Vacuum-assisted closure of a complex pilonidal

Discussion in 'Pilonidal News' started by Sasha, Jul 8, 2003.

  1. Sasha

    Sasha Administrator Staff Member

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    Vacuum-assisted closure of a complex pilonidal sinus
    Diseases of the Colon and Rectum. Feb 2003

    McGuinness JG, Winter DC, O'Connell PR.
    Department of Surgery, University College Dublin, Mater Misericordiae Hospital, Ireland.

    INTRODUCTION: The annual incidence of pilonidal sinus is approximately 26 per 100,000, of which complex pilonidal sinuses are the minority. Many different approaches have been described for managing simple cases. Treatment options for complex pilonidal sinus include excision with healing by secondary intention or plastic surgical procedures to obliterate the defect. Recently, vacuum-assisted closure has been used by plastic surgeons to facilitate healing of chronic or complicated wounds with particular success in treating pressure wounds overlying the sacrum. METHODS: A patient with a complex pilonidal sinus was managed with excision and vacuum-assisted closure. RESULTS: A large tissue defect after radical excision healed relatively quickly when the subatmospheric pressure dressing was applied. The patient was discharged with the vacuum pump and change of dressings for alternate days. CONCLUSION: Vacuum-assisted closure of a complex pilonidal sinus shortened the length of hospital stay and the need for further surgery and provided a cosmetically acceptable result.



    Age is a very high price to pay for maturity.....
     
  2. irishdoc

    irishdoc New Member

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    Integra and the VAC

    Sasha, I have used the vac dressing with a twist. In serious cases in which a lot of tissue has been removed, I place Integra on the base of the wounf to leave a "neo-dermis". This is followed by a VAC dressing for 3-4 days. Then a split thickness skin graft and another VAC dressing. The graft takes in another 3-4 days and you are done!. Occasionally I follow up with laser treatment if the patient looks like a gorilla. Good results so far.

    irishdoc
     
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  3. cricket1

    cricket1 Helpful

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    We just tried the wound vac with failure already by day 4. It sucked bad.

    My wound was still oozing too much blood and my machine while on had the stench of death. Also the canister liqued turned into a full solid.yuck!

    my doc through the whole unit in the garbage.
     
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  4. Sasha

    Sasha Administrator Staff Member

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    Wound VAC is not right for all circumstances, very rarely do you see a doctor suggest using one, most often it is a Wound Care Center that has longer experience with them.
     
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  5. Daverl

    Daverl New Member

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    I had vac-assisted closure in 2003...

    I was a candidate in 2003 due to severe fistulas (sinus channels everywhere) radiating on my right cheek. I had scar tissue from my first surgery in 1984 which was mostly down the "center" with a excision of a major sinus.
    the surgery, although I was still worried poop-less went fine, but I truly had no ideal how much they were going to excise, and how unbelievable painful the recovery with the vac-asssited closure would be. I was in the hospital for 8 days(!)and was put under no less than 3 more times just to change those (horrible) black sponges. ( I must have been a real wuss???)

    I had a home health care nurse 3 days a week and I swear she was into torture. I pray there is better way or material used for the "sponges" because they really bond well to the wound. I was in such extreme pain when I let the nurse remove the dressing, fist my wife complained for me and they saturated the wound site with lidocaine-saline solution to "dull the pain!")
    Yah...right... it must have been mostly saline as it did zero good.

    I finally began getting up 1 to 2 hours b4 the nurse arrived and took a shower, and became an "expert" at torturing myself. slowwwwlllly removing the black-material-of death from my rear.[oyo]

    [=(] ON A SIDE NOTE....WHEN I FINALLY LOOKED IN THE MIRROR WITH THE BLACK SPONGE REMOVED, I KNEW WHY MY FAMILY WERE SO HORRIFIED IN THE HOSPITAL WHEN I (PROUDLY?) SHOWED THEM MY WOUND!!!

    To get to the point, and as I hope you can see by my history (I stupidly have endured these cysts for over 2/3rds of my life @ 47) The wound eventually healed quit well, I did not have any issues on the right side of my cheek for nearly 4 years, (I am a "hairy" male along with the spina-bifida type defect on tail bone) but in November of 2007 I went in to my surgeon in Minnesota and wanted him to look at what I feared was a forming cyst on my (GOd NO!) left cheek. Now: I still have raging fear from two surgeries and countless lancings yet I was proud of my insistance that "DOC" almighty was sure when he diagnosed me with (his words)........... A BUTT PIMPLE!
    Fast forward to now a year later, it never went away, I lost my insurance (and job) shortly after his "diagnosis" and as I type this I am sitting in a tub on with my lap-top trying to sit comfortable on my scar-tissue riddled right cheek since my left one now has too many channels and cysts for a grown man to count (w/out sobbing!)[=(]

    To put a cap on vac-assisted closure, it worked for me,[^^] from a standpoint of the surgical area being cyst-free (no where to go but "left" due to scarring????) yet I am not "cured", I fear I will allways be a suceptible candidate for reacurrances, and I have not always been diligent in shaving, cleaning, etc...which you ALL MUST DO. I am not an advocate of putting off any treatments out of fear, and I only tell the story of pain as a truth-in-advertising statement. Find out the best solution for you. get it early, dont delay. if u are a lucky one you will be free of these life-afflicting, embarrasing events for ever. Best of luck to all. I empathise with you all.
     
  6. usa777

    usa777 New Member

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    Wound Vac

    I had a open surgery 4 weeks ago and got the wound vac two weeks ago. Docter told me this week that I should be done in two weeks. The first two weeks you could just tell a little healing happened. In just 3 days you could tell a huge differance, after I got the vac. Other than the pain of carrying it around and a nurse coming by 3 times a week. The wound vac has been great. Just wish I got it from the beginning but my insurance did not think I needed one.[vv] My nurse though has been A-1. She is great. She has been a blessing.
     
  7. Daverl

    Daverl New Member

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    nice to hear its going well so far. any details of the vac-closure you can share?
     
  8. cricket1

    cricket1 Helpful

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    the wound vac was an utter nightmare for me. i've heard people have had wonderfull results with it,but for me i got really sick,there was a toterous smell comming from the vac and it wasn't keeping my wound dryed up at all. the day they told me that my body rejected it,they had to put me back in the hospital cause i was too ill.
     
  9. cricket1

    cricket1 Helpful

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    daverl.... i wish you'd quit talking like your a baby about the pain. everyone who endures such a horrific experience should be given a medal of strength. i for one have given birth 4 times and i'd rather do that 10 more times than do this. your stong and deal with pain beyond most peoples comprehension.
     
  10. Daverl

    Daverl New Member

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    You are right on both accounts, of course!

    I think I allow what people say (who cannot relate enough) effect the true reality of what we have and probable will still endure.

    You are so very right on point to (gently) scold me, however.

    Thank you for the well intended reminder.[o+o]
     
  11. Carrie89

    Carrie89 New Member

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    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. :cool:
     
  12. depilo

    depilo New Member

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    Wound Vac Therapy

    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.[x0x] Also, I now use just over the counter pain meds, so no more constipation!!![:8)]...

    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!!![:8)]...
    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!!![oyo]...
     
  13. JessicaV

    JessicaV New Member

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    I said I would never do this again.

    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 :D 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.[X(] 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. :)
     
  14. cricket1

    cricket1 Helpful

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    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.
     
  15. Benjamin

    Benjamin New Member

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    I had a bad experience with the wound vac after one of my surgeries. I had a cavity the size of a full grown males fist carved out of my tailbone area and it was expected to take a year or so to heal. My home visiting nurse had never used one before but they were new on the market and were supossed to cut down the healing time quite a bit. My insurance only covered 80% of the cost for the vac and the remaining 20% was over $2500 so I def couldnt afford to do it. After that my visiting nurses boss called the vac company, told them my situation, and they agreed to waive the 20% that my insurance didnt cover. So the nurse had no idea how to apply the vac and she ended up putting the clear plastic tape stuff across my entire ass and my butt turned into the biggest yeast infection in the world! My ass was sooooooooooo itchy and irritated! After months of carrying around this stupid pump it ended up doing no good and I missed a year at work and the wound never actually healed completely. It was very frustrating cause the nurses made it sound like this great new technology and told me that I would be healed up in no time. I returned the pump when I was done and they never honored paying the 20% my insurance didnt cover and sent me a bill. I refused to pay the bill so they sent it to a collection agency and it started to effect my credit. I ended up paying the $2500 to save my credit and vowed to never use a wound vac again. They entire experience sucked!
     
  16. ree777

    ree777 New Member

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    Hey Everyone! I am so glad to see this forum and to read about everyone else's experiences. I had my surgery for pilonodial sinus in this march but as it was my first surgery I completely zoned out and didnt understand much of what my doc said as I was shocked that I would have to take a month of uni. I had stitches and I was healing nicely when my wound got infected and then I later found out a month ago that pilonodial sinus reoccured and so I am 1 and a half month away from my wedding and I am having my surgery next week and this time my doc said she will put VAC dressing. As I go to public hospital and my surgeon/ doc is fairly busy it is quite hard to learn more about the type of surgery I will be having. I was hoping if someone can help me out as to how long I should take time off uni for this? can I take two months off? or will I heal in a month and a half?
    and how long will I need the VAC dressing for? can I take the dressing off after 4 weeks?
     
  17. LILLY

    LILLY Very Helpful

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    You would get more responses if you started a thread in the general forum. What I can tell you is that an open wound can take many months to heal. Even with the vac it's not something I would take on 6 weeks before my wedding.
     

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