Whatever kind of operation you had for pilonidal disease, the incision or wound has to heal. Of course, you should follow the instructions given to you by your surgeon – but here are some strategies that we use in our clinic to optimize healing. Keep in mind that healing in human beings has a certain way that it works and a certain time frame that it takes for healing (6 weeks in a normal situation). These strategies won’t “speed up” healing, but may help you avoid things that “slow down” healing.
Unfortunately, in some situations a pilonidal wound just will not heal no matter how much you optimize the situation – and that is because of the location of the wound and the shape of the gluteal cleft. You can read more about that here.
The first issue that we address to optimize healing is nutritional status. It is important to make sure that you are taking plenty of protein – since creating healthy scar tissue requires protein as one of its main building blocks. We recommend patients consume at least 50 grams of protein per day. Vitamins also play a role in the healing process, especially vitamin C. We have developed a vitamin and supplement regimen that we recommend that all our cleft-lift patients take as long as possible before surgery, and for at least 6 weeks after surgery, and you can see those recommendations here.
Again, you should follow your surgeons instructions, but in general you want to avoid trauma to the operative site. Exact activity instructions really do depend on what particular operation you have had performed, and the precise technique used by your surgeon. The activity instructions we give our cleft lift patients can be see by following this link.
No matter what operation you had performed, it is important to keep the wound clean and dry, and allow good air circulation. In most cases, tucking gauze into the remaining gluteal crease to separate it a bit is helpful. This should be changed several times a day, and kept in place until complete healing occurs.
Whether hair removal is beneficial is a controversial subject, and depends on the specific situation. It is not recommended after a successful cleft-lift operation. If you had open wound surgery, and hair around the wound is impeding your ability to keep the area clean and dry, using a clipper to trim the hair is a good idea. Here is more about hair removal in general, as it pertains to pilonidal disease.
There are many topical medications that are recommended for wounds that will not heal. Sometimes they help, and other times they are ineffective. One of the more popular topicals is Manuka Honey. You can read my thoughts on that here. The idea behind using honey or any type of antibiotic or antiseptic on the wound is to decrease bacterial counts. However, in cases of slow wound healing bacteria are usually not the problem, except in some cases with wounds right on the anus (in which case anaerobic bacteria can be the culprit, and metronidazole ointment can be helpful). The more likely reason for slow healing is lack of air circulation with a wound deep in a cleft, possibly nutritional or vitamin deficiencies, or the presence of hidradenitis suppurativa (HS) or other auto-immune diseases.
One medication that we frequently recommend is Vitamin C serum. There are rarely any side effects from using this, and often it is very beneficial. Another is Skinuva scar cream. This is something that aids healing and improves scar appearance. Not everybody needs this, but there are times when it can be useful. I’m not aware of any downside to using this, but it is somewhat expensive. This is available on Amazon, directly from Skinuva, or from other retailers.
We routinely take care of patients with pilonidal cysts, non-healing pilonidal wounds, and pilonidal abscesses with great success in the pediatric, teen, and adult age groups.