The dressings discussed here are for the two following surgical techniques:
- Closed Incision: The is pretty easy for you folks, just keep a clean pad over top of your incision, taped down.
- Open Healing: As the new tissue grows in the wound bed, it is very fragile and needs to be protected from drying out. It is also important to keep the inside of the wound clean and remove the Exudate. (Exudate is a by-product of healing, it is a gooey greenish-white substance that will look like pus but isn't - it's a collection of leftover cells and material that is sloughed off as the body builds new tissue.) The traditional route is called "packing" with an absorbent cotton gauze, however, there are a plethora of high-tech products also. The packing serves three purposes: to debride the wound bed of dead tissue during healing, to absorb the Exudate and to keep the sides of the wound from touching and mending together. Pilonidal excision wounds are infamous for "bridging", which is the sides mending together before the bottom has filled in, this can leave dead space at the bottom of the wound and an abscess may form.
Open wounds that are deeper than 1 inch are traditionally packed with gauze and then taped over top. In many cases, you might be able to get your insurance to cover a home health aid to come to your home twice daily. Other people have spouses/family/significant others do their packing. It is also possible to do your own packing changes, requirements are a fair bit of flexibility, determination and mirrors. The first few days of learning to work with a backwards reflection in the mirror are challenging, but after that you get the hang of it quickly.
Not every surgeon uses the packing method. Wounds can heal just fine without packing as well, as long as extra care is taken to prevent bridging or the top healing over too soon. If you are going the no-packing route, make sure you are being seen by a health care professional EVERY WEEK to have the wound evaluated and make sure it is healing correctly. Flushing the wound twice daily to remove exudate is still a requirement.
How to pack your wound (traditional gauze method): Changing the packing can be painful at first. Try to take your pain med 1/2 hour before a packing change. If you have trouble with the gauze sticking to the inside of the wound try soaking the gauze with warm water (in the shower or using a washcloth) for 10 minutes to loosen up the gauze before removing it. It's also helpful if you slightly moisten the packing before you put it into the wound - it's less likely to completely dry out this way.
Supplies you should have ready before you start: scissors, gauze, tape, q-tips.
- After you have removed the old packing, carefully flush the inside of the wound out to remove all the debris and gunk.
- Gently pat dry the top area around the wound. The size of your wound will determine how large a piece of gauze you need to put inside.
- Fold the gauze over at least once, but not so many times that it becomes a wad that is painful when you've placed it in the wound.
- Moisten the gauze slightly and then carefully put it inside the wound. The object is to keep the sides of the wound from touching and you want the gauze to go all the way to the bottom of the wound. Sometimes it is easier to use a Q-Tip to push the gauze all the way down. Obviously, as the wound heals your pieces of gauze packing will get smaller and smaller.
- Now, put a pad over the top of the wound and tape it down. You may need to try a series of tapes before you find one that won't irritate your skin. We have recommendations of various dressing products here on the Products Database page.
It is entirely likely that you will complete your Pilonidal treatment with a deep seated hatred of all forms of medical tape. Different types work better for different people and you'll have to experiment a bit. The residue left by the tape can be removed with Uni-solve Adhesive Remover (more info on the Products Database Page.)
A dressing is available on the market that one of our consultant surgeons has been using for about a few years now. It was approved by the FDA just a few years ago. He first started using it on open wounds like diabetic ulcers and pressure ulcerations etc. Lately he has used it on unhealed Pilonidal wounds. The results have been almost miraculous. Healing usually takes place in a few weeks. It also has an anesthetic property so that pain disappears in days.
Our surgeon suggests to simply cut a piece to cover the entire open wound and then place a 4x4 or 2x2 (depending on the size) over it and leave it on for 24 to 72 hours. He then has the patient remove it, shower, dry and the replace it. You'll need another person to help replace it as hte product needs to be in contact with the whole wound and the patient can not see the wound well enough to do that. Product can be left in place up to 3 days.
The High-Tech World of Dressings:
There are literally hundreds of products used by Wound Care Specialists. Some of them are showing up more regularly with the more alert surgeons. These fall into two uses for Pilonidal excision patients: cavity dressings and topical dressings. Cavity dressings go inside the wound during the primary healing phase. Topical dressings are for healing surface problems, such as would that keeps splitting or won't completely close.
- Alginate Dressings: These are derived from seaweed and can be gently laid in the wound bed, where they will absorb exudate and produce a hydrophillic gel, so creating a moist, warm environment (Sorbsan, Kaltostat, Kaltogel, Tegagen, omfeel, SeaSorb) More info on Alginate Dressings.
- Foam Dressings: There are two dressings which are designed for cavity wounds, Cavi-Care and Allevyn Cavity. Both fill the wound and absorb Exudate but need to be changed far less often than gauze. Allevyn is a pre-formed pad that fits inside the cavity and is changed daily. Cavi-Care is mixed and then poured into the wound, where it conforms to the wounds shape.
- Hydrocolloid Dressings: These products absorb wound exudate to produce a gel, which provides a moist environment and reduces pain at removal of dressing. According to an article in the European Journal of Surgery (March 2000) the "Hydrocolloid dressings lessen pain and increase comfort for patients after excision of pilonidal sinus, though time to healing is no shorter than when a conventional gauze dressing is used."More info on Hydrocolloid Dressings.
An extensive description of these newer dressing products can be found at World-Wide-Wounds or via an internet search.
Ointments & Antimicrobial Agents:
As noted on other pages, use of antibiotic ointments Neosporin or Bacitricin is not recommended due to their history of creating contact dermatis reactions, the exception being Polysporin (which has much less risk of contact dermatis reaction). Antibiotics are used in the presence of infection, not to simply limit the possibility. What is really called for in care of Pilonidal wounds is antimicrobial agents and healing accelerators. These products are not considered "necessary", but are an adjunct to wound care. Insurance may cover them if your doctor writes a prescription.
Zinc - Zinc can be very helpful in stimiulating healing. See Derma Science's line of wound care products with Zinc (Dermagran).
Multidex Powder - many of our forum users have had good luck with Multidex Powder to help in the final stages of healing or when healing has slowed. Forms a protective "coating" to create and maintain a moist environment beneficial for granulation tissue growth and epithlial proliferation.
UMF Manuka Honey (pdf) - the current rage in antimicrobial ointments. Info on the product from World Wide Wounds. We have had many reports on the message boards that Manuka Honey works well and is easy to use. When shopping for products, look for UMF Manuka Honey, this is the preferred product for wound care. UMF is the scale of antibacterial qualities of the honey. UMF of 10+ is the mimum, the highest we've seen is 20+. Obviously, the higher the better.
UMF Manuka Honey is also showing great signs as a treatment for MRSA (pdf), reasearchers have found that Manuka Honey inhibits protein production within MRSA cells, which leads to their death. It has also been found that bacteria could not form resistance to Medical Grade Honey the same way it does antibiotics. Also see Derma Science's line of MediHoney Products.
Topical Silver - demonstrated to possess broad-spectrum antibacterial, antifungal, and antiviral activity. There are number of wound healing products on the market inflused with Silver - these are only a small selection:
- Acticoat - Smith & Nephew
- Actisorb Silver 220 - Systagenix
- Restore Calcium Alginate Dressing Silver - Hollister
- Silvercel - Systagenix
- Silverseal Dressings - Derma Sciences
In no way, does this site recommend Colloidal Silver potions taken internally or used topically on wounds.
This page last updated: 11/13/2010