Experience with wound healing from 7137 operations on pilonidal sinus

Wound healing after coccyx fistula surgery

(Status: 05.06.2024)

This page is currently being fundamentally revised. You will soon be able to find comprehensive information about your situation here and actively contribute to optimizing your healing time. We apologize for the current restrictions.

Avoid mistakes: The wound will not heal without perfect surgery

Optimal wound healing starts with choosing the right surgical method and an experienced surgeon . The more that is removed during the operation, the greater the challenge for your body to heal - a process that should not be underestimated. 

Many patients initially try surgery at their nearest hospital, thinking they will only go to a specialist if they have a problem. This approach can lead to an unexpectedly long recovery time and time off school, work and sport. Our advanced therapies are designed to avoid such problems. Find out about other patients' experiences and reviews before making your decision. A long journey to a specialized facility usually pays off.

Already had surgery? Your checklist for follow-up treatment

Have you had an operation on Pilonidal Sinus and are unsure how to deal with the wound properly? It is understandable that you are confused by the numerous opinions from doctors, friends and on the internet. Our wound healing checklist summarizes what is really important. The success or failure of an operation at Pilonidal Sinus is decided in the first 4 - 6 weeks after the procedure.

Stocktaking: Was the operation performed suitable to heal the fistula?

Was your treatment aimed at removing an Pilonidal Sinus or was an abscess simply split? Even if you feel symptom-free at the moment, a second procedure is usually necessary. Without this procedure, the risk of abscess recurrence remains high.

This was only the first of two steps: Examples of abscess drainage

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This is not how it should look: Examples of incomplete fistula removal

Have you had a complete removal of the Pilonidal Sinus performed? It is important to carefully inspect the entire gluteal fold to ensure that no noticeable openings have been left behind. The presence of such openings can be a clear sign of impending recurrence. If you suspect this, take the initiative immediately and consult a doctor who specializes in this matter. 

Example of incompletely removed pilonidal fistula
20-year-old female patient, 4 operations in 2 years, ingrowing hair (1) and overlooked primary fistula (2)

Unfortunately, this is not uncommon: despite repeated operations under anesthesia, the origin of the fistula remains unnoticed. This means that it cannot heal.

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Basics of wound healing

After an Pilonidal Sinus operation, different priorities need to be set for follow-up treatment depending on the procedure. It is helpful to know what physiological processes take place in the body when a wound heals.

Primary wound healing with closed procedures (midline suture, Karydakis surgery)

In primary wound healing after surgical procedures with wound closure, the wound is sutured, stapled or glued. Healing then goes through four phases:

  1. Coagulation phase (day 1): This is when blood platelets and coagulation factors stick the wound together. The resulting fibrin is the body's own superglue. Antibodies and white blood cells are active in the defense against infection. Cohesion is primarily ensured by the skin sutures, which is why strain should be avoided.
  2. Inflammation phase (day 1 - 4): Messenger substances are released that cause vasodilation, increased blood flow, new blood vessel formation and the attraction of connective tissue cells (fibroblasts). These fibroblasts are true masters in the production of stabilizing fibres. The increased blood circulation can be recognized by the reddish or purple color of the scar. The mechanical stability is still low.
  3. Proliferation phase (day 5-14): The fibroblasts multiply and form procollagen. This protein transforms into tropocollagen and contains larger amounts of the amino acids lysine, glycine and proline. The collagen fibrils formed by cross-linking these proteins give the scar mechanical strength.
  4. Contraction phase (day 15 -): During this phase, the formation and breakdown of collagen fibrils are in balance and the fibers rearrange themselves. The mechanical strength of the scar continues to increase, while the color gradually returns to the normal skin tone. The scar contracts and takes on a more compact structure. The scar is now fully resilient again.

Secondary wound healing in open procedures ("Metzger" method, pit picking, sinusectomy)

Open wound treatment with secondary wound healing is usually chosen for an Pilonidal Sinus operat