Surgical Aspects of Pilonidal Sinus Disease

Sinus

Sinus

SURGICALLY RELEVANT ASPECTS OF PILONIDAL SINUS DISEASE
1) The key aim of PSD treatment is to prevent the entry of new hairs.
2) The primary goal of surgery is to change the configuration of the gluteal cleft and achieve a healed wound.
3) Excision of pilonidal sinus disease is therefore not the main surgical objective.
4) Because hair has a tendency to self exit, not all secondary fistulae need to be excised as these will self-heal.
5) Scar tissue is weaker than intact skin, implying surgical scar must not cross the midline.
6) A wound at the base of the anaerobic environment of the natal cleft will not heal, again avoid a scar in the midline and “keep out of the ditch”.
7) A flat natal cleft prevents the buttocks rolling on each other thereby forcing hair through the skin.
8) Finally, hidradenitis suppurativa may resemble PSD with multiple secondary fistulae but requires different management.

REFERENCES
Karydakis GE. Easy and successful treatment of pilonidal sinus after explanation of its causative process. The Australian and New Zealand journal of surgery. 1992;62(5):385-9.

Immerman SC. Treatment of pilonidal disease using the Bascom 'Cleft-Lift' procedure. The American surgeon. 2014;80(2):E49-50

Corr DT, Gallant-Behm CL, Shrive NG, Hart DA. Biomechanical behavior of scar tissue and uninjured skin in a porcine model. Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society. 2009;17(2):250-9.

Bascom J, Bascom T. Utility of the cleft lift procedure in refractory pilonidal disease. American journal of surgery. 2007;193(5):606-9; discussion 9.

Ypsilantis E, Carapeti E, Chan S. The use of topical 10% metronidazole in the treatment of non-healing pilonidal sinus wounds after surgery. International journal of colorectal disease. 2016;31(3):765-7.

Bostanoglu S, Sakcak I, Avsar FM, Cosgun E, Hamamci EO. Comparison of Karydakis technique with Limberg Flap Procedure in Pilonidal Sinus Disease: Advantages of Karydakis technique. Pak J Med Sci. 2010;26(4):773-7.

Stelzner F. [Causes of pilonidal sinus and pyoderma fistulans sinifica]. Langenbecks Archiv fur Chirurgie. 1984;362(2):105-18.