Pilonidal sinus: Finding the right track for treatment

Abstract

Management of pilonidal sinus is frequently unsatisfactory. No method satisfies all requirements for the ideal treatment--quick healing, no hospital admission, minimal patient inconvenience, and low recurrence--but greater awareness of the strengths and weaknesses of existing methods would lead to improved management. Early excision of the pilonidal pit at the time of treatment of pilonidal abscess reduces the high (40 per cent) risk of subsequent sinus. Treatments for pilonidal sinus that flatten the natal cleft halve the risk of recurrence. En block excision of pilonidal sinus with secondary healing should be abandoned and emphasis given to development of treatments, such as primary asymmetric closure, which have more potential. Some treatments are operator-dependent and, to achieve the best results, junior surgeons must be correctly trained and supervised. Future treatment studies must be prospective and randomized, and should compare healing time, recurrence rates beyond 3 years, nurse and hospital visits, patient inconvenience and loss of income.

Modified Bascom's Asymmetric Midgluteal Cleft Closure Technique for Recurrent Pilonidal Disease

“…Recurrences are often associated with granulation-lined sinus tracts, which are the result of chronic inflammation and foreign body reaction in a sometimes incompletely healed surgical wound; this becomes a focus for infection and skin debris, including hair, which continues the granulation process. 1 Consequently, emphasis should be given to excision of sinus tracts and resection of affected midline tissue and that sacrificed by the disease process, whereas simply wiping the pilonidal cavity free of debris (as is described in the cleft closure technique) might be more applicable for chronically draining sinuses without new extensions and recurrent tract formation. However, the preservation of as much healthy fat as possible to provide padding remains necessary.…”

“…1,[7][8][9][10][11][12] The deep hirsute natal cleft is the anatomic site of minimum resistance for loose-hair insertion. 1,6,13,14 Surgery itself creates a midline wound that may act as an open portal of entry for hair, triggering recurrences. 14 The surgical principle of wound lateralization, first described by Karydakis, 14 has been applied after asymmetric and oblique elliptical skin incisions to create a thick flap and advance it across the midline.…”

“…4 None of the existing treatment approaches for pilonidal disease are perfect; impaired wound healing and recurrence are their major complications. 1,5 Few data are available specifically addressing the management of recurrent disease. To deal with the significant problem of impaired wound healing secondary to pilonidal disease surgery, Bascom 6 described the technique of midgluteal cleft closure for unhealed presacral wounds.…”

“…[1][2][3] The incidence of the disease in recruits rises after their enrollment in the Greek army. 4 None of the existing treatment approaches for pilonidal disease are perfect; impaired wound healing and recurrence are their major complications.…”

Tratamento cirúrgico da doença pilonidal: meta-análise dos principais procedimentos adotados mundialmente

“…Allen-Mersh propõe que como o cisto pilonidal é considerado uma doença adquirida, as recidivas tardias representam, na realidade, novos cistos adquiridos e não verdadeiras recidivas 37 . Nesta situação, um seguimento à longo prazo revelaria apenas o número crescente de pacientes com nova doença 38 .…”