A pilonidal cyst is a pocket of skin infection, often containing hair and skin debris, that develops near the tailbone at the top of the buttocks crease. When surgical removal (excision) is performed, the resulting wound is frequently left open to heal from the base upward. This method, called healing by secondary intention, requires the wound to be packed with gauze to prevent the skin edges from closing prematurely over the deeper cavity. Proper wound packing is standard post-operative care, often performed at home, and is crucial for ensuring the wound heals completely and reduces the risk of recurrence.
Essential Supplies and Preparation
Gathering all necessary items and preparing a clean space ensures a sterile and smooth procedure before beginning the dressing change. You will need sterile, non-adherent strip gauze (which may be plain or medicated, such as iodoform), sterile saline solution for cleaning, sterile gloves, clean scissors, medical tape, and a designated trash receptacle for the soiled dressings.
Setting up a clean, well-lit area is an important first step, as the wound’s location often makes visibility difficult. Thoroughly wash your hands before opening any sterile supplies, even if wearing gloves. The packing gauze should be cut to the appropriate length before removing the old dressing, ensuring a small “tail” is left outside the cavity for easy removal. Due to the location of the wound, having a caregiver assist is often necessary.
Detailed Procedure for Wound Cleaning and Packing
The process of changing the wound dressing begins with the gentle removal of the old packing material. It is often helpful to take pain medication about 30 minutes before the dressing change, as the removal process can cause discomfort. Pull the old packing out slowly and steadily, inspecting the material to ensure the entire strip is removed and no fragments remain in the wound cavity.
Next, thoroughly clean the wound to remove discharge and debris. This is often best accomplished while showering, where the wound can be vigorously irrigated for several minutes using a hand-held shower head aimed directly into the cavity. After showering, clean the wound further using saline solution to ensure that no foreign material or exudate remains. Pat the surrounding skin dry with a clean towel, but leave the wound cavity slightly moist.
Once clean, prepare and insert the new packing strip. Moisten the sterile gauze with saline solution and squeeze out the excess liquid so the material is damp, not saturated. Gently fill the entire wound cavity without packing it too tightly, as excessive pressure can impede the healing process. A cotton-tipped applicator or a gloved finger may be used to ensure the gauze reaches the deepest parts and crevices of the wound.
The packing material must contact all inner wound surfaces to encourage healing from the bottom up. Leave a small piece of the gauze strip extending outside the opening to serve as the removal tab for the next dressing change. Finally, cover the packed wound with a sterile, dry outer dressing, securing it with medical tape or a snug garment to protect the site.
Monitoring the Healing Process and Warning Signs
The open wound typically heals over several weeks to a few months, often averaging 52 to 68 days. As the wound heals, observe the formation of healthy granulation tissue, which appears as pink or red, moist, bumpy tissue filling the defect from the base upward. Drainage is a normal part of the healing process; initially, it may be serosanguinous (a thin, pink or light red fluid).
The amount of drainage should gradually decrease over time, potentially becoming cloudy or yellowish-white (normal exudate). A small amount of bleeding is also common, especially during packing changes, as new blood vessels form within the wound. However, specific signs indicate a possible complication requiring immediate contact with a healthcare provider.
You should seek medical attention if you experience any of the following warning signs:
- A fever of 100.5°F or higher.
- Pain that increases and is not relieved by prescribed medication.
- Excessive or foul-smelling drainage, suggesting infection.
- Significant, bright red bleeding (e.g., soaking through the bandage quickly).
- Increased redness, warmth, or swelling that spreads beyond the wound edges.