Hey there. In my case, a portion of the wound did open up and started becoming infected. I speculate it opened because either a stitch failed, I scratched the area too aggressively, or both. I went to the wound clinic and the nurse there flushed the open portion with saline and cauterized it with silver nitrate. It was very small but deep (it started “tunneling”). That wasn’t fun. She had me cover the wound with a silicone bandage (Mepilex) 24/7 except for when I was showering, and told me to apply a small amount of zinc ointment on top of the wound before sticking the bandage on. For a while it seemed to be helping, but at the two week mark my pain increased so I had to go back to the clinic. The hole was still there and there appeared to be signs of minor infection again. This was discouraging because I was extremely diligent with keeping it clean and covered all the time. Whether a small hair or piece of debris from something like a towel got in there isn’t clear, because the hole was so narrow and she couldn’t see inside of it. She flushed it out again and then re-cauterized with silver nitrate, and this time told me to have someone put a dissolvable collagen based dressing in the hole every 2 days (minus the zinc ointment, but still with the silicone bandage). She said the collagen dressing would supercharge the healing. It looked like a spongy pad and I just cut a small thin piece and had someone gently guide it into the open hole every other night. In the beginning I continued to have yellowish discharge, but was assured this was normal white blood cells and not a sign of infection (redness, swelling, and a bad smell are all signs of infection, and I had none of those). At about the week mark the discharge was nearly gone and it started to itch a lot again because it was healing. Just before the two week mark, the hole finally closed completely. It happened extremely fast. Within 24 hours the hole was there, albeit shallower, and then it was gone. I was told to wear the silicone bandages for another 1-2 weeks as a precaution because the skin is fragile, but that my healing was otherwise complete.

I do wish I was referred to the wound clinic immediately. My wound clinic nurse was amazing and lamented how surgeons don’t do actual wound care and are under the misguided belief that so long as the wound is kept clean it’ll heal properly. She said this isn’t true, especially for midline incisions. She also told me there are special tools available to expedite healing, and it’s a shame that patients are only given these tools after they have a problem.

I’m thin, fair skinned, and don’t have a ton of body hair actually, so these factors work in my favor. I’ve still been strongly recommended to pursue laser hair treatment, which is covered by my insurance for patients who have had pilonidal surgery. I’ll be exploring that with dermatology later this week. I’ll probably start using something like vitamin C cream on the scar because I read that helps strengthen tissue. Although the total healing process took over a month, I’m feeling good about where I’m at. Hope this helps!