Frequently Asked Questions about Sinus
If you have undergone a Pilonidal Sinus procedure or suffer from the disease, you probably have the following questions
Surgery Frequently Asked Questions
* How long does the surgery last?
This depends on several factors, mainly on the technique performed. In the case of the modified Karydakis flap, which is the longest, it can take approximately one hour.
* What type of anesthesia is used?
In almost all cases, the anesthesia used is regional (or spinal anesthesia), which will put you to sleep from the waist down, accompanied by some degree of sedation to make you more comfortable throughout the process.
* How long will I be in the Hospital?
Most cases can be performed without hospitalization, so that you can go home a few hours after surgery. In some cases an overnight stay will be required, and the patient will be discharged the day after surgery.
* Will I have a lot of pain after surgery?
In most cases, the postoperative period is hardly painful (pain less than 3 on a scale of 0-10), and is perfectly controlled with oral analgesics. When the pain is greater, or is not controlled with the prescribed medication, it may be an alarm sign that something is not going well (wound infection, obstruction of the drainage or wound opening), and is a reason to request a revision appointment in case you do not have one scheduled in the next 2 or 3 days. If you are unable to get a follow-up appointment, it is advisable to go to the emergency room to see the wound.
* I have had SP surgery and left the wound open weeks ago, but it has not closed. Can I have surgery to close the wound?
Yes, although part of the problem is already caused (removing a large amount of tissue), and recovery may be longer and more complex than if the flap had been made in the first operation, it is possible to evaluate your case and possibly help make wound closure less painful and faster.
*Will I have to take a lot of medication after surgery?
In addition to painkillers (one every 4 hours for the first 5 days, and then only if you have pain), you will have to take a full 10-day course of antibiotics.
*Can I take a shower after surgery?
Yes, it is highly recommended to keep the wound clean. From the day after surgery, you can take a shower in the morning and dry the whole area very well (it is also essential to keep it dry). However, you should avoid soaking for a long time, so it is advisable to take one short shower a day.
* Will I need help after the procedure?
Although it is not mandatory, it is advisable to have someone to lend a hand during the first days of the postoperative period, especially those during which you keep the drain in place.
* Who heals the wound after surgery and how?
The wound should be kept clean and dry. After showering or belly-flushing, just clean the wound with clohexidine and let it dry. It is recommended that the wound be covered with compresses or gauze to avoid staining underwear, and to identify if there is oozing or fluid leaking through the skin. In addition, wearing tight underwear helps to keep the gauze in place without the need for adhesive tape, which is not very appropriate during recovery, especially the first few days, because removing it can cause damage to the wound.
* What are the most common complications after Karydakis flap surgery? Are they very frequent?
The two most feared complications are separation of the skin edges (medically called “wound dehiscence”) and wound infection.
– > Skin separation: occurs in approximately 15-20% of cases and is typically superficial and a few millimeters (less than 1 cm). It usually heals in about 10-12 days and does not delay return to normal life, except for sports.
– > Wound infection: it is much less frequent, and when it occurs it can cause a larger wound opening that delays healing and return to normal life, sometimes up to 2 months after surgery.
* What are the factors that may favor the development of complications?
The most frequent is the obstruction of the drainage, which produces accumulation of liquid in the wound, which means an increase in the pressure of the edges of the skin, and at the same time an excellent breeding ground for bacteria. A direct blow or fall on the scar in the first days after surgery can also produce it. Overweight, chronic use of corticosteroids, smoking and diabetes are other factors closely related to wound healing problems and infections.
* How do I know if the wound is infected?
An infected wound may present as redness and increased volume of the area around the wound, or as drainage with a cloudy or purulent content. If this is your case, we should evaluate you in the office.
* After surgery, when will I be able to work?
It depends on what you do. If you work in front of a computer, you will be able to work as soon as you feel little discomfort for most of the day and we have removed the drain (usually 4-5 days after surgery). You can sit, with some care, from the first postoperative day.
* Will the wound be near the anus?
It will depend on the size and initial location of the sinus, which may vary slightly in each case. In any case, it is advisable to have a lot of hygiene in the area, especially after each bowel movement. Ideally, it should be cleaned with a shower, and if this is not possible, with wet wipes.
* The wound has opened up a little, is this normal?
Yes, it is common for the edges of the skin to separate 1-2mm after surgery, keeping in mind that this is a region that must withstand a lot of pressure and friction when walking and sitting.
*When will I be able to return to sports?
After drain removal. Use common sense and avoid those activities with risk of falls or blows until one month after the removal of the drain. It is also not a good idea to do any activity that causes pain. In some cases (usually recurrent or very large sinuses) we recommend rest for a longer period of time (about two months).
* Is it convenient to perform laser hair removal in the area?
Although there are scientific studies that do not find benefits of laser hair removal with respect to the risk of recurrence of the disease, there is no contraindication. If you decide to have it done, it is not advisable to do it during the two months following the surgery. Afterwards, it can be performed without any problems.
Recommendations before and after surgery
- It is advisable to buy dark-colored, tight-fitting underwear before surgery. This way you will be able to keep the gauze in place without the need for adhesive tape, which can damage your skin after several days.
- Do not accept surgery leaving the wound open as a first option, unless the reason for it is explained to you very well.
- Do not undergo a surgery that will keep you limited in your daily life for months, unable to play sports or lead a normal life.
How to manage drainage after surgery?
* The drainage has the function of evacuating the fluid that is produced after surgery, and prevent it from accumulating in the wound. When it accumulates, it greatly increases the risk of skin opening and even wound infection.
* The drain is a tube that connects to a “pear” shaped container, which must maintain suction pressure.
* Before handling the drainage you should wash your hands with soap.
* Once a day you should write down the volume contained in the “pear” and empty it afterwards. To empty it:
- First open the “pear” cover.
- Note the date, time and amount of drainage.
- Empties the “pear” in the toilet
- Crumple the “pear” completely and, while it is crumpled, put the cover in place
* Once a day, after showering, you will change the wound gauze.
* The main problems associated with drainage have to do with loss of vacuum (suction pressure) and with obstruction of the drain. It is therefore important to rule out both problems on a daily basis:
- Each day confirm that the “pear” is wrinkled. If it is not, it may be because it has been completely filled (drain too full), or because it has lost its vacuum. In the first case, the “pear” will need to be emptied more often (at least twice a day) to prevent it from becoming too full again. In the second case, you should check the tube and confirm that it is correctly connected to the “pear” and confirm that the “pear” has the cap on. If that is correct, it is possible that the drain has come out slightly and we will have to check it in the office.
- Crush the drainage tube from near its insertion to the skin, and run along the tube crushing it all the time until you reach the “pear” (this is easier with wet fingers), while with the other hand we firmly hold the drain next to the skin so that it does not come out of its place. With this maneuver we will avoid clot obstruction.
* Once the drain barely draws any content, less than 20cc per day for two days in a row, and it is confirmed that it maintains the vacuum and is not obstructed, it can be removed. This usually occurs within 4-7 days of surgery.
* After removal of the drain, it may leak a little for 2-3 days. It is not a cause for concern as long as it is a clear orange or transparent liquid. If it is white and pus-like, it should be seen in consultation.
Frequently Asked Questions
about Pilonidal Sinus (SP)
- Reddening of the skin
- Pain
- Presence of pus or blood in an opening of the skin.
- Unpleasant odor of oozing pus.
This pathology should be treated by a specialist in coloproctology, which is responsible for the diagnosis and treatment of diseases of the colon, rectum and anus.
As we know, the pilonidal cyst is located in the region above the intergluteal fold, an area of treatment for this specialist.
OUR SPECIALISTS
Dr. Daniel Serralta
I was born in Madrid in 1979, where I grew up and studied Medicine (University of Alcalá), with a parenthesis during which I was able to move to Marseille (France) to study at the University of Marseille for a year within the European Erasmus program.
Dr. Carlos Ortiz J
I was born in Sweden in 1970, from a Spanish father and a Swedish mother, so I am bilingual in these two languages, although I also speak English very fluently and French, somewhat less fluently.
