My open excision recovery process

#1
I'm a 34 year old male and had an open excision surgery on 2/25/19 for a pilonidal abscess I had for about 3 years. I never had pain but plenty of drainage and blood sometimes after BM's. I ignored it for a long time, being a little embarrassed and trying my best to heal it with ointment and keeping the area clean (before I knew what it was). I finally went to the doctor in December '18 and brought it up at my physical, and he referred me to a colorectal surgeon in Cedar Rapids, Dr. Imran Hassan. He recommended the open excision surgery for my pilonidal abscess.

I'm going on week 6 of recovery, and so far the healing process is going well even though it's been a little bit of an ordeal. At this point, I am basically back to my normal routine, no pain, some drainage throughout the day, and able to be pretty active again (to a degree). It was 3.5 cm deep, 6 cm long, and 1.5 cm wide when excised; now it is down to 1.5 cm deep at the middle, 4 cm long, and .3 cm wide.

I struggled to find info on the open excision surgery on this forum because it seems like the cleft lift is the one that most people here pursue, so below is what I experienced to help others who may have this type of surgery. I didn't find this forum until after the surgery, so I didn't even know cleft lift existed until I read about it here. However, I am pleased so far with how my healing process is gone and don't regret having the open excision performed.

Pain
For me, day 3 through 8 post-surgery were the worst for pain, with the pain maxing out around day 6. At that point, the anesthesia has worn off and the inflammation is in full force. My max pain level was maybe a 6 or 7 out of a 1-10 scale when I was rolling off the bed or couch or sitting directly on it. If I was just laying or even walking, it was maybe a 3 or 4. It was manageable most of the time, but there were periods where I was really sore. During this period I also had trouble finding a comfortable position when sleeping. I don't sleep well on my stomach, so generally I would try sleeping on my side, but throughout the night the wound would get sore and I would wake up in pain. I usually kept Tylenol and ibuprofen nearby so I could take pain medicine without needing to get out of bed in the middle of the night. I was prescribed oxycodone by my doctor and took it for the first several days, but I will warn you that it does cause constipation, so I generally was down to only 1 pill a day by day 5 (I would take it 45 minutes before wound change or doctor appointments).

I started phasing off Tylenol and ibuprofen toward the end of week 2. By the middle of week 3, pain was greatly reduced and usually only occurred when sitting directly on the wound. By week 5, my pain was completely gone.

Wound Care at Home / Hygiene
Part of the reason I think I have had so much success is hygiene. Hygiene is a big part of avoiding infections with these types of wounds. I developed a morning routine, usually starting with a bowel movement, then removing the dressings, showering, drying, and then applying temporary dressing before going to the wound center.

Without getting too in depth, when cleaning up after a BM I would wipe away from the wound, then use Balneol and generic antiseptic wound cleaner to clean after I was done wiping. Avoid wiping toward the wound or dressing, because I would assume that is an easy way to get it infected.

In the shower, I would take out the packing and then gently apply Johnson & Johnson's Baby Soap to the area to clean, then rinse it out with warm water. Baby shampoo is also what they use at the wound center. Initially I didn't like digging around to get the packing out, so the wound center started leaving a "tail" on the packing that I could grab and made it easier to pull out.

Once out of the shower, I took a hair dryer and spent about 5 minutes drying on either a cool or warm setting. When done, I put on the temporary dressing, which usually involved 4" gauze pads taped over the wound, or later on when I had less drainage I was just stuffing them in my butt crack.

The entire routing of getting ready each morning was about 30-45 minutes.

Wound Appointments / Drainage
I have been going to the wound center every day since day 2 following the surgery. With week 6 starting next week, I am getting close to the point where my wife will probably start doing it at home.

Packing involved a little pain for the first couple weeks, so I would take an oxycodone 45 minutes before my appointment and then ask for them to use lidocaine which numbs the wound. I stopped using oxycodone during week 2, and stopped having them apply lidocaine toward the middle of week 3 because the pain was mostly gone. The cleaning / packing process only takes 5-10 minutes.

They started off by using gauze for the packing, but I was having a lot of issue with bleeding early on, so the wound center doctor switched me to Melgisorb AG and Maxorb AG. They are an alginate product that becomes more like a gel as it absorbs drainage, and it's less abrasive on the wound tissues. It causes much less pain than gauze.

After week 2, the issue I had was not with pain from the wound, but irritation from the drainage (exudate). Even when they pack the wound and put gauze over top to catch drainage, you will still have some that flows downward due to gravity, which then causes irritation and rashes on the skin if it sits too long. I started stuffing 4" x 4" gauze pads in my lower butt crack area to catch that drainage, and it helped quite a bit (I would usually have to change them a couple times a day). Your skin will also get irritated from pulling the tape off to change the dressing, sometimes resulting in mild rashes, so I usually applied hydrocortisone cream and/or aloe vera to my butt cheeks after showering to help keep the skin moisturized. You can also get fungal infections in areas where the drainage collects, so I would also use a little jock itch cream occasionally and it seemed to keep it under control. For me, drainage was worst around week 2-3, and then started decreasing significantly by week 5. I have very little drainage now going into week 6.

Bedsides taping the dressing, they also used DuoDERM anchors which are a sticky tape-like substance that can stay on the skin several days. They then tape directly to the DuoDERM. They worked great for a while, but I stopped using them after week 4 because I was having a lot of itchiness underneath. They tend to trap moisture, so your skin may need a break from them for a while.

My wound is now shallow enough that the packing doesn't stay in very well, so later this week they will probably be switching to a foam dressing.

Diet
Diet is another big one to helping the wound heal faster. You should be actively seeking out foods high in protein, zinc, Vitamin A, and Vitamin C. I ate pretty healthy for the first 3-4 weeks, although I'll admit I have been eating less healthy as the wound is getting better. Drinking lots of water also aids in the healing process; I tried to drink 48-60 oz per day. I generally tried to avoid sugary foods and sodas, although I would slip up every now and then. My meals often consisted of beef or chicken, dairy, fruits, vegetables, and whole grains. I avoided alcohol completely for the first 5 weeks.

Work / Activity
I was off work full-time for 2 1/2 weeks, and the last half of the third week I started doing half days. I bought a coccyx cushion (ComfiLife gel cushion - you can find it on Amazon) that I would use to sit on at work. They had an extra sit/stand desk at work that was not being used, so I was able to get that installed at my desk which helped greatly. Initially I could only sit for about 30 minutes at a time, but each day I worked my way up so that by week 5 I was able to sit for 2-3 hours at a time.

Going into week 6, I am able to do most of my normal activities again, although I have not tried running or bike riding yet.

Last item I can think of is cushions. Like I said, I bought a ComfiLife gel cushion for work, although I could not sit on that thing for the first 2 1/2 weeks; it puts too much pressure on the wound initially. I bought a donut cushion (by Ergonomic Innovations - on Amazon) before the surgery and I found that one much easier to sit on the first couple weeks. However, once the wound was better healed and less painful, I found the ComfiLife cushion more comfortable for long duration sitting.

Anyway, I hope this post helps someone who is dealing with the same type of surgery. I was getting down on myself during week 2 because things seemed to be getting worse rather than better, but trust me it will get better! Focus on diet and hygiene, and try to slowly build up your activity levels over several weeks. Good luck!
 
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#3
Thanks for sharing all that. Did the wound care involve any hair removal?
The wound nurses shave around the perimeter of the wound once every 2 weeks or so. I have yet to take this over myself, but will probably be having my wife do it soon. I've been shaving my bottom about once a week because otherwise pulling the tape off is a PITA if the hair gets too long.
 
#4
End of Week 7 update. At the start of this week the doctor switched me to a blue foam RTD packing because the wound is getting too shallow for the alginate dressing. The foam means I only need to go to the wound center every other day now. On the off days I do a sponge bath on my backside to avoid getting the dressing wet. The foam seems to catch more drainage, but I've noticed by the end of the second day I'm getting a little odor down there which I'm not as happy with. Also, the foam is tougher to take out than the alginate dressing--it seems to stick to the wound more, even when I get it wet in the shower. Apparently this is good as it helps with the debridement process, but it does make the wound a little sore for about an hour afterward.

My wound is down to 1 cm deep and continues to make progress. I still have doctor visits once a week, but I mostly see the wound doctor now and only see Dr. Hassan about once every 3 weeks.

The drainage amount seems to vary each day. Some days I have had very little, others I have had to change gauze out multiple times.

One problem I am having is rash / bumps due to constantly changing the tape over the last few weeks. It was really bad earlier this week, although it seems to be getting better. I've been using hydrocortisone and aloe vera a couple times daily and it seems to help with the skin problems. The rashes are worst right after shaving. I try to have them tape in different spots each time to give the skin a break, and it seems to be helping. They gave me some 3M Cavilon skin protectant to put on the skin before applying the tape, so we'll see if that helps.
 
#5
Start of week 9. It has been almost exactly two months since my surgery. Today I saw the wound doctor today and they are now adding a collagen dressing that goes on before the RTD foam. The wound changes are still every other day. My wound is 4 cm long, 0.1 cm wide, and 0.1 cm deep. They said the wound bed is looking very good and the new tissue is much stronger and less friable than a couple weeks ago when I was still on the alginate dressing. The doctor put me on doxycycline today for 10 days to kill off any bacteria that may be present in the wound. I still alternate between seeing the wound doctor and colorectal doctor, but my doctor appointments have been reduced to once every two weeks instead of once every week.

I don't have any pain with the wound, but I still have a decent amount of drainage that varies day by day. I'm also still having mild rash issues due to the tape, although they have improved significantly over the last couple weeks thanks to putting on Cavilon spray each time before the tape goes on.

Activity-wise, I'm basically back to normal except I haven't run or ridden my bike yet since the surgery. I do long walks, yard work, mild exercising, etc. with no problems. I drove 7 hours this weekend and had no issues sitting for 3 1/2 hours each way without stopping.
 
#8
I'm now at the end of 10 weeks, and according to my doctor the wound is 90% healed. They now use only a collagen dressing with gauze over top. I still have a some drainage, but it has decreased over the last couple weeks to the point where about 1/3 of a 4x4 rolled up gauze has drainage after 2 days (as opposed to the whole gauze).

The bigger news is that my culture test two weeks ago came back that I had both a moderate staph and e.coli infection, despite my best efforts with hygiene. I finished the doxycycline antibiotic last Friday, and the wound drainage and odor does seem much improved. It sounds like infections are fairly common and they were surprised I wasn't having any pain from it. The actual wound is basically flush now, with almost all of the tissue now a white scar tissue.
 
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