Enough Is Enough: Pilodoc Weighs in on the  Open-Wound Problem in Pilonidal Care

Simply put: patients should not be subjected to open-wound excision for pilonidal disease.

In my experience as a physician specializing in pilonidal disease at PTCNJ, this operation is most often offered by surgeons who have not taken a focused interest in the condition itself. Pilonidal disease is frequently misunderstood, minimized, or treated as a minor problem; despite its very real physical, emotional, and social impact on patients, particularly adolescents and young adults.

Open-wound excision is a morbid and outdated approach. It is not a targeted or disease-specific solution, and it frequently results in prolonged healing, significant disruption to daily life, and an unacceptably high rate of wound failure or recurrence. In many large teaching hospitals, this operation is considered routine and is often delegated to the most junior members of the surgical team. The procedure itself is technically simple, brief, and easily taught early in surgical training but simplicity should never be confused with appropriateness or effectiveness.

If you or your child have already undergone open-wound pilonidal surgery, there is no need to panic,but caution is warranted:

1. Do not consider the operation a success or leave a positive review until at least one year has passed without wound complications, delayed healing, or recurrence.

2. If healing is prolonged or incomplete, or if the wound remains open, consider evaluation at a specialized center such as PTCNJ, where immediate or definitive closure options may be available.

I am deeply committed to curing pilonidal disease and am fortunate to do so regularly using modern, evidence-based surgical techniques. For that same reason, I am firmly opposed to open-wound pilonidal surgery. Our patients deserve a better understanding of the disease, better surgical planning, and better outcomes.