FAQs

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 one week oral antibiotic course, which will later be tailored following wound culture results.

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

A: 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, a one day absence should suffice.

Q: How do I care for my wound following pilonidal cystectomy?

A: The gauze bandage on the wound is removed after 24 hours and the wound is then cleansed with soap in the bath or shower. The wound is patted dry, and then left unbandaged, with the exception of the drain sponge and the small glued tape strips  The strips will naturally fall off in several weeks, and may become wet in the bath or shower.

Q: Will there be a drain in place following surgery?

A: 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 home by a family member at one week following surgery.

Q: Is sitting discouraged following pilonidal cystectomy?

A: Sitting is permissible, however, periods of prolonged sitting of 2 hours or more is 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.

Q: Is pain severe following pilonidal cystectomy? 

 A: 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.

Q: What does a pilonidal surgeon treat?

 A: A pilonidal surgeon treats the inflammatory symptoms of pilonidal disease, a hair-based infectious process arising in the intergluteal cleft skin. These symptoms include skin redness, pain, chronic drainage, swelling, and fevers. The pilonidal surgeon may treat the symptoms in a temporizing way. Alternately, the pilonidal surgeon may cure the disease.

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. Radiographic imaging studies, bloodwork, and biopsies are rarely (if ever) indicated. Some pilonidal surgeons may offer an anorectal examination under anesthesia to confirm the diagnosis.

Q: What is a pilonidal cyst?

 A: A pilonidal cyst is a collection of thick hair shafts furrowed in the subcutaneous fat deep to the intergluteal skin. The pilonidal cyst becomes symptomatic when infectious organisms thrive within it, causing accumulation of purulent fluid. This so-called suppuration in turn causes the overlying skin to become reddened, swollen, and painful.

Q: What is a pilonidal cyst excision?

 A: A pilonidal cyst excision is the surgical removal of a pilonidal cyst. There are many described techniques with varying outcomes. These excisional surgeries range from conservative “pit-picking” techniques, to a complete removal of all disease and a simultaneous lifting of the intergluteal cleft. It is highly recommended that any excisional treatment be performed by a dedicated pilonidal surgeon.

Q: What is a pilonidal sinus?

 A: A pilonidal sinus is a draining canal or “tract” connecting a pilonidal cyst to the skin surface. 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, increased body hair. Certain leisure activities including biking and horseback riding are also prominent in patients. 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: Most effective treatments for a pilonidal sinus involve excision of some form. These excisional surgeries range from conservative “pit-picking” techniques, to a complete removal of all disease and a simultaneous lifting of the intergluteal cleft. It is highly recommended that any excisional treatment be performed by a dedicated pilonidal surgeon.

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 avoidance of prolonged sitting. Should a nonsurgical approach be pursued, annual surveillance of the area to rule out malignant transformation is recommended.

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. Pain relief following incision and drainage is immediate and dramatic.

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

 A: Following pilonidal cystectomy, one should plan for a 2-3 day absence from work or school. If duties mandate prolonged sitting, bending, or heavy lifting, 1-2 weeks of leave is preferred. Alternately, shorter leave with work duty modification may be arranged. Acquisition of a standing desk should be considered to minimize leave duration. If only an incision and drainage has been performed, a one day absence should suffice.

Q: May I travel following pilonidal cystectomy?

 A: Automobile travel is permitted immediately following pilonidal cystectomy. Travel of this type should be limited, however, to 6 hours per day, with several rest stops. 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 one day following surgery. A coccyx pillow to offload pressure is prudent.

Q: What medication will be prescribed after pilonidal surgery?

 A: Following incision and drainage of a pilonidal abscess, both a ten-day oral antibiotic course and a light opiate analgesic will be prescribed. Following pilonidal cystectomy, an opiate analgesic, a stool softener such as docusate sodium, and a nonsteroidal anti-inflammatory such as naproxen sodium will be prescribed.

Q: How do I care for my wound following pilonidal cystectomy?

 A: The gauze bandage on the wound is removed after 24-48 hours and the wound is then cleansed with soap in the bath or shower. The wound is patted dry, and then left unbandaged, with the exception of the drain sponge and the small glued tape strips on the incision itself.The strips will naturally fall off in several weeks, and may become wet in the bath or shower.

Q: Will there be a drain in place following pilonidal surgery? How do I take care of a pilonidal drain?

 A: Following pilonidal cystectomy, a small drainage tube is left deep to the wound to prevent fluid accumulation. The tube is connected to a self-expanding bulbwhich may be pinned to the underwear or taped to the skin. The bulb is emptied several times a day, re-compressed and capped. Quantity and quality of the drainage is recorded by the patient. It is generally removed at home one week following surgery.

Q: Is sitting discouraged following pilonidal cystectomy?

 A: Sitting is permissible, however, periods of prolonged sitting of 2 hours or more is discouraged for 2 weeks following surgery. A coccyx pillow, available at most medical supply stores, is highly recommended to offload pressure from the surgical site Other considerations include working from a standing desk for several weeks following surgery.

Q: Is pain severe following pilonidal cystectomy?

 A: The pain is not severe following pilonidal cystectomy. We do medicate with routine nonsteroidal anti-inflammatoryand as-needed opiate analgesic. The area will likely be numb for several weeks and this will gradually resolve over 2-3 months. With specific regards to postoperative pain, it should be reiterated here that pilonidal surgery should always be performed by a pilonidal specialist. Many surgical techniques used by nonspecialists are associated with higher levels of pain.

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