This topic is about a person who had a proctectomy, often referred to as a "Barbie butt" surgery, and is experiencing issues with the wound reopening 14 months after the procedure. Despite being almost healed, a small area keeps reopening, enlarging, and draining. The person has tried various treatments but is concerned about the possibility of needing another surgery, especially given their medical history. They are reaching out to see if others have had similar experiences and if further surgery was necessary.

Here are some pieces of advice and insights shared by others:

1. Hyperbaric Oxygen Therapy (HBOT)
- Some people have found this therapy effective in closing long-standing wounds. It involves daily sessions in a hyperbaric chamber over several weeks.

2. Placental Tissue Graft
- This involves placing a small sheet of preserved placental membrane on the wound, often after HBOT. It helps new skin grow and may need to be repeated. One person healed after three applications.

3. Topical Medications and Dressings
- Silver sulfadiazine and other silver-based dressings are commonly used, though not always effective for everyone.
- Mupirocin 2% ointment helped clear infections and maintain wound closure for some.
- Collagen dressings have been used to promote slow but steady healing.
- Compounded antibiotic ointments are being tried with mixed results.

4. Mechanical Support and Positioning
- Kinesiology sports tape can help hold wound edges together during movement.
- Keeping dressings in place on Barbie-butt sites can be challenging, and extensive taping might be necessary, though it can be painful to remove.

5. Factors That Can Impede Healing
- Previous pelvic radiation can delay healing.
- Autoimmune conditions like pyoderma gangrenosum may cause recurrent issues and need medical evaluation.

6. Expectations and Patience
- Healing can take 1–2 years or more, with minor breakdowns being common.
- Regular follow-ups at a wound clinic and trying different dressings are important.

7. When to Seek Further Help
- If there is increased drainage, signs of infection, or the wound deepens, it's important to contact the surgeon or wound team immediately.
- Surgical revision is considered only after trying less invasive options like HBOT and advanced dressings.