Post-surgical wound management of pilonidal cysts with a haemoglobin spray: a case series.

Painful acute cysts in the natal cleft or lower back, known as pilonidal sinus disease, are a severe burden to many younger patients. Although surgical intervention is the preferred first line treatment, postsurgical wound healing disturbances are frequently reported due to infection or other complications. Different treatment options of pilonidal cysts have been discussed in the literature, however, no standardised guideline for the postsurgical wound treatment is available. After surgery, a common recommended treatment to patients is rinsing the wound with clean water and dressing with a sterile compress. We present a case series of seven patients with wounds healing by secondary intention after surgical intervention of a pilonidal cyst. The average age of the patients was 40 years old. Of the seven patients, three had developed a wound healing disturbance, one wound had started to develop a fibrin coating and three were in a good condition. The applied wound care regimens comprised appropriate mechanical or autolytic debridement, rinsing with an antimicrobial solution, haemoglobin application, and primary and secondary dressings. In all seven cases a complete wound closure was achieved within an average of 76 days with six out of seven wounds achieving wound closure within 23-98 days. Aesthetic appearance was deemed excellent in five out of seven cases excellent and acceptable in one. Treatment of one case with a sustained healing disturbance did result in wound closure but with a poor aesthetic outcome and an extensive cicatrisation of the new tissue. Based on these results we recommend that to avoid healing disturbances of wounds healing by secondary intention after surgical pilonidal cyst intervention, an adequate wound care regime comprising appropriate wound debridement, rinsing, topically applied haemoglobin and adequate wound dressing is recommendable as early as possible after surgery.

Clinical efficacy of a new monofilament fibre-containing wound debridement product.

OBJECTIVE: To evaluate the wound debridement efficacy (that is, achievement of 100% granulation tissue on the wound bed) of a new monofilament fibre product (Debrisoft). METHOD: This multicentre, prospective, observational evaluation assessed the debridement efficacy, safety, patient comfort and user satisfaction of this new product. Time taken to perform the debridement procedure was also recorded. The new product was wetted with either saline or polihexanide and applied for 2-4 minutes, following which the usual dressing regimen was applied. Clinical outcome was scored by a trained clinician. Additionally, before and after photographs were assessed by one and the same clinician, who was blinded to the treatment given. The debridement outcomes achieved with the test product were compared with results obtained using other methods of debridement, both non-surgical and surgical, taken from an electronic database but using the same scoring systems as here. RESULTS: Sixty patients with chronic wounds requiring debridement were recruited, of whom 57 were included in the analysis. Debridement was effective in 93.4% (142/152) of the sessions, and the product remained intact in 95.4% (145/152). The average time for each debridement session was 2.51 minutes, markedly less than for the current debridement methods at the evaluation centres. Visible debris and slough were successfully removed with the test product. Patients reported no pain during the procedure in 45% of cases and slight discomfort for a short duration (2.0 minutes on average) in 55% of cases. CONCLUSION: The results indicate the potential for this monofilament fibre product to replace several modes of debridement, based on its efficacy, short procedure, ease of use and patient comfort. CONFLICT OF INTEREST: The evaluation protocol was proposed and supported by Lohmann & Rauscher GmbH, who provided the evaluation products. MS and MA are employees of Lohmann & Rauscher. The other authors declare to have no relevant financial interest in the evaluation. Apart from input to the protocol, the sponsors had no role in the conduct of the study, such as data collection, analysis, or preparation, review, or approval of the manuscript.