Pilonidal Sinus Pilonidal Sinus

Pilonidal Sinus

Pilonidal Sinus Treatment in Faridabad, Delhi NCR

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Pilonidal sinus

Sacrococcygeal pilonidal sinus is a common disorder among young adults. Observed most commonly in people aged 15-30 years, with a 3:1 male-to-female ratio, it usually occurs after puberty. 

Pilonidal Sinus Treatment in Faridabad

Predisposing factors to pilonidal disease are believed to include the following

  • Obesity
  • Sedentary lifestyle or occupation
  • Deep natal cleft
  • Family history of pilonidal disease

Treatment options are now available that provide a rapid rate of cure and a lower recurrence rate and minimize the number of hospital admissions. Although numerous randomized clinical studies have evaluated different treatments, no clear consensus has been reached as to the optimal medical or surgical treatment of pilonidal disease.

Approach Considerations

The ideal treatment for a pilonidal sinus varies according to the clinical presentation of the disease. First, it is important to divide the pilonidal disease into the following three categories, which represent different stages of the clinical course:

  • Acute pilonidal abscess
  • Chronic pilonidal disease
  • Complex or recurrent pilonidal disease

Surgical management is then tailored to the classification category. Although there are several treatment options for pilonidal disease in each category, they all have similar goals, as follows:

  • Wound healing with a low risk of recurrence
  • Short hospitalization
  • Maximal patient comfort
  • Low morbidity, with few wound-management problems

Surgical Therapy

Acute pilonidal abscess

A pilonidal abscess is managed by incision, drainage, and curettage of the abscess cavity to remove hair nests and skin debris.

The wound should be cleansed daily in the shower or with a sitz bath. Paying close attention to hygiene and hair shaving of the surrounding area is important in preventing hair from penetrating the healing scar and causing further pilonidal sinuses to form.

Of these patients, 40% develop a recurrent pilonidal sinus that requires further treatment.

Some studies have shown that as many as 85% of patients require further surgical treatment.

Chronic pilonidal disease

When patients have undergone at least one pilonidal abscess drainage procedure and continue to have a pilonidal sinus tract or a pilonidal sinus that is associated with a chronic discharge without an acute abscess.

Surgical options for management of a non-complicated chronic pilonidal sinus include the following:

  • Excision and laying open of the sinus tract
  • Excision with primary closure
  • Wide and deep excision to the sacrum
  • Incision and marsupialization

Complex or recurrent pilonidal disease

A wound that has not responded to initial therapy must be reexcised down to the sacrococcygeal fascia. The reexcision must include the unhealed wound, scar, and granulation tissue. A flap procedure is then performed to achieve primary wound closure. The techniques available include the following:

  • Cleft closure
  • Local advancement flap (3-plasty rhomboid flap [34or V-Y advancement flap)
  • Rotational flap (gluteus maximus myocutaneous flap)

Whenever an advancement flap is contemplated, a myocutaneous flap should be considered.

Complex wounds are reconstructed by using muscle and myocutaneous flaps because these flaps typically heal well and cover areas of extensive skin loss. Compared with skin flaps, they are less susceptible to infection and have a predictable vascular supply that promotes safe elevation and better wound healing (with recurrence rates of 6-20%).

Long-Term Monitoring

With excision of pilonidal disease and healing by secondary intention, the open wounds left after surgery require aggressive management in the form of frequent dressing changes, cleansing, hair removal, and close observation by the patient and surgeon.

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