Pilonidal Sinuses

Pilonidal sinus is a condition found in the midline posteriorly, between the buttocks, in the cleft overlying the tailbone. There are one or more midline pinpoint openings, which may or may not be infected and which communicate under the skin with a cavity which is lined by granulation tissue and which may contain hair lying loosely or in tufts.It is a condition which can exist in the noninfected state or there may be infection with abscess formation.

The patient presents with single or multiple episodes of swelling, pain and discharge from the natal cleft in the lower back. When the swelling discharges pus, the tension inside reduces and the patient feels comfort and a relief from pain.

On examination, besides the opening from where the pus discharge is seen, there are multiple pinpoint openings seen which serve as the conduits through which small hairs gain entry into the skin. In the subcutaneous area, they form a pocket where the hair rests and form a nidus of infection. This causes multiple episodes of infection giving rise to pus formation, pain, and even fever.

Initially, it may be managed with antibiotics, anti-inflammatory medication, and local applications but a cure may be achieved with surgery.

Surgery for pilonidal sinus:

In an episode of acute infection with pus formation, an incision and drainage procedure needs to be performed whereby the pus is removed and the resultant cavity is allowed to slowly heal with regular dressings.

When surgery is conducted during a quiescent stage of the disease, all the sinus tracts along with all the external openings must be excised. The resultant opening may heal by various means.

  1. By secondary intention with regular dressings
  2. Flap cover by a plastic surgical procedure
  3. Direct suturing of edges. This may not withstand opposing forces when the patient moves and may break down.