A Pilonidal sinus also called Pilonidal cyst, Pilonidal abcess or Sacrococcygeal fistula is a cyst ( small sac ) or tunnel in the skin. It develops over the tailbone at the top of the cleft of the buttocks. The cyst usually contains hair and skin debris. More than one cyst may develop and these are linked by tunnels under the skin. Patient Testimonials

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Treatment of Pilonidal sinus

No treatment is necessary in case of a Pilonidal sinus that lies dormant, which means it is not infected. In this silent phase, certain precautions are advised which may abate the chances of infection and thereby, the need for a surgery.



Following care should be taken :

Keep the area as clean and dry as possible.

Avoid sitting in one place for too long, avoid driving for long hours.

Remove hair from the area using a razor or hair removal cream. You could see a dermatologist ( skin specialist ) and consider permanent hair removal with Laser.

If there is pain or discharge from the Pilonidal sinus, it spells infection and surgery is likely to be needed.

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I. WIDE EXCISION OF PILONIDAL SINUS



In this procedure the surgeon does a wide bore local excision of the skin containing the sinus tract. The resulting cavity is left open to heal and fill in naturally from the bottom upwards. The wound is kept covered with a dressing.

The disadvantage of wide excision is that the wound size is large and healing may take upto 3 months. The dressing needs to be changed daily making it a tedious process. However the procedure is safe with a recurrence rate of 10-15%.

II. LASER PILONIDOPLASTY ( LPP )



This is a minimally invasive procedure done using the Leonardo laser. This laser was first introduced in India at Healing Hands Clinic. In LPP, a small cut is made on the skin and all the pus is drained out. The entire sinus tract is then sealed with the laser fibre. Advantages of LHP Patient is discharged within 24 hours and can return to routine work by the 5th day.

and can return to routine work by the 5th day. Wound healing occurs in about 6-8 weeks and thus recovery is much faster as compared to conventional Wide excision.

and thus recovery is much faster as compared to conventional Wide excision. Recurrence rate is negligible.

III. EXCISION WITH PRIMARY CLOSURE



In this procedure, the abscess and sinus are surgically removed and the wound is closed with stitches/sutures. The stitch line is preferably off the midline, where the tension is less and chances of healing are better.

The advantage of this technique is that the healing is faster and takes about 4-6 weeks. The main drawback is that the infection rate is almost 20-25%. In case of such an infection a revision procedure is done and the wound is left for open healing anyways.

IV. Z-PLASTY



In Z-plasty after removing the abscess and sinus, the surgeon loosens triangular flaps on each side of the midline to fill the cavity, with points of flap towards the head and foot. While closing the surgeon crosses the pointed flaps to cross the midline in a horizontal direction, thus converting an N-shaped incision to a Z-shaped closure.

Z-plasty is not a preferred choice of treatment because :

The chances of recurrence are very high.

Flap necrosis may occur in which case the dead portion of the flap also has to be removed.

The post-operative pain and discomfort is very high.

V. CLEFT LIFT / MODIFIED KARYADAKIS / CLEFT CLOSURE



In this procedure the surgeon removes all the area of disease and makes sure the wound is healthy. The resultant defect, a football shaped 'ellipse' or cavity, lies parallel to the midline but to one side. The edges of the skin are then freed up a little and the wound is closed with multi-layered stitches. In cleft lift, the actual shape of the cleft is changed to be more shallow and allow for better healing. By almost flattening the cleft, the gathering of loose hair is less likely, and the less deep cleft does not favour the growth of anaerobic bacteria.

VI. LIMBERG FLAP / GLUTEAL FLAP



This procedure is done in patients who have extensive Pilonidal disease or who have disease affecting both sides of the buttock. The surgeon removes an oblong shaped plug containing the abscess, skin and fat, thus creating a cavity. To fill the cavity, a flap of skin and thick fat is mobilised from the buttock beside and below the cavity. The flap is swung into the centre and the edges are sutured.

NOTE : The flap procedures are quite invasive and patients are hospitalised for a couple of days afterwards. The post-operative recovery time is also quite long. These surgeries remove a large amount of tissue, which destabilises the area and leave few options to the patient if they fail.



