- A pilonidal sinus is a subcutaneous sinus containing hair
- Lined by granulation tissue rather than epithelium
- Usually occur in the natal cleft
Picture provided by Miss Avril Chang, Central Middlesex Hospital, London, United Kingdom
Picture provided by Dr Ovidiu Florica, Royal Melbourne Hospital, Melbourne, Australia
- Also seen in interdigital clefts, face and axilla
- Usually seen in young adults.
- Rare after the age of 40 years
- Male : female ratio is 4:1
Aetiology
- It is generally believed to be an acquired condition
- Inflamed hair follicles in the cleft result in abscess or sinus formation
- Hair becomes trapped in cleft and enters sinuses
- Results in a foreign body reaction and perpetuates sinus formation
- 80% present with recurrent pain
- 80% present with a purulent discharge
Treatment
- Consider methylene blue injection to identify all of the tracts
- Antibiotic prophylaxis may be of benefit
- Options available included:
- Excision and healing by secondary intention
- Requires regular wound dressing and shaving
- Produces 70 - 90% healing at 70 days
- 5-15% recurrences rate
- Excision and primary closure
- Produces 70% healing at 2 weeks
- 20% develop wound infection
- Lord's procedures
- Involves excision of pits, removal of hair and brushing of tracts
- Produces 80-90% healing
- Phenol injections
- Produces 60 - 70% healing
- Skin flap procedures (e.g. Karydakis procedure)
- Aim to flatten natal cleft and keep scar from midline
- In expert hands produces good results
- Failure rates as low as 5% have been reported
Bibliography
Duxbury M S, Blake S M, Dashfield A, Lambert A W. A randomised
trial of knife versus diathermy in pilonidal disease. Ann R Coll Surg Engl 2003; 85:
405-407.
Peterson S, Koch R, Stelzner S et al. Primary closure
techniques in chronic pilonidal sinus. a survey of the results of different surgical approaches. Dis
Colon Rectum 2002; 45: 1458-1467.
Senapati A, Cripps N P J.
Pilonidal sinus. In: Johnson C D, Taylor I.
eds. Recent advances in surgery 23. Edinburgh,
Churchill Livingstone, 2000:
33-42.
Senapati A, Cripps N P J, Thompson M R. Bascom's operation in
the day-surgical management of symptomatic pilonidal sinus. Br J Surg 2000; 87:
1067-1070. Velasco A L, Dunlap W W.
Pilonidal disease and hidradentis. Surg Clin North Am 2009;
89: 689-701. |