Tips for dealing w open surgical wounds

Discussion in 'Pilonidal Discussions' started by excision2011, Apr 13, 2012.

  1. excision2011

    excision2011 New Member

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    Hi all,

    This topic is for fellow members/newcomers who have had "Pilonidal Excision Surgery" and were left with an open wound that is making their life miserable. I've learned the hard way during the last 4 months how exactly to deal with an open surgical wound that won't close or stop hurting.
    The main issues (among many):
    1. Handling the daily dressing changes. How to do them yourself.
    2. How to sit down comfortably without being in pain.
    3. How to handle the drainage/smell.

    I'm no expert, but here's some tips for those afflicted (i.e. how to avoid months of needless suffering like I did):
    1. Visit a Wound Care Center: Having an open wound requiring daily dressing changes doesn't mean you need home healthcare or that your family/friends need to help you. There's no reason to have to endure humiliating dressing changes performed by an endless parade of home nurses & terrified relatives. Immediately post-op, ask for a referral to a Wound Care Center. They will show you how to properly change the dressing yourself and let you know exactly what you're in for recovery wise. They can also set you up with a Wound Vac which may eliminate the need for dressing changes. Plus you'll get to see a Doctor who specializes in wound treatment, not some oblivious surgeon who only knows how to "create" wounds not heal them.

    2. Get a Coccyx Cushion: This is the only cushion that helps with Pilonidal cysts/wounds. My original surgeon told me for 2 months that no cushion would help me and a nurse told me to use a hemmorhoid donut which made sitting down even more painful. I got 2 of these at a local Medical Supply Store for around $30. Sitting down without one is torture!
    [​IMG]

    3. Use pantyliners/feminine napkins to block the drainage: Specifically, Always Maxi Pads w Leak Guard Plus (Odor Control). Being a guy, I fought using these for months and still feel less than masculine having to use maxi pads. However, it beats the hell out of having my open wound drain all over my clothes. No need for the leakage to stain & destroy your underwear, shorts, dress pants & cause you constant social anxiety. Plus the smell can cause a lot of embarrassment too. Note: Not any maxi pad will work. Get the large ones with an "odor neutralizer."

    Lastly, my main tip is:
    Don't have full excision surgery done at all! And be careful with "Incision & Drain/Debridement" procedures. Those "cures" are worse than the disease!

    Of course, all this is just my opinion.
    Check out the main page and Dr. Bascom's site for more info on Pilonidal Surgery & Recovery.
    http://www.pilonidalsurgery.com/surgery

    Hope that helps.
    md
     
    Tzyarles, Nutshell and UnluckyOne found this helpful.
  2. excision2011

    excision2011 New Member

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    Message to the moderators, is there anyway to make this a "sticky thread?"

    Not to toot my own horn, but it seems like thread could be helpful for a lot of new members considering or recovering from Pilonidal surgery.
    I hate to see other people suffer needlessly because of bad advice from their surgeon.

    Thanks.
     
  3. Jah is Real

    Jah is Real New Member

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    It's a great post.
     
  4. Laura M

    Laura M New Member

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    What are the best procedures? I had surgery 20 years ago and never had another problem until last week. I am terrified about what to do now. My doctor has retired and I have an appointment with another surgeon from his practice tomorrow.
     
  5. johnf

    johnf New Member

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    I'm just curious about the need for panty liners. I had the open excision almost 2 weeks ago. Occasionally the wound leaks through the bandage a little bit but nothing extreme. And there is no smell whatsoever to the wound. I'm just wondering , did you experience this because your wound was extremely large? Or am I just not at the stage of healing where this would occur?
     
  6. UnluckyOne

    UnluckyOne Very Helpful

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    I can't speak for him but mine never required panty liners or anything. At one point it did drain quite a bit and almost leak through the gauze so my nurse had to put a thicker layer of gauze padding, but I was also getting it changed only once a day and I believe you're changing yours multiple times a day; therefore, yours should never really get too bad with the drainage. Also, I'm not quite sure what he meant by the smell but there should not be a foul one. My drainage never smelled other than the smell of iodoform which is what the gauze packing was soaked in. On the main pilonidal.org page there is a bunch of explanation about drainage and what it should look like/be like. It says that if it smells, it must be infected.

    Just keep up with your dressing changes and hopefully you won't have to go through any horrible stage!
     
  7. johnf

    johnf New Member

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    thanks...thats pretty much what I thought..I change the dressing 3 times a day. There's always a little drainage that gets soaked up by the outer gauze and goes no further.
     
  8. excision2011

    excision2011 New Member

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    The best procedure IMHO is the cleft lift. Or a simple Incision & Drain is you can get by with that.
     
  9. excision2011

    excision2011 New Member

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    My surgical wound was so wide and deep it would drain through the gauze packing and the leakage destroyed most my underwear & shorts. Not everyone's open wound is the same. For me the stains and odor were the most annoying parts to deal with. Especially socially because other people would notice my stained pants and the awful drainage smell.

    My home nurse suggested the panty liners early on when she was doing my dressing changes. I didn't really start using them until once I stopped the dressing changes. Because after 7 months my surgical wound still drains and the smell is nasty.

    Hopefully you won't have to deal with having to use maxi pads everytime you go out. My surgeon excised so much infected tissue from around my Pilonidal Cyst that it's been a nightmare to get to heal.
     
  10. excision2011

    excision2011 New Member

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    Yeah, the crap they soak the gauze in causes a lot of the unpleasant odor.
    Although having an open wound leaking blood and pus 24/7 doesn't exactly leave a pleasant smell either.
     
  11. Hastynurse

    Hastynurse New Member

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    I am a nursing student who had a pilonidal cyst excision about a week ago. I had had Pilonidal sinuses for probably 4-5 years, just living with the discomfort, drainage, smell, etc. About 6 months ago a true cyst formed at the sacrum, with exudate that was generally murky and ranged from pale yellow (purulent) to blood (sanguineous). It seemed as though it could get better for some time, and I was already overwhelmed with school, so I was using neosporin and bandaging it on my own. It is important to note for those new to these wounds that they DO NOT go away on their own. The wound in my case was trying to heal itself, but because of the constant exudate this only lead to the formation of granulation (new tissue) under the wound, causing the wound to protrude further and further out the longer I waited. Being an incredibly busy (and already incredibly stressed) student I had no time to see a surgeon about this until spring break. When he took a look at the site, he told me what I already knew; that surgery was the only option. He told me it wound be a closed wound, which are more likely to become infected but are much less trauma and work. He gave me the choice of addressing it over that same break, or waiting 2 months until Summer. Because it was bothering me and he seemed to think it would be a fairly simple surgery and recovery, I elected to do it in a few days.

    The actual surgery ended up going very differently. Because of how long I had waited, the sinuses and infection went very deep into my tissues. Instead of a closed wound, I awoke to a gaping one, requiring twice daily packing and dressing. The surgeon told my family that had I chosen to wait until the summer to take care of this issue, I would have ended up in the Emergency Room with a systemic infection, which people die of every day. I'd like to note here that YOU SHOULD NOT DO WHAT I DID. Had I addressed this issue when I first started showing symptoms, I could have had a much more simple surgery and not be having to go through the extensive packing, dressing, and treatment that I am having to deal with now. Excision2011 recommended not doing surgical excision/drainage. DO NOT FOLLOW THIS ADVICE. Although these cysts and sinuses are annoying, embarrassing, and sometimes debilitating issues, they can KILL YOU if they go unaddressed and untreated. While recovery will be long, difficult, and probably force me to take another semester to graduate, it is better than ending up in the ER and fighting for my life.

    Another note on Excision2011's post, the foul odor mentioned is concerning. Regular drainage from a healing wound should not smell. Drainage should also decrease as the wound is healing.

    The first tip about seeing a wound care center is excellent. The surgeon I saw knew nothing about wound healing or what my recovery would be (although instead of telling me these things he just gave me recommendations that were completely false). When I went to my Student Health office they saw the large wound and post-surgical blood and immediately sent me to Wound Care, where I am now scheduled for weekly visits throughout healing. Admittedly, every nurse that I have consulted has told me that my wound is the worst they have ever seen, so not everyone needs to go to Wound Care throughout recovery, but it is a great idea to go to a center after surgery to get good recommendations for post-surgical care.

    Lastly, going through this process has made me realize just how common these little bastards are. While I had never heard of anyone having one before, as soon as I became vocal everyone around me has as well. Everyone that I mention this problem to has gone through this themselves or has someone close to them who has. Don't feel that this is something you have to struggle with by yourself. I had read on several sites that these are more common with large, hairy men and since I am the exact opposite of all of those things I was embarrassed to have this issue. ANYONE can get these.

    TL,DR: Take it from a nursing student, do not wait to address this issue with a healthcare professional. While these are embarrassing and painful wounds, they can escalate into a systemic problem if untreated. Post-surgical wound drainage should mostly be blood, should not smell, and should decrease over time. See a wound care center after surgery, since most surgeons know more about making wounds than the healing process. You are not alone in this issue, they are much more common than you think.

    If you are reading this for yourself or a loved one, I hope you/they get the treatment they deserve and the recovery you/they need.

    Ciao,
    Hastynurse
     
  12. Tzyarles

    Tzyarles New Member

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    I have a nurse coming daily, to take out the stuff they fill the open wound with, but it hurts so much I end up crying and hyperventilating.
    Any tips to deal with that pain? I can't keep begging her to stop touching me.
     
  13. LILLY

    LILLY Very Helpful

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    Take your pain meds a half an hour before she comes and get in the shower and let the packing get wet and fall out.
     
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  14. Tzyarles

    Tzyarles New Member

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    The shower indeed helps to get it out, but no matter how many pain meds I take, I end up crying in pain and having a panic attack once she starts stuffing the packing in. The crying continues once she is gone as I keep realizing my life is put on hold right at the moment I got it back together after depression lost me my last job. I am considering benzodiazepines in combo with pain meds.
     
  15. LILLY

    LILLY Very Helpful

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    It does get better pretty quickly. It may not be fun but it will be tolerable. Keep in close contact with your doctor so your meds can be adjusted as needed.
     
  16. Dannnyyy

    Dannnyyy New Member

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    Hi seems like I have the same story that you have would love to talk to you about it maybe you can give me some tips. I've have a lot of trouble with the healing process. Would be great if we can have a chat
     

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