Pilonidal Wound Healing Overview
A wound is a break in the protective layer of the skin, it can be accidental or intentional as with surgery.
All wounds, whether small or large, go through the same basic stages of healing that will be discussed in Wound Healing 201. Your job, as the recipient of a Pilonidal surgical wound, is to help your body heal the damage so that the skin barrier is rebuilt and the underlying tissue stable.
On this page we are going to focus very specifically on Pilonidal surgical wounds – wounds created intentionally by a surgeon in the name of helping a patient overcome an infected abscess. The companion page, Wound heading 201, will take you on a deep dive into the miracle how the body heals itself so that you understand the processes as they are happening.
The final result of wound healing is scar tissue. A scar is an area of fibrous tissue that replaces normal skin after injury. Scar tissue never regains the full ability to stretch that unbroken skin has and it will always be more fragile than the surrounding skin.
When you leave the surgical center, you will have one of two types of wounds as a result of the surgeon’s handiwork: Open or Closed.
“Open” Surgical Wounds
An “Open” Pilonidal excision wound is also called a “Cavity Wound”, meaning that a large chunk of tissue has been removed, leaving a cavity. Small cavity wounds can be closed with stitches but larger cavities need to replace the removed tissue so that the natural shape of the body is retained, along with padding, stability, and flexibility. The difference in technique can be imagined as digging a hole in your yard. In a closed surgery, you push the sides of the hole together and let them mend. In an open surgery, you allow the hole to refill itself from the bottom.
An open healing is also refereed to as “healing from the bottom up” or “healing from the inside out.” The wound will fill itself in by building new tissue starting at the bottom of the wound. As the bottom begins to fill upward, the sides of the wound also will grow new tissue and fill inward.
The most important part of open healing is to keep the sides of the wound from fusing together until the bottom of the wound has filled in at least halfway. If the sides of the wound are allowed to form bridges and knit together too early, they can trap fluids and exudate (debris resulting from healing) deep in the wound bed. This is part of the role of packing for an Open wound.
Those people who go through open healing will have an unforgettable experience watching the healing process of a gaping cavity wound fill in and heal into a small patch of scar tissue over the course of about 8 weeks. It won’t be fun, but it will be fascinating to watch your body at work.
Additional Reading
Managing Cavity Wounds – Journal of Community Nursing 1998
Sutured Wounds (Closed, Stitched)
Closed surgical procedure wounds heal much faster because in a closed wound the inside has only to knit itself back together, not completely rebuild a lot of tissue from the bottom. The more tissue that the surgeon removed, the more likely it will be that the wound needs to heal a large cavity from the bottom up. The less tissue removed, the more likely that sutures/stitches would be used.
Closed wounds do have a higher rate of infection, which is something you need to always be on the watch for. Painful, red, swollen, and pus discharge are all BAD symptoms. Get to the doctor without delay. Closed wounds deep in the midline of the natal cleft are particularly at risk because now you have lots of openings where anaerobic bacteria can breach the skin easily.
Additional Reading
Caring for Sutures or Staples at Home – Medline Plus, US National Library of Medicine
Related Links
The main overview page for our Surgery Aftercare section where you’ll learn all about wound care and healing after surgery.
The Master Class on how the body heals wounds, both surgical and accidental. We go over the stages of wound healing and processes.
What you put into your body has a profound impact on how quickly you heal. Your body needs fuel and supplies to heal fast.
This page last updated: January 5, 2019
