Pilonidal sinus excision wounds

A pilonidal sinus is a cyst or abscess in the natal or intergluteal cleft. Treatment of pilonidal sinus requires eradication of the sinus tract, healing of the tissue deficit and prevention of recurrence. Following surgical intervention, these wounds can be closed by primary intention (off-midline closure preferred) or left open to heal by secondary intention. Closed wounds can be managed as for other surgical wounds.

Complications following pilonidal sinus excision include surgical site infection and wound dehiscence. The risk factors for surgical site infection and wound dehiscence are the same as for other surgical wounds; see Prevention of surgical wound complications. Hair removal from the wound area with tweezers or laser epilation may be beneficial; however, shaving hair may increase the risk of recurrence.

For wounds healing by secondary intention, healing should occur from the bottom of the wound upwards, and this must be assessed and confirmed at every dressing change. An abscess can form if the wound is inappropriately allowed to heal across the surface.

Open wounds or wounds that have dehisced can be managed by packing with a hypertonic saline dressing (see c_lwg2-c17-s4.html#lwg2-c17-s4__tlwg2-c17-tbl13), a gelling fibre dressing or an alginate fibre dressing. Advise patients to wear firm-fitting trunks (eg bicycle shorts) for compression.

For wounds with delayed healing, consider using a silver gelling fibre dressing (eg Aquacel Ag), topical negative wound pressure therapy, or a silver polyurethane foam dressing (eg Biatain Ag—see Foam dressings). Principles of packing the wound are as for cavity wounds.

Showering is encouraged to keep the wound clean; sitz baths are not routinely recommended.