% over the remainder of a year. However, the body is constantly strengthening and remodeling wounds for a lifetime. (This is evidenced by the fact that with severe vitamin C deficiency, called “scurvy”, old wounds will open up and start bleeding.)
There are things that can cause the incision after a cleft lift to separate:
The suture material provides strength for as long as 6 weeks, but it lingers in the tissues for up to six months. These sutures cause problems months later if patients have reactions to the residual suture. The suture that I use seems to be a good balance between strength and longevity.
This is where the construction of the cleft lift becomes very important. When I create a cleft lift two of my goals are to move the incision away from the midline and make sure the incision is not in a skin fold. If I can accomplish these things, any separation of the wound will usually heal.
This is what may differentiate this type of wound separation from any problems you may have had after other operations. In my experience if the wound is off the midline and outside of a skin fold it will always heal. So, the main thing is not to panic, and follow certain simple wound care instructions.
If a wound separates in the first month there is some sort of problem that has made the wound come apart. It may be fluid coming through that area, tension on the incision, infection, an autoimmune process, reaction to the sutures, etc. When this occurs it may continue to separate a bit more for a week or two, and then seem like not much is happening; the opening is not really getting bigger or smaller. But, if all goes well it will begin healing rapidly as it approaches six to eight weeks from the operation. Even fairly significant wound separations will be healed by week 12 if the wound is off the midline and outside the gluteal crease, as demonstrated in the image below.
The body’s healing process works on a six week time-line. So, no – you can not “speed up” healing, but you can make sure that you are optimizing the situation so as not to slow down healing. Those strategies are:
If you experience wound separation as described here, keep us notified of the situation, follow the instructions on this page, and realize that this usually will resolve with proper wound care. Of course, every patient is different, and no strategy works 100% of the time. If another operation is needed to change the shape of the cleft to get a wound to heal, we will discuss this around week 6-12 and make plans. But, understand that would be very unusual.