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Specialities

Pilonidal Sinus

A Pilonidal sinus also called Pilonidal cyst, Pilonidal abcess or tunnel in the skin. It develops over the tailbone at the top of the cleft of the buttocks. The cyst usually contains hair and skin debris. More than one cyst may develop and these are linked by tunnels under the skin.

Causes of Pilonidal Sinus:

  • More common in males
  • Sedentary lifestyles
  • People who sit for long hours at a stretch eg. Drivers
  • Thick body hair
  • Obesity
  • Previous injury in the area
  • Family history of Pilonidal sinus
  • Having a deep cleft between buttocks
  • History of previous Pilonidal cyst

Signs & Symptoms:

  • Recurring episodes of pain or swelling in the area of the tailbone.
  • Yellowish pus-like or bloody discharge from the tailbone area which may be foul smelling.
  • Painful lump under the skin in that area.
  • Fever

Surgical Treatment for Pilonidal Sinus :

  • WIDE EXCISION OF PILONIDAL SINUS – In this procedure the surgeon does a wide bore local excision of the skin containing the sinus tract. The resulting cavity is left open to heal and fill in naturally from the bottom upwards. The wound is kept covered with a dressing.
  • LASER PILONIDOPLASTY (LPP) – This is a minimally invasive procedure done using the laser. In LPP, a small cut is made on the skin and all the pus is drained out. The entire sinus tract is then sealed with the laser fibre.
  • Excision with Primary Closure – In this procedure, the abscess and sinus are surgically removed and the wound is closed with stitches/sutures. The stitch line is preferably off the midline, where the tension is less and chances of healing are better.
  • Z-Plasty – In Z-plasty after removing the abscess and sinus, the surgeon loosens triangular flaps on each side of the midline to fill the cavity, with points of flap towards the heads and foot. While closing the surgeon crosses the pointed flaps to cross the midline in horizontal direction, thus converting an N-shaped incision to a Z-shaped closure.
  • Z-Limberg Flap / Gluteal Flap – This procedure is done in patients who have extensive Pilonidal disease or who have disease affecting both sides of the buttock. The surgeon removes an oblong shaped plug containing the abscess, skin and fat, thus creating a cavity. To fill the cavity, a flap of skin and thick fat is mobilised from the buttock beside and below the cavity. The flap is swung into the center and the edges are sutured.