Is it really a problem with pilonidal wounds?
Patients with open pilonidal wounds are often told that the wound is not healing because of “hypergranulation tissue”. The usual response is treatment with silver nitrate.
In many cases, this is the wrong diagnosis — and the wrong treatment.
Granulation tissue is a normal part of healing. Healthy wounds are supposed to look red and moist. Just because tissue appears raised or beefy-red does not mean it is abnormal.
True hypergranulation occurs when tissue grows significantly above the skin edges and physically prevents the wound from closing. In pilonidal wounds, this is rarely the reason why wounds are not healing.
More often, the real problems are:
- moisture, friction, and inflammation in the cleft
- the shape or depth of the residual gluteal crease
- midline wounds deep in the cleft
The key to healing pilonidal wounds is correcting the underlying mechanical and structural problems:
- flattening the cleft
- reducing moisture and friction
- improving wound geometry
- treating persistent disease when present
The answer is NOT silver nitrate application, which damages the tissues that are trying to heal.
A cleft lift will address the anatomic issues that are preventing the wound from healing and staying healed.
