Many times, physicians will blame patient’s personal hygiene for either the initial development of pilonidal disease or the failure of a post operative wound to heal. In 2018 a German researcher, Dietrich Doll published information investigating this issue. The conclusion was:
Neither urine or fecal contamination nor a potential increase in sweating due to higher BMI (weight) promote PSD (pilonidal sinus) incidence. The causative factors of pilonidal disease still remain incompletely understood till today. Patients who are blighted with PSD classically experience embarrassing recurrent infections before the disease is surgically cured; they should not be further insulted by emphasizing “maintaining exquisite personal hygiene” in the discharge letter. Recommending this is insulting and neither prevents the development of PSD nor its recurrence.
So, if your surgeon is blaming you and your degree of personal cleanliness for this problem, they are relying on outdated information or misguided personal experience. If you have a wound that is not healing, there are other factors involved, and your surgeon should be helping you solve the problem.