First 48 Hours — What to Expect

• Leave the dressing in place for at least 48 hours unless it becomes visibly soaked or painful. Read More: Promoting wound healing after surgery by choosing the right dressing.
• Your surgeon or nurse will let you know when you can begin gentle cleaning beneath the dressing.
• If the lower part of the incision “separates” and begins draining, this is common but requires specific care to prevent it from becoming a chronic open wound.

Dressing Basics You Should Know

• Moist environment: Keeps healing tissue from drying out and helps new skin form.
• Absorb drainage: Helps control fluid and prevent blistering or breakdown.
• Gentle removal: Choose materials that won’t stick to healing tissue.
• Ointments like Neosporin are not recommended, as they can cause dermatitis.

Choosing the Right Dressing (Quick Chart)

Wound Type	Use This Dressing	Why It Helps
Light drainage	Hydrocolloid or film	Maintains a moist environment, protects from bacteria, low maintenance
Moderate/heavy drainage	Alginate, hydrofiber (e.g., Aquacel®), or foam	Highly absorbent, conforms to wound shape, reduces dressing change frequency
Open healing cavity wound (secondary intention)	Moist gauze packing (saline-moistened or hydrofiber rope), covered with absorbent outer dressing; consider alginate rope if heavy drainage	Fills dead space to prevent premature closure, wicks drainage, supports granulation tissue, and is easily removed without damaging new tissue (WoundSource)
Deep or slow-healing wound	Hydrofiber or alginate rope with secondary foam/film	Maintains moisture, absorbs exudate, supports faster epithelialization

How to Change Your Dressing Safely (Step-by-Step)

1. Wash your hands with soap and water.
2. Gently remove the old dressing—don’t pull on the wound.
3. Inspect for bleeding, odor, or changes in appearance.
4. Replace with a fresh moist pack if needed (for open wounds), then apply a clean outer dressing.
5. Wash your hands again and clean up.

When to Call Your Doctor

• Dressing becomes soaked or won’t stay in place.
• Signs of infection: foul smell, redness, or fever.
• You notice the wound looks deeper, larger, or isn’t improving.

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Open Wound Packing

As new tissue grows in your wound, it’s delicate and needs to be kept moist—not allowed to dry out. It’s also important to keep the wound clean and regularly remove the exudate. Exudate is the gooey greenish-white fluid you’ll see; it looks a bit like pus, but it’s actually just a mix of leftover material your body is getting rid of as it heals.

Traditionally, “packing” with cotton gauze is used for open wounds. Packing helps in three ways: it removes dead tissue, absorbs exudate, and prevents the wound edges from closing too early. If the sides close before the bottom fills in—called “bridging”—it can leave a pocket that might turn into an abscess.

For wounds deeper than an inch, gauze is packed into the wound and covered with a dressing pad. Some people get help from family, friends, or even a home health aid (which insurance might cover) for packing changes. Others do it themselves—it takes some practice with mirrors and flexibility, but most people pick it up pretty fast.

Not every surgeon recommends packing; some wounds heal well without it, as long as “bridging” is prevented and the top doesn’t seal shut too soon. If you’re not using packing, it’s vital to have your wound checked by a healthcare provider weekly to ensure it’s healing properly. No matter your method, you’ll need to flush the wound with exudate twice a day.

How to Pack Your Open Pilonidal Wound (Traditional Gauze Method)

Packing changes can hurt at first, so try taking your pain meds about 30 minutes before you start. If the gauze is stuck inside the wound, gently soak it with warm water—either in the shower or with a wet washcloth—for 10 minutes to make removal easier. It also helps to slightly moisten new gauze before putting it in, which keeps it from drying out too much.

Supplies you’ll need: scissors, gauze, tape, Q-tips.

1. Remove the old packing and flush out the wound to clean away any leftover gunk.
2. Pat the skin gently around the wound to dry it.
3. Pick a piece of gauze that’s the right size for your wound—fold it once, but not so much that it becomes a bulky wad that hurts.
4. Moisten the gauze a little, then carefully place it in the wound, making sure it reaches the bottom so the sides don’t touch. A Q-tip can help push the gauze down if needed. As your wound heals, you’ll need to use smaller pieces of gauze.
5. Finally, cover the wound with a pad and tape it down. You might need to try different tapes to find one that’s comfortable and doesn’t irritate your skin.

Medical Tape

It is entirely likely that you will complete your open healing Pilonidal treatment with a deep-seated hatred of all forms of medical tape; experiment until you find one that works for you. The residue left by the tape can be removed with Uni-solve Adhesive Remover.

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Healing Accelerators

Multidex Powder – many of our forum users have had good luck with Multidex Powder to help with the final stages of healing or when healing has slowed.  This product forms a protective “coating” that creates and maintains a moist environment beneficial for granulation tissue growth and epithelial proliferation.

More info on Multidex Powder.

Antimicrobials

Manuka Honey – we have had many reports on the forums that it works well and is easy to use. When shopping for products, look for UMF Manuka Honey; this is the preferred product for wound care.

UMF Manuka Honey is also showing great signs of reducing the likelihood of MRSA infections. Researchers have found that Manuka Honey inhibits protein production in MRSA cells, leading to their death. It has also been found that bacteria could not form resistance to medical-grade honey the same way they do to antibiotics.

Look for Derma Science’s line of MediHoney Products.

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Additional Reading on Manuka Honey

Case Studies Confirm Effectiveness of Honey for Wound Care

Honey as a topical treatment for wounds

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