- 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
- 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
- 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
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