Chronic infection of the Skin & underlying soft tissue near Tail bone which do not cure with dressing & Cleaning & Reappear after some interval.
Symptoms of Pilonidal Sinus
Persistent Pain Near tail bone.
Foul smelling discharge / Staining under clothes in tail bone Region since long duration
Embarrassing stink.
Sometimes presents with painful/Tender Swelling with Pus near Bone region (Acute Infection/Abscess)
Changing Concept
Problem lies deeper than it looks!!
Patient and even Surgeons might be fooled by appearance. They presume that wound is Superficial & open with Small Sinus track.
But the wound is rarely open!!
Gluteal cleft which is deep, damp & poorly aerated - creating an ideal environment for infection to settle & negative suction while standing & walking does the rest of the job!
Root Cause
Pilonidal disease is caused by factors associated with a deep cleft between buttock cheeks (gluteal Cleft/natal cleft). Standing & walking causes negative suction in Gluteal cleft, which causes rupture of hair follicle in lower part of cleft. Accumulated dirt & fallen hair get sucked upwards in subcutaneous region due to negative situation and this is how Sinus forms. Hair entrapped in sinus track over a time is an associated finding and not the root cause.
Aim for Treatment of Pilonidal Sinus
Cleaning of all infective tissue with Retaining soft tissue with as much as possible.
Restore anatomy of gluteal cleft which is shallow & well aerated.
Primary closure of wound.
Restore daily routine as early as possible.
Problems with Conventional Surgery
Many surgeons encourage patient for excision of infective & surrounding fibrous tissue & keeping the large wound open and allow to heal by dressings. But the disadvantages of this are:
Usually this wound takes couple of months to heal, so dressing continues for long time.
As the root cause has not been taken care of, recurrence rate is high.
Don't & Do
Don't:
Don't treat Abscess with antibiotics. Get it drained.
Don't pack the wound.
Don't Rush for Surgery in acute - Abscess Stage.
Don't agree to have open wound & long term dressings.
FAQ
Should we keep wound open after Surgery? NO
How frequently dressings to be done? Usually twice a day
How long the dressing Continues? Usually 3 / 4 week.
Newer Approach with Laser
Reduces post op recovery & discomfort significantly.
