Recovering after your IGAP reconstruction

Introduction

Your doctor has recommended that you have an operation which involves removing your cancerous tissue and using your own healthy tissue reconstruct the remaining area within your perineum. When a tumour is removed a space is create and if this is not filled it can lead to wound breakdown and infection. Your own tissue (flap) is used to fill this space by transferring a piece of skin with fat attached from your buttock into the space. In this case the ‘flap’ of skin is called the Inferior Gluteal Artery perforator (IGAP) flap.

Following your operation

You will be taken to the intensive care unit (ICU) for about two to three days and then stepped down to a surgical ward. During this time you will need to lie on your sides and not on your back. The nursing staff will assist you whilst in ICU. This is to avoid putting pressure on the new flap/s as this can affect the blood supply and damage it. The nurse looking after you will check your flap regularly most likely every time they assist you to turn which is approximately every two hours. You will have 2-4 wound drains from your perineum and your abdomen to collect any fluid will collect any excess fluid.

You will have an abdominal wound which will be stitched and dressed.

There will be dissolvable stitches where the skin has been taken and stitches on the surface to secure the flap down the center of the buttock wound which will all be covered with a dressing.

You will be seen on a daily basis by the plastic surgery team and colorectal team until you are discharged. You will also be seen daily mon-fri by the stoma nurses and Plastic surgery clinical nurse specialist (CNS)

Step down to ward

After your 2-3 say stay in ICU you will be transferred to a surgical ward. The physiotherapist will begin working with you to stand up.

You will not be able to sit until 5 days after your operation at the earliest. If your plastic surgery team are happy, after this time you can sit for short periods of time which can gradually be built up as follows: (please note this is an example and may change dependent on your surgeon)

Day 5- siting on an air cushion for 15mins

Day 6- sitting on an air cushion for 15mins twice daily

Day 7- sitting on an air cushion for 15mins 3 times a day

Day 8- Sitting on an air cushion for 30mins twice daily 

It is important that you so not sit for longer than advised to avoid causing damage to your flap/s. Sitting may be uncomfortable whilst your drains are still in place, this will ease following removal and continue to improve over time. 

You should be able to have a shower but when this happens will be dictated by your specialist nurse. 

Dressings can stay in place whilst you shower but you may also be asked to have a shower with your buttock wounds exposed to help with cleaning of the area.

Going home after your surgery

We expect you to go home at approximately day 7-10 post surgery but this is dictated by your recovery.

When you leave hospital it is important that you rest and build up gentle exercise such as walking gradually. You must remember that you have had major surgery and that your body is still recovering.

In the early days your body will need to use large amounts of energy to repair itself, this leaves you with small amounts for the rest of your day so you need to ensure you eat more than you would normally with adequate vitamins and a varied diet. You may have good and bad days which is very normal. It is also quite normal to have days where you feel tired and sometimes tearful. It can be months before people feel like themselves.

Caring for your bottom area

By the time you are discharged home you should have minimal dressing on your bottom. Some of the stitches may need to be removed in the plastics dressing clinic approx. 2 weeks post-surgery. If you still have open wounds in this area the plastic surgery CNS will see you pre discharge and go through dressing care at home. We may need to ask a family member to help you with this. Wound care at home usually involves showering the wounds daily then re dressing them.

You may find it more comfortable to use an air cushion whilst you are building up your sitting time and strength.

The length of time you are able to sit will increase as you recover. You will also be seen regularly in PDC until you are completely healed. You may have some mild discomfort or a pulling or dragging sensation in the area which is a common side effect.

Caring for your abdomen

The colorectal team, stoma nurses and ward nurses will advise you on dressing care before discharge. They may arrange for you to be seen in the community by district nurses.

You will also be given consultant clinic follow-up appointments for both teams post discharge.

General Advice

• Wear loose comfortable clothing following surgery
• You should not drive for at least 6 weeks post-surgery- discuss with your team
• You should not smoke after your operation as this slows the healing process and increases risk of infection
• You should not return to work until your surgeon advises you to.

If you experience any of the following contact your team

• Feeling generally unwell
• Fever or temperature
• Severe/increasing pain
• Your wound opening or any signs if your wounds breaking down
• Swelling, redness or bleeding at operation site
• Increased leakage from wound or leakage that is smelly, green/yellow.
• Increasing pain when sitting.

Contact information

Plastic surgery CNS (Mon-Fri 8am-4pm) - 07385384435 OR 07824502944

Plastics dressing clinic (Mon-Fri 9am-5pm) - E: PDC@chelwest.nhs.uk

Weekend/emergency - Attend A&E

Patient Advice & Liaison Service (PALS)

If you have concerns or wish to give feedback about services, your care or treatment, you can contact the PALS office on the Ground Floor of the hospital just behind the main reception.

Alternatively, you can send us your comments or suggestions on one of our comment cards, available at the PALS office, or on a feedback form on our website www.chelwest.nhs.uk/pals.

We value your opinion and invite you to provide us with feedback.

T: 020 3315 6727
E: cwpals@chelwest.nhs.uk