Pilonidal Cyst Excision

About Pilonidal Cyst Excision

Pilonidal disease is a chronic inflammatory condition of the skin in the natal cleft, the crease between the buttocks, in which loose hairs penetrate the skin and provoke infection, sinus tracts and abscesses. It most often affects young adults, especially men, and is associated with a deep natal cleft and abundant body hair. The term pilonidal, meaning nest of hair, was introduced by the American surgeon Richard Hodges in 1880. An acute pilonidal abscess is treated by incision and drainage. For chronic disease several operations exist. Excision with the wound left open to heal from the base has a low recurrence rate but involves a long healing period and prolonged wound care. Excision with midline primary closure heals faster but is associated with more wound breakdown and recurrence. Off midline techniques, such as the Karydakis flap, the Limberg rhomboid flap and the cleft lift operation popularized by John Bascom, flatten the cleft and move the scar away from the midline, and are associated with lower recurrence rates. Minimally invasive approaches, including pit picking and endoscopic or laser treatment of the sinus tracts, are increasingly used. Removal of hair from the area, by shaving or laser epilation, is commonly part of management to reduce the chance of recurrence. Recurrence and delayed wound healing remain the main problems with all techniques.