This topic is about a young woman who has undergone significant surgeries, including a permanent colostomy and urostomy, along with a "Barbie butt" closure, which means her anus and rectum have been removed. She is experiencing a recurring issue where the incision in her perineal area keeps reopening. Here’s a summary of her journey and some advice that might help:

- The first closure of her incision used dissolvable stitches, but it reopened during a follow-up exam.
- For the second closure, nylon stitches were used, and she was advised not to sit for nine weeks. The stitches were removed on February 2nd.
- By February 17th, the healing looked good except for some granulation tissue, which was treated with silver nitrate.
- On March 9th, a visit to a local plastic surgeon revealed a new small opening in the incision area.

She is worried about the possibility of the opening getting larger, which might require another surgery and more restrictions on her activities. She is seeking advice from others who might have faced similar issues.

Here are some suggestions and insights that might be helpful:

1. Consider the possibility of hair-related irritation. Sometimes, regrowth of hair in the perineal area can cause the incision to reopen. Laser hair removal might be a solution to discuss with your healthcare provider.

2. Hyperbaric oxygen therapy (HBOT) has been beneficial for some people with tissue-healing problems, especially after radiation. Daily sessions have been reported to help close wounds quickly.

3. Minimize tension on the incision. Avoid positions or movements that might pull on the wound, as this can affect blood flow and slow down healing. Also, check if you might be hypersensitive or allergic to the suture material used.

4. Explore alternative closure materials. Some people have found that nylon sutures hold better than dissolvable ones, while others have had success with steel staples for added strength.

5. Investigate the possibility of an underlying fistula. In some cases, a non-healing wound might be due to a hidden fistula, such as a recto-vaginal fistula. A contrast fistulogram can help identify any hidden tracts that might be preventing the wound from closing, and surgical repair might be necessary.