Delayed Wound Healing Following Pilonidal Cyst Excision

Case at a Glance

A 26-year-old female presents with persistent wound healing complications more than one year following pilonidal cyst excision, experiencing intermittent bleeding despite careful post-operative care.

Patient's Story

The patient underwent pilonidal cyst excision approximately 14 months prior to presentation. Despite maintaining meticulous wound care and following all post-operative instructions, the surgical site has failed to achieve complete healing. She reports intermittent episodes where the wound appears to be healing well, followed by spontaneous bleeding episodes. The patient expresses significant concern about the prolonged healing time and is hesitant about seeking further surgical intervention due to concerns about potential complications from repeat procedures. She describes the condition as significantly impacting her quality of life, particularly given her active lifestyle.

Initial Assessment

Patient presents with a non-healing surgical wound at the site of previous pilonidal cyst excision. Physical examination reveals an incompletely healed wound with evidence of intermittent bleeding. No acute signs of infection were noted at the time of evaluation.

The Diagnostic Journey

The patient was initially managed conservatively with continued wound care following the original procedure. Given the prolonged healing time exceeding 12 months, differential diagnoses considered included incomplete excision with retained pilonidal tissue, chronic wound infection, foreign body retention, or development of a chronic sinus tract. The patient was counseled regarding the need for specialized evaluation.

Final Diagnosis

Chronic non-healing wound following pilonidal cyst excision with suspected incomplete healing or recurrence.

Treatment Plan

Patient was referred to a colorectal surgeon for specialized evaluation. Recommended diagnostic workup includes wound assessment with possible imaging to evaluate for sinus tracts or retained tissue. Treatment options discussed include revision surgery if indicated, advanced wound care techniques, or alternative surgical approaches depending on findings.

Outcome and Follow-up

Patient was counseled regarding the importance of specialist evaluation despite concerns about repeat surgery. Follow-up scheduled with colorectal surgery for comprehensive assessment and development of individualized treatment plan. Patient education provided regarding realistic expectations for healing and available treatment modalities.