19.8 Discussion

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19.8 Discussion

325

However, long-term studies are required to

know the efcacy in stula wounds.

19.7.3 Use ofSilver Dressings forPilonidal Sinus

An ideal dressing needed for proper wound healing must be able to absorb excess exudate, reduce bacterial load, ll cavities, maintain moisture, and enhance the blood supply. Silver reduces the bioburden of the wound, thus taking care of the biolms [37].

19.7.3.1 Mechanism ofAction

The silver ions have a bactericidal effect by acting in three ways: rst on the bacterial proteins and DNA, second on enzymes involved in vital cellular processes, and third on a cell wall, or cell membrane, thus inhibiting the respiration process [38]. Studies have reported a rapid decrease in wound size after using silver ointments [39, 40]. The dressing is done twice a day.

19.8 Discussion

Successful wound management depends on the basic understanding of the physiological changes in the wound healing process, the type of surgery performed, the type of wound closure, and the optimal treatment of the resultant wound [37]. The cleaning of the wounds is done as a part of the wound managing regime. However, the choice of a cleansing agent remains controversial [38]. Role of povidone-iodine, is questionable as it is cytotoxic. An ideal wound cleansing agent should be nontoxic to human tissues, reduce the bioburden, and not cause sensitivity reactions [39]. Studies have reported that normal saline, simple tap water, sterile water, and even potable water can be used as cleansing agents for the wound [39].

There are two cleaning methods: scrubbing and irrigation [38]. Scrubbing or rubbing the wound should be avoided to minimize trauma. Irrigation is considered one of the best methods for cleansing the wound [38]. The cleansing of

postoperative stula and pilonidal sinus wounds should be carried out with gentle irrigation with either normal saline or water.

Postoperative care involves the use of topical ointments that should be antimicrobial, maintain moisture, and enhance wound healing. Commonly used ointments include a mixture of lidocaine, metrogyl, and sucralfate. Using topical agents like PHMB on the wound promotes wound healing by targeting the bacteria [40]. It is noncytotoxic and is clinically proven superior to povidone-iodine and silver nitrate for treating wounds [38, 41, 42]. The principle behind using hemoglobin spray in chronic wounds is well documented. The topical hemoglobin spray transports oxygen from the surrounding air and increases oxygen availability in the wound bed. It has been documented that hemoglobin spray should not be used with certain disinfectants, like octenidine, as it may impair its effectiveness [30, 31]. We achieved excellent results with hemoglobin spray in pilonidal sinus and stula wounds at our center. Although there was a considerable reduction in wound size after the spray, this evaluation was not conducted as a formal randomized clinical study. Therefore, more studies are required to evaluate the efcacy of the hemoglobin spray. After dressing, the wound should be inspected. A healthy granulation tissue is usually pink and is indicative of good wound healing. If hyper granulation tissue is present in the stula or pilonidal sinus wounds, curetting can be done in the OPD. Curetting refreshes the wound bed and promotes wound healing.

A question most frequently asked by a patient is how many times one can use an ointment postoperatively? The ointments should be applied twice a day but can also be used after each motion.

The third most crucial postoperative care is the management of pain. The patients operated on for anorectal surgeries often complain of pain during defecation. Lidocaine ointment 5% can be applied before defecation to avoid pain.

Laxatives, antibiotics, sitz baths, and analgesics are also a part of the postoperative regime. An adequate dietary supply of nutrients and sup-

326

19 Postoperative Management ofAnorectal Wounds

plements enhances wound healing and encourages rapid patient recovery.

The fourth most considerable point of postoperative wound management is educating the patients about maintaining good hygiene. After pilonidal sinus surgery, the navicular area should be kept clean.

The presence of co-morbidities like diabetes and hypertension, may hamper wound healing. The patients should be advised to continue with the medicines prescribed for these morbid conditions for a speedy recovery.

Take-Home Message

Wounds are reported to recover fast after minimally invasive procedures as the creation of the raw areas is very small. Timely and proper wound management, appropriate cleansing, and dressings can prevent the wound from becoming infected. During the patients’ wound healing journey, the nurses and the treating surgeon must do their best to encourage, counsel, and adequately educate patients on wound care.

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