Vacuum-assisted closure of a complex pilonidal

[Carrie89]

I remember when I had to wear the vac for a month. It was horrible. Bad smell..CONSTANTLY having problems with suctioning because of it being in such a damn akward spot...But I do have to say..alot of people claim the vac isn't very good and it isn't recommended often..but it truly is.. it is amazing how it works and even though I am not even healed after 5 months..it still closed my wound up pretty fast. I don't think I would want to wear it ever again but it does it's job.

[depilo]

Hi guys:- I dunno if this will help, but I'll tell my story anyways- I am 24 years old and had surgery in the beginning of January to remove my pilonidal cyst. The wound cavity was rather large, and because there was no home care available where I lived, I have to go in to my local wound care center 3 times a week to get the sponge changed.

The first couple of dressing changes were excruciatingly painful; it was also difficult for the nurses to achieve a proper seal because of where the wound is located; Going to the bathroom was difficult at first (especially because the pain meds can make you constipated......).

After the first week, however, there was an appreciable drop in pain levels when the sponge was removed. I am now starting my second month on the wound vac, and I barely feel any pain at all during the dressing changes. Also, I now use just over the counter pain meds, so no more constipation!!!...

My nurse and I have come up with a sort of technique to dull the pain:- 1. Take your pain meds BEFORE going to get the dressings changed. 2. My nurse pours saline on the sponge and lets it sit like that for about 60 seconds or so to allow it to saturate the sponge and make removal somewhat less painful. 3. She then puts lidocaine in the wound, which I feel really helps me with pain relief for several hours afterwards. 4. She also puts Santyl in my wound to help it heal faster (I really feel this is helping to speed up the healing process A LOT). 5. She then replaces the sponge and drape.

Another nurse of mine who I rarely see occassionally puts Adaptic (basically, gauze with Vaseline on it) to help make it easier to pull the sponge out; In my particular case, I did not find it helped to decrease the pain significantly, and it slows down the stimulation of the cell growth.

I do have some minor skin irritation from the drape, as the tackiness can be very drying.

Pros of Wound Vac:-
1. Your wound WILL heal faster- my wound is already less than one inch deep in just one month!!! They say it helps cut healing time in half!!!...
2. You only need to get it changed 3x a week, as opposed to once or twice a day.
3. The device is easily portable and you can drive with it.
4. You don't need to buy the sponges or canisters separately- KCI will deliver them to your house or apartment.

That being said, no treatment is perfect:-
1. Sometimes my sponge has a minor odor- it smells a bit like a wet sponge for your dishes...it's not a very pleasant odor.
2. The machine makes noises- it gurgles a lot, sometimes the motor runs harder than other times, etc., and it can be distracting in class or when you're trying to fall asleep. However I got used to it, and so can you.
3. The tubing is very long and presents a tripping hazard- BE CAREFUL!!! I wrap the tubing around my shoulder or hold it in my hand to avoid falling down.
4. Sometimes drainage is visible in the tubing-there are people out there who get squeamish at the sight of blood (I'm not, thankfully).
5. At first, it is difficult to get a seal (but this gets easier with the passage of time) and going to the bathroom can get messy, but once again, as the wound heals and gets smaller, this too gets easier (Oh, use baby wipes).
6. You have to keep the machine plugged in 24/7 and can only be unplugged for a few hours, so make sure you're batteries are well charged before going to the movies, library, etc.

Be advised that the Wound Vac is an external device; it is therefore visible to the public. You are GOING to have people ask you what happened to you. I don't like telling everyone my personal business, so I just tell them I had back surgery to remove a cyst, and that seems to satisfy their curiosity.

After all is said and done, I am happy with the Wound Vac- although the first week or two after surgery was rough, it was definitely worth it because my wound is healing much faster than anticipated. I am glad I don't have to go to the hospital 7 days a week to get a dressing changed. My dressing changes are also MUCH shorter now- they used to take about an hour, and now can be done in half that time.

Other tips:- Wear sweatpants the first month or so after the surgery. Carry baby wipes with you in your purse or backpack (for the dudes out there, fear not- Cottenelle wet wipes come in single packets; just keep one or two in your wallet or pocket). Get a Tush Cush people!!! Seriously, best invention ever!!! You don't have to buy the expensive one- look for cheaper knockoffs by googling "coccyx cushions". Don't get one of those donut cushions- the hole part is where your anus is; the cyst is higher up than that, and for me, the cushion part kept pressing on the cyst- remember, you want to relieve the pressure on your cyst area, not your anus, hence the tailbone cushions are better. Keep some extra drape/waterproof bandages at home- in case there's a leak, you can try to slap some on there to temporarily take care of the leak. Oh, and always make sure you check to see how many sponges/canisters you have left, so that way you can allow enough time to re-order your supplies and wait for KCI to deliver them for you.

Well, that's my Wound Vac story thus far...hope it was helpful in some way!!!...

[JessicaV]

I am currently sitting here with my wound vac in my lap. This is the second time around for me. Which obviously means it didn't help in correcting the issue, but it does help the post surgical wound heal "quickly". I had my 4th pilonidal surgery on April 1st. It is now May 21st and my wound is still 3.5 centimeters deep. The surgeon actually attatched the wound vac while I was under this time. Two surgeries ago they tried this, but waited a week or so after the surgery to get the wound vac started, which the surgeon says may have been part of the reason it came back reguardless. I don't follow up with the surgeon though, I see a wonderful infectious disease doctor, who also deals with wound care. He had me on IV antibiotics until about a week ago to avoid a potential bone infection. My wound was very very deep. The first cyst I had at 16 actually surfaced and protruded from my cleft. Ever since then with multiple surgeries and lancings, it has tunneled. No surface signs of an abscess except hot to the touch.

Anyway, the first time I had the wound vac was very unpleasant. This was about 2 years ago. I had the wound vac from November-January. The nurse I had was NOT gentle, and I don't think I was very nice to him But after it was all over I said " I will never ever do this again." And here I am 2 years later and almost 2 months down. This time around it's not really so bad. I've mostly had very nice nurses coming 3 days a week. I can sympathize with the beeping, gurgling, and the sounding like you're on a dirt bike everytime you sit on the toilet. Also, the 3lb ball and chain with tubes that somehow magically get wrapped around EVERYTHING.

And I don't know about anyone else, but my doctor laughed at me when I asked about going back to work. In my line of work I cannot have many physical restrictions because I take care of people. As a result of my indefinite time of return, my job let me go because I "could not complete the job responsibilities." So, now I'm unemployed on top of it. I hate going out in public. Too many stares and questions and if I sit wrong, forget it. I've been spending a lot of time at home which is in turn making me depressed. That's the only part that drives me crazy. It's not very painful anymore. On a rare occassion the sponge going in or out of the wound hurts, but other than that, it's been a lot better. I did get a 5 day break due to a bad rash from the tape. To avoid such rashes I take Acidophilus which seems to help. So, that's just but one aspect of my pilonidal experience. Good luck to all of you who have or are expecting to have a wound vac.

[cricket1]

i am really sorry you lost your job. this illness can be so debilitating to alot of us. luckily i stay atr home with 4 kids but i've missed alot as well and also have become depressed at times from this thing. i just had my fifth surgery in april and for my fourth one they tried the wound vac. my wound was 4 inches deep, 5 inches wide and 6 inches long which i have no clue how much that is in centimeters. my wound vac failed after 4 days. my body rejected it and i became seriously ill and ended up in the hospital for a long time. 3 of my surgerys for this were in the last 6 months. my last surgery i went with a surgeon off the list and recieved my second cleft lift.

i'm really sorry we are both going thru thios and i guess at times its nice to know we are not alone. i can feel your pain. please keep me posted on your proggress.