Pearls for Practice: Management of the Excised Pilonidal Wound

     Pilonidal disease is acute and chronic, affects young men three times more frequently than women, and is believed to be caused by ingrown hairs that stimulate an inflammatory and granulomatous process. In our clinic, most patients with the disease present after surgical excision and curettage; a few have undergone marsupialization, which decreases the surface area left to heal but still leaves an open wound. Wound size varies from 2 cm to 4 cm deep with an equally wide wound base. Typical postoperative instructions include dry gauze dressing changes and sitz baths.

     Comfort during wound dressing application, wearing, and removal seems to be a primary patient concern. Dry gauze, while inexpensive, often sticks to the wound on removal and can leave fibers; some patients complain of the sensation of “sitting on something.” For persons with active lifestyles, the need for dressing change during the day because of strikethrough or saturation is cumbersome and embarrassing. Sitz baths, while comforting, do not provide a clean environment for the wound once the perineum enters the water.

     Our approach to the pilonidal wound begins with ensuring all surrounding hair is adequately clipped so it will not fold into the wound bed. The dressing should be easy to apply, have as little bulk as possible, and not adhere on removal. Ideally, the dressing should keep the wound bed moist but absorb, wick away, and contain excess fluid and exudate. Lastly, at the termination of the sitz bath, the patient is asked to elevate the perineum out of the tub and use a 60-cc syringe or other plastic bottle with nozzle to irrigate the wound with clean water.

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This article was not subject to the Ostomy Wound Management peer-review process.