This topic is about finding ways to heal a large open perineal wound after a surgery known as "Barbie-butt" surgery, without resorting to a thigh muscle skin graft. The person sharing their experience is looking for advice and insights on alternative healing methods. Here are some helpful points gathered from the discussion:

- The person is 12 weeks post-surgery and still has a significant open wound. They tried using a wound-vac for four weeks, which helped a bit but also caused infections and pain, leading to its discontinuation.

- Hyperbaric oxygen therapy was suggested but denied by insurance. The person is currently managing the wound with daily wet-to-dry dressing changes, rinsing with a handheld shower, and using a blow-dryer to dry the area.

- The surgeon has recommended a skin graft that would involve using an inner-thigh muscle, but the person is concerned about the potential for a second difficult-to-heal wound and the risk of graft failure.

- They are seeking experiences with non-graft products like Grafix and tips for speeding up healing at home.

Additional questions and information include:

- The insurance denial for hyperbaric oxygen therapy was due to coverage limitations, but an appeal is planned.

- They are curious about "silver-infused things" and how to use them.

- They currently consume "Ensure Extra Protein" drinks but are unsure of their daily protein target.

- They are interested in knowing how long others took to heal without grafting.

- They plan to consult an intestinal-rehab physician to help with the insurance appeal.

Advice and insights shared by others include:

1. Dakin’s Solution: Some have healed large wounds using daily wet-to-dry dressings soaked in Dakin’s solution. It's important to consult with a surgeon or wound-care nurse before starting this treatment, as it can take weeks or months.

2. Silver-Based Dressings: Silver Alginate dressings can help speed up healing and control infection. They are suitable for deep wounds but should be used with guidance from a wound-care nurse.

3. Hyperbaric Oxygen Therapy: It's worth re-appealing the insurance denial with the help of treating physicians. Home monoplace chambers are an option but require physician supervision.

4. Avoiding Thigh Muscle Graft: Some have declined this option due to potential complications like a permanent limp. Seeking a second surgical opinion is advised.

5. Nutrition for Wound Healing: Aim for about 1 gram of protein per pound of body weight or at least 100 grams per day. Include high-protein foods in your diet, control blood glucose levels, and consider taking a multivitamin along with extra Vitamin D, Vitamin E, and fish oil if tolerated.

6. General Wound-Care Tips: If healing progress stalls, ask for a referral to a wound-care center. Wet-to-dry with Dakin’s is effective but slow; silver alginate or a wound-vac might speed up closure. Ensure adequate calorie intake, seek help at home, and prepare for a lengthy healing process. Be mindful of caffeine in protein drinks if sensitive.