This topic is about the healing challenges faced after a surgery known as abdominoperineal resection, often referred to as "Barbie-butt" surgery. The person sharing their experience is dealing with issues like wound drainage, pain management, and considering different healing therapies. Here are some insights and advice shared by others who have been through similar situations:

1. Pain Management
- Short-term use of opioids like 5 mg oxycodone is generally considered safe and unlikely to lead to dependence. Managing pain is crucial for healing.
- If concerned about opioid use, consider splitting the tablets to take smaller doses.

2. Rest and Positioning
- It's important to rest as much as possible, minimize sitting, and avoid activities like car rides that can cause bouncing.
- When sitting, try to off-load weight from the buttocks by leaning back or using your thighs.
- Stay hydrated and aim for a high protein intake, around 100 grams daily, to support healing.
- Let family and friends help with daily tasks to allow more time for rest.

3. Wound-Vac Experience
- Experiences with perineal wound-vacs vary; some find them uncomfortable, while others appreciate how they keep the area dry and promote healing.
- Expect weekly dressing changes and some leakage, which should decrease as healing progresses.

4. Radiation-Related Delay
- Those who have had pelvic radiation may experience slower healing. Hyperbaric Oxygen Therapy (HBOT) is often recommended and has helped some heal significant wounds.

5. Hyperbaric Oxygen Therapy (HBOT)
- Typically involves 2 to 3 hours per day, 5 days a week, for 40 to 60 sessions.
- Check if your insurance covers this, as it can be costly.
- Be aware of potential side effects like ear issues and temporary vision changes.
- Discuss with your facility about keeping the ostomy pouch on during sessions, as policies vary.

6. Biological and Surgical Adjuncts
- GraphX, a sterilized placental matrix, can be used after HBOT to aid healing without needing a donor site wound.
- Some have found success with a Y-to-Z skin-flap surgery to help close the wound.
- An autograft from the thigh is another option but involves creating a second wound.

7. Dressings and Day-to-Day Care
- For heavy drainage, use absorbent pads like abdominal pads or maxipads, and change them frequently to prevent skin irritation.
- Packing the wound cavity, under the guidance of a nurse, may help manage drainage better than surface gauze alone.
- Collagen pads have mixed reviews and can be expensive with varying effectiveness.

8. Self-Advocacy
- Stay persistent with your healthcare team and seek second opinions if you feel your care is not progressing.
- Visit the emergency department if you experience a sudden increase in pain or suspect an infection, as imaging can help rule out complications like an abscess.

9. Facilities Mentioned
- The University of Nebraska Medical Center (UNMC) Hyperbaric Unit allows ostomy pouches during HBOT sessions, which might be a consideration for those worried about removing their pouch.