Monday, October 18, 2010

A "CIGAR" TO GIVE THE FINAL PUSH TO HEALING







Subject: Vent cigar A patient describes an almost healed surgical wound in the cleft--no symptoms aside from minimal moisture. He wants final healing.

The buttocks, like lips, seal pus in the cleft. You might improvise around this idea and see if it helps. Minimal risk carrying this open wound for years. Surgery practically guaranteed to cure it if a Cleft Lift is used.

MD, from Seattle, wrote, "Photos, both of the products, the assembly process, and the final product, both on the table and in situ, would be an enormous help. I think I understand it, but could always improve my understanding." As soon as I learn to post photos I'll add photos to this blog.

This may interest you. The message includes three pictures that may not come through. If you don't see them, tell me. I'll try again.

The aim of this device: To let air reach non-healing wounds trapped in a cleft. I used this sort of device to heal one challenging patient with Crohn's and a non-healed wound from top of cleft to vagina where the proctectomy had fallen apart 2 years before. Plus, she had, between the coccyx and the back edge of vagina, an open cavity 7 cm deep!

A cleft lift healed almost all. However, a 2 cm skin defect refused to heal at the posterior edge of the vagina.

The defect remained open for months. Then I realized the problem! She sat with her legs together all day and lay all night with her legs together . I drew a "rim trail" on the line of contact of the thighs, down the front of the thighs from pubis to knees and up the posterior side from knees to the top of the cleft. I spread thighs to examine. The defect lay in the center of the huge airless area. She kept the cigar against the raw area day and night and it healed.

Details of construction:
Screen is soft fiberglass window screen or "fly screen". Orange is plastic kitchen scrub sponge everted by patiently pulling out the center. The steel scrub sponge is included for comparison. The thread is common cotton. A monofilament might be better.

Details of use:
Insert the "cigar" in the cleft with the side of the "cigar" against the wound. Wash the wound and cigar 1-2X/day.

Concerns expressed:
Irritation of the wound or discomfort. Falling out. Sharp ends of broken fiberglass.
Experience: The patient did not experience them. I wore the above device for a night and for several hours in a day. I found it comfortable. It did not fall out with walking despite my slack form. It did fall out with large steps or stairs. Tight briefs or other inventions should solve that.

The fiberglass is so fine and soft that I found no ends even after hours of wearing.

My interest:
I want to hear of experience of others. I will share any experiences I have or hear of. The "cigar" seems a low risk preliminary step for patients to use or doctors to recommend. It can be discontinued if uncomfortable, useless or irritating. In theory the "cigar" should help all forms of persistent pilonidal disease.

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