How Should I Care For My Pilonidal Cyst Excision Site?

Medically reviewed by: Gary H. Hoffman, MD

With the proper care and a little luck, the healing time after a pilonidal cyst excision can be minimized. If there is an infection or other complications, however, it could take as long as six months to heal completely. This means that making every effort to prevent these complications is vital to a quick recovery.

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What is a Pilonidal Cyst?

A pilonidal cyst surrounds  hair follicles, and may be caused initially by an ingrown hair, which explains why they are more common in men with thick, coarse body hair. Located only a few centimeters from the anus, pilonidal cysts may be infected with bacteria during bowel movements. This is one reason these cysts have a high rate of infection.  Normal skin contaminants also play a role in infection.

When the cyst becomes an abscess, it may drain pus or blood-tinged discharge on its own. Even if it appears to have drained on its own, however, you should still schedule an appointment with your doctor or a proctologist The cyst may not have fully drained, leading to a more serious infection. They also recur frequently in people who are at an increased risk, and can cause chronic problems if not treated properly.

If they don’t drain on their own, they can become swollen and painful. Your doctor can drain them in the office using only local anesthesia. Draining the cysts often provides immediate relief from pain and the swelling begins to subside. Your doctor may also prescribe antibiotics.

What Happens During Pilonidal Cyst Excision Surgery?

A pilonidal cyst excision is most commonly considered a day surgery, and you will be released to go home within a few hours of the procedure. You will, however, need to arrange for a ride home, since the surgery requires monitored anesthesia care, general anesthesia or a nerve block. In typical cases, the surgery usually takes 45 minutes or less, although you may spend several hours in a designated recovery area.

Once in the OR, the surgeon will make an incision near the cyst, and remove not only the cyst but a small amount of tissue surrounding it. Once the tissue has been removed and the area has been flushed, there are two options for how the resulting wound will be managed. These options are primary closure and open wound healing.

During an excision with primary closure, the wound is stitched closed. This greatly speeds healing, but both studies and many doctors’ anecdotal evidence show that there is also a much greater risk of postsurgical infection at the site. If this occurs, the stitches must typically be removed, the wound cleaned and the incision left open to heal.

Open wound healing is just as it sounds. The wound is packed with sterile gauze that may have been treated with antibiotic substances. This helps to protect the incision from infection. Allowing the wound to heal in this way promotes the most natural and complete healing, and reduces the risk of postsurgical infection. Full recovery, however, may take two months or more.

Your surgeon may offer you a choice in the decision, but many colon and rectal specialists have strong opinions on the topic, and prefer one method over the other. You should discuss the pros and cons of each method with your doctor, and make sure you feel comfortable with the drawbacks of your chosen method before proceeding.

What Type of Aftercare is Required?

As mentioned before, proper wound care can help speed your recovery after a pilonidal cyst excision, and may also help you cut your risk for recurrence. It is possible to provide your own wound care after excision surgery, but this can be awkward and difficult. Some health insurance plans will cover a few visits by a specially trained home health care nurse, but others will not. The tasks aren’t difficult and a spouse or trusted friend can easily assist you with no previous training if you find that you need help.

Your surgeon is the expert in your case, so it is vital you follow the instructions given before you are discharged and contact the office if you have any other concerns. This article and other online medical writing is not intended as advice, but can be used to give you an idea of what may be required.

If you have undergone an excision with primary closure, taking care of the wound may be more straightforward. There will be regular dressing changes for approximately two weeks, and a closed-suction drain may be placed to help drain excess fluid for the first few days. You may also be given special antiseptic wash that is used to keep the incision clean. The drain, if necessary, is usually removed within a few days of the procedure. The stitches are typically removed at the two week follow-up appointment.

The wound care instructions for an incision that is not closed may require flushing the cavity with a special wash to aid healing and prevent infection. The cavity will then need to be re-packed with sterile dressing. In other cases, only the flushing is required and the incision is not packed with gauze. Because fluids can easily flow from the open wound, a drain is not required for open healing. Your doctor may schedule follow-up visits on a weekly or bi-weekly basis for a month to six weeks after the procedure, or until you are fully healed.

Los Angeles Colon and Rectal Surgical Associates

The board certified surgeons of Los Angeles Colon and Rectal Surgical Associates are experts on the treatment of pilonidal cysts. They are specialists in all diseases of the colon, rectum and anus. By calling (310) 273-2310, you can schedule a confidential appointment and discuss any of your questions with your physician.

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