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Discharge Instructions for Pilonidal Cystectomy

PAUL E. SAVOCA, MD, FACS, FASCRS

You have had a pilonidal cyst removed. Depending on the surgeon’s preference, the incision may be down the middle of the buttock crease or off to the side an inch or so. There may be some stitches placed as well. In most cases the majority of the wound is left open to heal in gradually. Caring for this open wound properly is essential for wound healing and to decrease recurrence of the cyst. Because of the difficulty seeing the wound, it is best to have assistance from a spouse, parent or sympathetic friend in changing the dressing.

  • You will be given a prescription for pain medication. Follow the directions given by your doctor for taking this medication. To avoid upset stomach, take your pain medication as prescribed with food in your stomach.
    Take these drugs exactly as directed. Never take more than the recommended dose, and do not take the drugs more often than directed. If the drugs do not seem to be working, consult your physician.
  • Do not share these or any other prescription drugs with others because the drug may have a completely different effect on the person for whom it was not prescribed. Some people experience drowsiness, dizziness, lightheadedness, or a false sense of well-being after taking prescription pain medications. Anyone who takes these drugs should not drive, use machines, or do anything else that might be dangerous until they know how the drug affects them. Nausea and vomiting are common side effects, especially when first beginning to take the medicine. If these symptoms do not go away after the first few doses, check with the physician who prescribed the medicine. Side effects may include: dizziness, lightheadedness, nausea, sedation, vomiting, if these side effects occur, it may help if you lie down after taking the medication.
  • Don’t drive while you are taking narcotic pain medication.
  • Don’t lift anything heavier than 15 pounds until your doctor says it’s okay.
  • Don’t mow the lawn, use a vacuum cleaner, or do other strenuous activities until your doctor says it’s okay.
  • You may walk indoors, outdoors, up and down stairs.
  • Expect to be off from work/school for at least one to two weeks following this surgery. Your surgeon will give you more guidance on return to normal activities.
  • Avoid constipation:
    • Eat fruits, vegetables, and whole grains.
    • Drink 6–8 glasses of water a day, unless otherwise instructed.
    • Use a fiber supplement and a stool softener twice a day. This is particularly true while taking narcotic pain medications.

Wound Care: For comfort take pain medication prior to dressing change.
The basic principle is to shower the wound twice a day and reinsert a fresh gauze in the wound after each shower.

  • Leave the dressing from surgery in place until the day after surgery.
  • The morning after surgery, remove the tape and outer dressing from the wound, getting in the shower and allow the rest of the dressing that is packed in the wound to be soaked with water and then pull it out. Unfortunately, this does hurt a bit.
  • When the dressing is removed, you may see a small amount of bleeding. This is normal.
  • Vigorously irrigate your wound in the shower for 5-10 minutes, using a hand-held shower head, it you have one. Aim showerhead directly at the wound. Bending forward helps open the wound. Let the water clean the area thoroughly.
  • Wrap a thin, clean wash cloth or 4×4 plain cotton gauze around your finger and clean gently, but thoroughly, the inner surface of the wound, removing any surface covering to expose clean, healthy pink tissue. Don’t scrub.
  • After shower, pat the skin around the wound edges dry.
  • The repacking of the wound is what usually requires help from another person. Wash hands. You may use gloves, but this is not necessary.
  • Moisten a fresh 4×4 inch plain cotton gauze with tap water. Squeeze out excess water.(The dressing should be damp, not wet).
  • Pack the wound gently but not tightly with the moist gauze. Use a Q-tip or your finger to ensure that the gauze reaches the bottom of the wound and place it so that all inner wound surfaces are in contact with the moist gauze.
  • Cover with a dry outer dressing and secure with tape or elastic bandage.
  • Dispose of the old dressing in plastic trash bag with twist tie.
  • As your wound heals, it will close from the bottom and sides, and you will need less and less gauze to pack it.
  • Shave the skin at least 2 inches around the wound at least once weekly. Use adhesive tape to pick up loose hair.

Follow up appointments are essential to ensure the wound is healing normally. The doctor will tell you how soon they need to see you back for the first follow up appointment.
When to Call Your Doctor:

Call the office if you have any of the following:

  • Excessive Bleeding
  • Increasing pain
  • Increased redness or drainage of the incision
  • Fever 100.5°F, or higher