Background: Pilonidal sinus(PNS) is a vexing problem for an individual and it became more vexing when it is in the form of inter mammary sinus(IMS). PNS is blind ending track lined with granulation tissue leading to a cystic cavity containing bits and pieces of hair. Aim: To assess the risk factors and treatment options for pilonidal sinus at a tertiary care centre with special reference to management of inter mammary sinus. Methods: The patients presenting with PNS to the general surgery department at a tertiary care centre in north Malabar, Kerala from 2009 to 2016 were included in this study. All PNS without abscess formation were treated with Z plasty. Those with abscess formation, I&D were done primarily. Later after the abscess healed, wide local excision and healing with secondary intention was followed. Results: 49 cases of pionidal sinus (39 sacrococcygeal PNS and 10 intermammary )were included in this study. Karydakis and Bascom method methods were not used. There was single recurrence each after wide excision and Z plasty in sacrococcygeal pilonidal sinus and no recurrence in the inter mammary group. Conclusion: Pilonidal sinus especially intermammary sinus is a vexing problem. The changes in the hormonal balance during puberty is the triggering factor. Many treatment modalities are in the offering, suggesting that a complete cure may not be possible with any of those available. Wide local excision with primary closure or Z plasty are two viable options for this condition.
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