Management of Nonhealing post surgical wound of Pilonidal sinus through Ayurveda: A case report

A chronic nonhealing wound is characterized by insufficient healing progress, typically defined as <40–50% closure after four weeks of appropriate treatment. It presents a significant challenge for medical professionals. The generally accepted frequency of significantly delayed wound healing found in medical literature is 2–5%. This condition can be correlated with Dushta vrana (~nonhealing/putrefied wound) mentioned in Ayurveda literature. Ayurveda holds significant promise in addressing such conditions owing to its comprehensive approach. Sushruta Samhita outlines Shashti upakramas (~sixty therapeutic measures) for managing wounds. Among these, Kashaya (~decoction), Varti (~medicated wick), Kalka (~paste), Ghrita (~clarified butter), Taila (~oil), Rasakriya (~concentrated thick liquid), Churna (~powder) are mentioned for the purpose of Vrana shodhana (~wound cleansing) and Vrana ropana (~wound healing). A 23-year-old male sought medical attention due to a nonhealing wound following surgical removal of a Pilonidal sinus. Upon careful examination, a diagnosis of Dushta vrana was established. The treatment was customized according to the principles mentioned in Sushruta Samhita. The wound was managed by regular irrigation using Nimba patra kashaya (~decoction prepared out of Azadirachta indica A.Juss. leaves), followed by dressing with Nimbadi kalka along with customized internal medication for a duration of 30 days. Full closure of the wound was attained within this timeframe, without any complications.