Dealing with Pilonidal Wounds that Open and Close

Sometimes wound from pilonidal surgery seem to heal, but then open up again, and this happens multiple times.

This is a common problem, and usually means that there is still a residual cleft, that the scar from previous surgery is in the cleft, and the skin is fragile and intermittently breaks down, and then seems to heal. Sometimes these small wounds can be the starting point of a new pilonidal sinus, but other times, the wounds remain superficial and do not tunnel anywhere.

During one of the phases when the wound seems healed, it is impossible to say if it is going to stay that way, but most patients eventually get a sense of the transient nature of the healing, and come to the conclusion that any healing is temporary.


What should be done in this situation?

The first part of the answer to this question is another question: What kinds of treatment are commonly tried, but rarely successful?


So, what is successful?
  • Re-shaping the gluteal cleft so there isn’t a remaining fold, and moving the scar away from the midline. In other words, a cleft lift.

Why is a cleft lift the answer?

The reason that this wound keeps falling apart is not because of infection, a generalized failure of wound healing, lack of oxygen, or not enough time. It is because of the configuration of the cleft that has remained after the previous operation. This problematic shape can develop after cyst removal, cyst drainage, minimally invasive procedures, flap procedures, and even a cleft lift. In any of those situations a cleft lift, or cleft lift revision can be the solution.

Although having another operation can seem like a lot to go through, especially if you have had a previous procedure, but overall it may actually be easier, less time consuming, less painful, and less expensive than another 30 wound clinic visits.

If this is happening to you, feel free to reach out to us. We can help.




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