An infected pilonidal cyst is an abscess that requires incision and drainage. Often, this procedure can be performed in a physician's office or in an emergency department with local anesthesia. After numbing the area with an injection of a local anesthetic, an incision with a scalpel is made over the infected area. The physician will then drain the pus and remove hair and any other debris from the wound. The wound is then packed with gauze and allowed to heal. Antibiotics are not necessary unless your physician feels that you have a spreading skin infection (cellulitis). For those individuals with recurrent or complicated pilonidal cysts, more invasive surgery may be necessary. Several different surgical techniques may be used in this case, and your surgeon will discuss the various options with you. In general, the major difference in surgical techniques involves either leaving the surgical wound open after surgery and allowing it to heal (requiring a longer healing time but having a lower recurrence rate) versus closing the surgical wound during surgery (with a shorter healing time but higher recurrence rate). Another surgical technique involves suturing the skin edges of the wound and allowing the open wound to slowly heal (marsupialization). Proper wound care and follow-up with a surgeon should be arranged after either of the above procedures. Keep the wound clean and remove any hair from around the site to prevent recurrence.
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