Problems During Wound Healing

Most Pilonidal patients have no problems healing, but the process can go wrong for some people or be unbearably slow. Below is a list of the primary reasons a wound isn’t healing or is healing far slower than expected and what to do about them.

Lack of Oxygen

The natal cleft is not just a place where the sun doesn’t shine, it’s also a place that gets very little oxygen. Lack of oxygen creates an environment where anaerobic bacteria thrive and those bacteria can bring healing to a full stop. The lower the surgical wound is in the natal cleft, the less oxygen it will receive. Getting oxygen to the wound is the first place to start if you are having a healing problem.

In a perfect world, your surgeon did most of their cutting “out of the ditch” to keep the suture line or open wound in an area where it will get oxygen. If that was not possible due to location or surgeon ineptitude, you can help yourself during healing by exposing the wound area to oxygen as much as possible. This will sound a little odd but we must do what we must do… Some forum members have used techniques of sitting in the jackknife position twice daily (bottoms up!) to keep the cheeks spread apart and get oxygen into the cleft. Some have even used tape to keep their buttocks apart.

Areas low in the cleft typically have the most difficult time healing and you might also try advanced care products such as Multidex Powder. Extra cleaning of the area with Hibiclens might also help lower the bacteria level.

Dr. John Bascom created a device called a Cigar Vent  to use over a non-healing wound that can left in place all day during normal activities. This is an easy to make at home way of providing way to air to the wound.

Additional Reading

Bascom Cigar Vent Device for Healing

Poor Nutrition or Poor Health

• Eat right and take vitamins. No Fast Food!
• RELAX! It has been proven that stress impairs your immune system and slows down healing.
• CHILL OUT! Research has shown that anger slows healing. Those who control their anger heal faster than those who have a short boiling point.
• Avoid using antibiotic ointments (Neosporin, Bacitricin, etc.) These are proven to frequently cause allergic reactions and contact dermatitis with regular use.
• Try doing sitz baths with Epson Salts in the water.
• Make sure you are getting at least 60 grams of high quality protein daily.
• Breathe. Deeply and slowly. Healing uses a lot of oxygen from the bloodstream. Try an exercise of doing 5 minutes of deep breathing, three times a day.
• Do you possibly have undetected diabetes or an immune system disorder? One of the symptoms is slow healing wounds. Levels of diabetes have been skyrocketing in the past few years, a simple fasting blood test should tell you if you are at risk.

Infection

• Is the wound inflamed, painful, or draining a bad smelling fluid? See a doctor ASAP, especially if you are running any kind of fever.
• It could be hair or debris getting into the wound and causing irritation.
• It could be that a sinus or pit was missed during surgery.
• Any surgical wound infection is serious business. If you suspect for one minute that you might have an infection, get to the doctor ASAP. Left untreated, wound infections can turn into Sepsis (infection moves into the blood) which will require hospitalization and can be fatal.

Wound Healing Centers

Once you have ruled out the above possibilities, it is time for a Wound Care Center. Most major cities have one, just do a browser search in your area. Wound Care Specialists are the SWAT team of healing, all they do is treat wounds and they are far more knowledgeable than your surgeon. Your surgeon has gone through extensive training in cutting and sewing; a Wound Care Specialist has gone through extensive training in wound healing. Surgeons frequently are not the best at things like aftercare and wound healing, which is why we recommend that if it has taken longer than 4 months to heal your wound, it’s time to bring in the wound professionals.

Other Things That Can Go Wrong

These are fairly rare occurrences, but they do happen.

• Hematomas – a pocket of blood, or clot, in the wound. More likely to happen in closed wound incisions. These need to be opened up to drain or be removed since they can become infected.
• Seromas – this is an accumulation of fluid in the “dead space” of the surgical wound. Unlike an abscess, this is not an infection, just a pooling of fluid. More likely to happen in closed wound incisions or in an open wound that has closed over at the top too quickly, leaving “dead space” open underneath. Some of these may resolve themselves, but most need to have the fluid drained and the “dead space” needs to be closed, either by deep suturing or by re-opening the top of the wound and packing until it heals from the bottom up.
• Wound Breakdown (dehiscence) – this is a softening of the wound tissues that can happen in the deep layers or the top skin layers. Wound breakdown is a disruption and bursting open of a surgical suture line. In a closed incision, this means that the sutures can’t hold and the patient needs to resort to open healing. If you are hearing the words “wound breakdown” from your doctor, get a referral to a Wound Care Center ASAP. Do not ask your doctor to go this one on his/her own, no matter how great or competent they are.

Consider a Wound VAC

Vacuum-assisted closure (VAC) is a non-invasive technique whereby negative pressure (suction) is delivered in a uniform manner to a wound. This improves blood flow, promoting a moist environment and assisting in the proliferation of granulation tissue. The use of the VAC system has resulted in progressive wound closure in cavity wounds, and is now often used on patients in the community as well as in the hospital setting.

Read Cathy’s experience with a Wound VAC

Additional Reading

Vacuum Assisted Closure – World Wide Wounds 2001

Related Links

This page last updated: February 10, 2016