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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 must be packed. 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.
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.
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.
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
www.worldwidewounds.com.
Ointments
& Antimicrobial Agents: As noted on other pages, use
of antibiotic ointments Neosporin or Bacitricin is not
recommended, 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:
www.dermasciences.com/woundcare
- line of wound care products with Zinc
Panafil - a well recommended ointment
Sterilised Active Manuka Honey - the current
rage in antimicrobial ointments. Info on why in
this
(pdf) from World Wide Wounds.
Topical Silver - demonstrated to possess broad-spectrum
antibacterial, antifungal, and antiviral activity. There are
two primary products on the market to investigate:
In no way, does this site
recommend Colloidal Silver potions taken internally or
used topically on wounds.
This page last updated:
03/25/2007
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