Q: What should I expect after incision and drainage of a pilonidal abscess?
A: 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. The small wound is then left unpacked to heal from its depths outward. You will initially be prescribed a ten-day oral antibiotic course, which will later be tailored following wound culture results. Following drainage, pain relief can be dramatic.
Q: How much time should I take off from work following pilonidal surgery?
A: Following the cleft-lift procedure, you should plan for a one-week absence from work or school. If your duties mandate physical labor, or heavy lifting, 2 weeks of leave is preferred. If only an incision and drainage or pit-picking procedure has been performed, a one-day absence should suffice.
Q: How do I care for my wound following cleft-lift procedure?
A: The larger gauze bandage is removed after 48 hours and the wound is then cleansed with soap and warm water in the shower. The wound is patted dry, and left unbandaged with the exception of the drain band-aid and the small glued tape strips. We also keep a twice-folded gauze pad tucked between the buttocks to aerate the bottom portion of the wound. This gauze wedge is changed twice per day until the two-week follow-up appointment. Showers are encouraged at least every 2 days until the follow-up appointment.
Q: Will there be a drain in place following a cleft-lift?
A: A drainage tube is left deep to the wound to prevent fluid accumulation. It exits the skin at least a finger’s length away from the main incision at the upper aspect of the opposing buttock. This is connected to a self-expanding bulb, which is often safely pinned to the underwear. The drain is emptied several times a day. It is generally removed at home by a family member at one week following surgery.
Q: Is sitting discouraged following pilonidal surgery?
A: Sitting is encouraged the day after cleft-lift procedure. We recommend patients sit on a cushioned yet supportive surface for as long as tolerated. This helps express seroma fluid from the drain in the week following surgery. We also recommend patients sit the day after the pit-picking procedure.
Q: Is pain severe following pilonidal surgery?
A: Pain is generally not severe following pilonidal surgery. In the cleft-lift procedure specifically, we perform an ultrasound-guided nerve block of the tailbone area just prior to incision. The numbing effect achieved with this lasts 48 hours. We supplement this with routine oral naproxen and prescription pain medication as needed. With this tri-modal approach to pain, patients find pain quite manageable. Patients can get comfortable in certain positions and can resume light exercise within several days.
Q: What does a pilonidal surgeon treat?
A: A pilonidal surgeon treats the inflammatory symptoms of pilonidal disease, an infectious process of the skin and subcutaneous fat occurring in and around the crease between the upper buttocks, a region known as the gluteal cleft. These symptoms include skin redness, pain, chronic drainage, swelling, and fevers. The surgeon may treat the acute symptoms in a temporizing way by draining an associated abscess or giving an antibiotic. In select patients, the surgeon may cure the disease with the cleft-lift procedure.
Q: How is pilonidal disease diagnosed?
A: Pilonidal disease is a clinical diagnosis, i.e. one made by an experienced clinician based solely on history and physical examination. The sine qua non physical finding that confirms the pilonidal diagnosis is the presence of midline pits at the gluteal cleft. Appearing as dilated pores, the pits represent traumatized hair follicles. Another finding may be a pilonidal sinus tract off the midline, which at the skin level appears as a reddened, raw, pus-draining nodule. Recurrent boils in the area also supports the diagnosis. Imaging studies are rarely used to establish diagnosis.
Q: What is a pilonidal cyst?
A: A pilonidal “cyst” is a traditional term that has been errantly used to describe a nest of hairs surrounded by a spherical sac deep below the skin at the cleft. Again incorrectly, it has been postulated that this pilonidal cyst becomes symptomatic when infectious organisms thrive within it, causing accumulation of purulent fluid and the so-called pilonidal abscess. The term “cyst” as it relates to pilonidal disease has been largely abandoned by specialists, as it is now accepted that no true sac-lined cyst is present under the skin.
Q: What is a pilonidal cystectomy?
A: A pilonidal cystectomy is a term used by non-specialists to define the surgical removal of the soft tissue at the cleft which has been inflamed and damaged by pilonidal disease. The term “cystectomy” is not optimal because it implies that a sac-lined cyst living deep under the skin is driving the infections, and it follows that the main objective of the surgery is full removal of this cyst. Unfortunately, the surgery is flawed in its objective, as no true cyst exists. As a result, the surgical outcomes are wraught with wound failures and persistence or recurrence of pilonidal symptoms.
Q: What is a pilonidal sinus?
A: A pilonidal sinus tract is a smoothly-lined tubular canal connecting a chronically infected area of the skin or subcutaneous fat to a raw reddened pus-draining nodule or “granuloma” at the skin surface. The pilonidal sinus is most frequently seen at the gluteal cleft but is also occasionally reported at the umbilicus. The sinus tract may be long and complex, leading to a skin opening far lateral on the buttock cheek. In some cases, sinuses may be multiple in number. The drainage seen is bloody, clear, or purulent. A longstanding pilonidal sinus left untreated can in rare cases lead to skin cancer.
Q: What are the risk factors for developing a pilonidal sinus?
A: A pilonidal sinus is most often seen in males between the ages of 16 and 40 years. Additional risk factors include obesity, sedentary work/lifestyle, and increased or coarse body hair. Pilonidal sinus disease is more prevalent in avid bicyclists and equestrians. It tends to be more common in patients of eastern European and middle Eastern descent. There is an association observed between pilonidal sinus and polycystic ovary syndrome in females. A pilonidal sinus may develop at the site of previous incision and drainage of pilonidal abscess, or it may develop in a spontaneous way.
Q: What are the treatment options for a pilonidal sinus?
A: There are two effective surgeries for a pilonidal sinus. The far most effective surgery is the cleft-lift procedure in which the sinus is removed as the gluteal cleft is made more shallow. The latter objective permanently disrupts the mechanism that drives the disorder. With the cleft-lift, fast wound healing and low recurrence rates are the rule, provided the procedure is performed by a dedicated pilonidal surgeon. For patients wishing a more conservative approach with a quicker recovery, the pit-picking procedure can be performed. In the pit-picking procedure, we remove the sinus opening and simultaneously clean and debride the midline pits, sometimes achieving prolonged periods of disease dormancy.
Q: Can pilonidal sinus be treated without surgery?
A: Conservative approach to a pilonidal sinus is appropriate in select patients. In these cases, lifestyle modification is routinely recommended, including weight loss, depilatory therapy, and antibacterial creams and soaps. Avoidance of prolonged sitting is recommended along with a specialized coccyx pillow to offload pressure. Distance bicycle riding and equestrian activities should probably also be avoided. Should a nonsurgical approach be pursued, annual surveillance of the area to rule out malignant transformation is recommended.
Q: May I travel following pilonidal surgery?
A: Automobile travel is permitted immediately following pilonidal surgery of any kind including the cleft-lift procedure. Travel of this type should be limited to 6 hours in a day. With regards to timing, the day or evening of the surgery is preferable to the day after the surgery because residual sedation allows for better patient sleeping during the ride. Reclining in a passenger seat or laying supine on connected back seats is recommended. With regards to air travel, it is recommended that flights not be scheduled until at least two days following surgery.
CONTACT US TODAY!
Contact us today and let us help you leave your pain behind.