Treatment for Contaminated Wound After Pilonidal Cyst Removal

David Humphrey, MD
Mission Hospital, Asheville, NC

Patient Presentation

A 22-year-old woman presented in Feb 2017 with a pilonidal cyst. The cyst was removed surgically. The patient had no comorbidities.

Failed Therapy

  • Failed surgical repair
  • Dakin’s antiseptic solution
  • Compression
  • Mupirocin
  • Negative pressure wound therapy (NPWT)
  • Wound remained non-healing for 31 days

Treatment

  • Microlyte® applied twice during the first week and at weekly evaluations, thereafter
  • NPWT was administered in conjunction with Microlyte®
  • The wound did not require debridement during weekly evaluations
  • Neither oral or topical antibiotics were administered

Clinical Outcome

The initial size of the stalled surgical wound was 6.9 cm2. After only 1 week of treatment (two applications of Microlyte®), the wound size decreased by 46%. Additional weekly treatments with Microlyte® in conjunction with NPWT closed the wound by 94% in 3 weeks and 98% in 6 weeks.

Conclusion

Faster and more complete closure of a chronically wound resulting from surgery was achieved by application of Microlyte® and NPWT than was achievable with other failed therapies. Microlyte®, applied weekly, was associated with a positive outcome, however, it is likely that if Microlyte® had been used in the post-surgical management of the wound the infection could have been avoided.

Figure 1: Accelerated wound healing in stalled wound after surgical removal of a pilonidal cyst. Microlyte® was applied to wound 31 days post-surgery (A). After one week (B), the wound had closed by 46%. One week later Microlyte® was applied again, at which point the wound was 65% closed (C). After 3 weeks treatment, 94% wound closure was achieved(D). An additional weekly treatment for 3 resulted in 98% closure of the wound (E). Microlyte® was reapplied at each evaluation. Negative pressure wound therapy was used in conjunction with Microlyte® at each application.

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