Incision and Drainage of a Pilonidal Cyst

What is Incision and Drainage of a Pilonidal Cyst

A pilonidal cyst is a fluid-filled sac that forms beneath the skin near the tailbone, at the top of the crease of the buttocks (pilonidal area). Incision and drainage is a procedure to open and drain a pilonidal cyst. You may need this procedure if the cyst becomes painful, swollen, or infected (pilonidal abscess).

There are three types of procedures to drain a pilonidal cyst. The type of procedure you have will depend on the size, location, and severity of your cyst. You may have:

  • Incision and drainage with wound packing. Wound packing involves placing a moistened sterile packing material (gauze) into the incision and then covering the wound with an outer bandage (dressing). This method lets the wound continue to drain and helps the wound heal from the inside out.
  • Marsupialization. This involves opening and draining the cyst, and then stitching (suturing) the wound so that it stays open while it heals. This method helps deep wounds heal from the inside out.
  • Incision and drainage without wound packing. This incision is closed and covered with a dressing on the outside.

Tell a health care provider about:

  • Any allergies you have.
  • All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
  • Any problems you or family members have had with anesthetic medicines.
  • Any blood disorders you have.
  • Any surgeries you have had.
  • Any medical conditions you have.
  • Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

  • Infection.
  • Bleeding.
  • Allergic reactions to medicines.

What happens before the procedure?

Medicines

Ask your health care provider about:

  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
  • Taking over-the-counter medicines, vitamins, herbs, and supplements.

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

  • Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

  • 8 hours before the procedure – stop eating heavy meals or foods, such as meat, fried foods, or fatty foods.
  • 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
  • 6 hours before the procedure – stop drinking milk or drinks that contain milk.
  • 2 hours before the procedure – stop drinking clear liquids.

General instructions

  • Follow instructions from your health care provider about bathing the night before or the morning before your procedure.
  • Ask your health care provider what steps will be taken to help prevent infection. These may include:
    • Removing hair at the surgery site.
    • Washing skin with a germ-killing soap.
    • Antibiotic medicine.
  • Plan to have someone take you home from the hospital or clinic.
  • Plan to have a responsible adult care for you for at least 24 hours after you leave the hospital or clinic. This is important.
  • You will need to have help from a caregiver after the procedure in order to manage wound care and dressing changes. Depending on the type of procedure you have, this may be needed for a period of days or weeks after your procedure.

What happens during the procedure?

  • An IV may be inserted into one of your veins.
  • You will be given one or more of the following:
    • A medicine to help you relax (sedative).
    • A medicine to numb the area (local anesthetic).
    • A medicine to make you fall asleep (general anesthetic).
  • You will lie down on your stomach.
  • Tape may be used to spread your buttocks, if needed.
  • Your pilonidal area will be cleaned with a germ-killing solution.
  • An incision will be made in the cyst.
  • A tube with a light and camera on the end (probe) may be used to see how deep the wound is.
  • Fluid or pus inside the cyst will be drained.
  • The cyst will be flushed out (irrigated) with a germ-free (sterile) solution.

The rest of the procedure will depend on what type of procedure you are having.

If you are having incision and drainage with wound packing:

  • Sterile packing material will be placed into the wound. This keeps the wound open so that it can continue to drain after surgery.
  • The area will be covered with a bandage (dressing).

If you are having marsupialization:

  • The edges of the incision will be sutured to the surrounding skin to keep the wound open.
  • A dressing will be placed over the wound.

If you are having incision and drainage without wound packing:

  • Some tissue around the opened cyst may be removed.
  • The incision may be closed with sutures, skin glue, or adhesive strips.
  • The incision will be covered with a sterile dressing.

These procedures may vary among health care providers and hospitals.

What happens after the procedure?

  • Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until you leave the hospital or clinic.
  • You will be given pain medicine if you need it.
  • Do not drive for 24 hours if you were given a sedative during your procedure.
  • You and your caregiver will be given instructions about how to care for your wound and any dressings you may have.

Summary

  • A pilonidal cyst is a fluid-filled sac that forms beneath the skin near the tailbone, at the top of the crease of the buttocks (pilonidal area).
  • Incision and drainage is a procedure to open and drain a pilonidal cyst. The type of procedure you have will depend on the size, location, and severity of your cyst.
  • You may need this procedure if your cyst becomes painful, swollen, or infected (pilonidal abscess).

Incision and Drainage of a Pilonidal Cyst, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

  • Pain that gets better when you take medicine.
  • Some fluid or blood coming from your wound.

Follow these instructions at home:

Medicines

  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • If you were prescribed an antibiotic medicine, take it as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.

Lifestyle

  • Do not do activities that irritate or put pressure on your buttocks for about 2 weeks, or as long as told by your health care provider. These activities include bike riding, running, and anything that involves a twisting motion.
  • Do not sit for long periods at a time without getting up to move around.
  • Sleep on your side instead of your back.
  • Avoid wearing tight underwear and tight pants.

Bathing

  • Do not take baths or showers, swim, or use a hot tub until your health care provider approves. This depends on the type of wound you have from surgery.
  • While bathing, clean your buttocks area gently with soap and water.
  • After bathing:
    • Pat the area dry with a soft, clean towel.
    • Cover the area with a clean bandage (dressing), if told to by your health care provider.

General instructions

  • If you are taking prescription pain medicine, take actions to prevent or treat constipation. Your health care provider may recommend that you:
    • Drink enough fluid to keep your urine pale yellow.
    • Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
    • Limit foods that are high in fat and processed sugars, such as fried or sweet foods.
    • Take an over-the-counter or prescription medicine for constipation.
  • You will need to have a caregiver help you manage wound care and dressing changes. Your caregiver should:
    • Wash his or her hands with soap and water before changing your dressing. If soap and water are not available, your caregiver should use hand sanitizer.
    • Check your wound every day for signs of infection, such as:
      • Redness, swelling, or more pain.
      • More fluid or blood.
      • Warmth.
      • Pus or a bad smell.
    • Follow any additional instructions from your health care provider on how to care for your wound, such as wound cleaning, wound flushing (irrigation), or packing your wound with a dressing.
  • Keep all follow-up visits as told by your health care provider. This is important.

If you had incision and drainage with wound packing:

  • Return to your health care provider as instructed to have your packing material changed or removed.
  • Keep the area dry until your packing has been removed.
  • After the packing has been removed, you may start taking showers.

If you had marsupialization:

  • You may start taking showers the day after surgery, or when your health care provider approves.
  • Remove your dressing before you shower, but let the water from the shower moisten your dressing before you remove it. This will make it easier to remove.
  • Ask your health care provider when you can stop using a dressing.

If you had incision and drainage without wound packing:

  • Change your dressing as directed.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.

Contact a health care provider if:

  • You have redness, swelling, or more pain around your wound.
  • You have more fluid or blood coming from your wound.
  • You have new bleeding from your wound.
  • Your wound feels warm to the touch.
  • There is pus or a bad smell coming from your wound.
  • You have pain that does not get better with medicine.
  • You have a fever or chills.
  • You have muscle aches.
  • You are dizzy.
  • You feel generally sick.

Summary

  • After a procedure to drain a pilonidal cyst, it is common to have some fluid or blood coming from your wound.
  • If you were prescribed an antibiotic medicine, take it as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.
  • Return to your health care provider as instructed to have any packing material changed or removed.
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