Recurring Pilonidal Cysts

Tired of dealing with a recurring pilonidal cyst? Also referred to as pilonidal disease, these cysts can be painful and uncomfortable, and cause issues in a patient’s day-to-day life. While incision and drainage is the most common method for treating these cysts, in some cases they do come back.

Here, we look at what causes pilonidal cysts to recur and how you can eliminate them once and for all if they do.

What are pilonidal cysts?

A pilonidal cyst is a pocket of skin, typically filled with hair and skin debris. They are often found at the top of the buttocks, near the tailbone.

These cysts generally form when hair penetrates the skin and becomes embedded. Infection of a pilonidal cyst can cause significant discomfort. They predominantly affect young adult males, and those who sit for extended periods face a higher risk of developing them.

Why might pilonidal cysts come back?

Although most treatments for pilonidal cysts are successful, they can return after surgery. Recurrence rates vary from 13.8% to 32% within five years, depending on the surgical method used. The recurrence rate of pilonidal disease with abscess following incision and drainage is higher, at up to 40%. This can be caused by inadequate management of debris, or wound healing issues. Cysts can return due to reinfection or hair growth near the surgical scar. If you experience recurrent pilonidal cysts, you may suffer from persistent wounds and draining sinuses.

Treating pilonidal cysts to prevent recurrence

Surgery to remove pilonidal cysts is typically the best option, and you have the option to either close the wound or let it heal by leaving it open. Each method has its advantages and drawbacks, and the final decision is usually up to you. However, if there’s significant lingering infection, an open approach may be the only choice.

The open wound method tends to be the most successful. After the initial discomfort from surgery subsides, you can resume most of your daily activities, including work. However, the drawback is that you may have a large wound that requires daily care. This can be managed at the clinic for the first 2 to 3 weeks, and less frequently as time goes on. Although healing can take up to 3 months or longer in rare cases, the open wound is generally painless and doesn’t limit your activities.

Managing your wound

When the wound is closed, it heals more rapidly, and you won’t need daily dressing changes. However, you’ll need to visit the clinic a few times within the first 2 to 3 weeks to monitor the healing process. A drain will be inserted during the initial surgery and removed about 3 days later in an outpatient procedure lasting around 20 minutes. Full healing occurs within 2 to 4 weeks.

The significant drawback of the closed wound method is that you must avoid sitting down for more than 5 minutes during the first 2 or 3 weeks, which can be quite disruptive to your daily routine. This restriction entails eating, working, and even lying on your side or standing. Wound closure involves creating a plastic flap, which can sometimes fail to heal and break down, leaving you with an open wound that requires daily packing. In rare cases, additional surgery might be necessary to clean the wound.

With closure techniques, Mr. Stellakis achieves full healing in around 90% of patients, but adhering to post-operative instructions is crucial. To discuss your options and determine which method is right for you, book an appointment today.