Question 1

What should I expect after incision and drainage of a pilonidal abscess?

Accepted Answer

The abscess cavity is usually filled with a 1/4″-wide packing strip. This packing may be self removed in the tub or shower at 48 hours. In more severe cases, the packing is changed at 48 hours by a family member or a visiting nurse. You will initially be prescribed a one week oral antibiotic course, which will later be tailored following wound culture results.

Question 2

How much time should I take off from work following pilonidal surgery?

Accepted Answer

Following pilonidal cystectomy, you should plan for a 2-3 day absence from work or school. If your duties mandate prolonged sitting, or heavy lifting, 1-2 weeks of leave is preferred. If only an incision and drainage has been performed, 2-3 days absence should suffice.

Question 3

How do I care for my wound following pilonidal cystectomy?

Accepted Answer

The gauze bandage on the wound is removed after 48 hours and the wound is then cleansed with soap in the bath or shower. The wound is patted dry, and both the wound and the drain are repeat bandaged in the same way with prescribed gauze supplies. This is continued on a daily basis for 2 weeks, or until drain removal, after which point the wound may be left open to air.

Question 4

Will there be a drain in place following surgery?

Accepted Answer

A small drainage tube is left deep to the wound to prevent fluid accumulation. This is connected to a bulb, which is often safely pinned to the underwear. The drain is emptied several times a day. It is generally removed at 1-2 weeks depending on the volume of drainage.

Question 5

Is sitting discouraged following pilonidal cystectomy?

Accepted Answer

Sitting is permissible, however, periods of prolonged sitting (2 hours or more) are discouraged for 2 weeks following surgery. A “donut” type cushion, available at most medical supply stores, is highly recommended to offload pressure from the surgical site. The cushion is best brought with you to the surgical center to be first used on the car ride home.

Question 6

Is pain severe following pilonidal cystectomy?

Accepted Answer

The pain is usually not severe following this procedure. We do medicate with routine ibuprofen, and as-needed opiate analgesic. The area will likely be numb for several weeks and this will gradually resolve.

Laser Hair Removal

Laser hair removal is now offered as a stand-alone treatment for patients with tailbone-area pilonidal disease seeking to avoid surgery.

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