Pilonidal cyst on the butt

Get rid of the pilonidal cyst!

noreply@blogger.com (Unknown) — Fri, 06 Apr 2018 12:07:00 +0000

"Showered - Blood in the water - Checked - Holes in the coccyx - Googled - Oh no, a huge chunk of flesh must be cut away...!"

Source: Arztbewertungsportal Jameda

If you are looking for specific solutions for your pilonidal cyst or tailbone fistula, you will find a wealth of valuable information on the following pages to help you keep track of the various surgical techniques. You may then find that a "huge chunk of meat" does not have to be cut away at all, but that a minimally invasive measure is completely sufficient. A prerequisite is an examination by one of the few surgeons who are familiar with minimally invasive fistula surgery and can individually assess the success of pit picking and the like.

Standard surgery - the big hole on the buttocks

As a standard procedure for pilonidal cyst and tailbone fistulas, radical cutting of the cyst and the fistula system with open wound healing is almost exclusively performed worldwide and also in Germany. This means that the wound is not sutured up, but instead covered with tamponades and must slowly heal "openly", as this is expected to produce better long-term results. The procedure is simple and quick from the technical point of view. It is usually performed under anaesthesia, and patients often spend 1 to 2 days in a hospital.

For the patient this means:

The wound must be showered daily and a new tamponade applied. Due to the localisation of the wound, it is difficult to change the dressing independently, so an assistant is necessary at least in the first few weeks. Sitting and lying on the back is not possible in the first time after surgery, the wound also causes pain, which requires the regular use of painkillers, especially before changing dressings.

Hygienically, it's all such a thing. If the dressing is saturated with wound secretion, it should also be applied freshly in between, then the assistant must also be within reach. Wound secretion can be found in underwear and favourite jeans, possibly also on the bed sheet. Even if the wound is well cared for, it can occasionally smell something. Frequently the skin in the wound environment reacts to wound secretion and plaster material, becomes sore and develops redness, itching and red spots.

Everyday activities are out of the question, at least in the first few weeks. Sport and other leisure activities are not possible, the average time of incapacity for work is one month, or longer depending on the profession.

Statistically, wound healing takes 1.5 to 3 months. However, there are also known cases in which patients have had to struggle with their wounds for up to a year or longer.

Apart from the unpredictable duration of wound healing, this does not have to go without complications. It can stagnate, which means that nothing happens over a longer period of time, the wound doesn't want to get smaller. Or, for example, skin bridges are formed between the wound edges. This is an unmistakable sign that the body has surrendered in terms of wound healing. A new surgical intervention is necessary, which not only throws the patient back in time but can also wear him down psychologically.

Once the wound has finally healed, a nasty surprise can occur after months or even years: The pilonidal cyst and fistula have returned, which is the case in up to 35% of patients undergoing surgery using this method.

Surgery of the pilonidal cyst as 70 years ago or rather minimally invasive?

The radical cutting out of the pilonidal cyst and tailbone fistula system is a surgical method that has been carried out for 70 years in an almost unchanged technique.

Those who are affected by a pilonidal cyst and fistulas and inform themselves about Google will sooner or later come across indications that much smaller interventions for the treatment of the fistula are also possible, e.g. pit picking. Minimally invasive fistula procedures have excellent results in experienced surgeon's hands. Thus, in up to 80% of cases, pit picking leads in a short time to a permanent elimination of the problem with a low impairment on the patient, who can usually resume their normal daily activities after 0 - 1 day.

Lord Lucan, Trephine surgery 1, CC BY-SA 4.0

noreply@blogger.com (Unknown) — Fri, 06 Apr 2018 08:27:00 +0000

Get rid of the pilonidal cyst!

Pilonidal cyst – what is it?

The frequency of pilonidal cysts and tailbone fistulas

Causes of pilonidal cysts and tailbone fistulas

Pilonidal cysts not only occur on the buttocks

Diseases that can appear like a pilonidal cyst or tailbone fistula

Symptoms of the pilonidal disease

How is a pilonidal cyst diagnosed?

Stage-adapted treatment of the pilonidal disease

Treatment methods for pilonidal cysts

Minimally invasive procedures

Phenol injections according to Maurice and Greenwood

Proceeding according to Lord and Millar

Pit Picking according to Bascom (Bascom I)

Procedure according to Moshe Gips

Sinusectomy

Traditional procedures

Excision with open wound treatment

Excision, marsupialisation of wound edges and open wound treatment

Excision with primary midline suture

Plastic procedures

Plastic closure with Z-plastic

Plastic closure according to Karydakis

Cleft-lift procedure (Bascom II)

Plastic closure according to Limberg

Laser application in pilonidal disease

Recurrence prophylaxis - Preventing new tailbone fistula

Rare complications of pilonidal disease

Updates

Laser hair removal for relapse prevention of pilonidal disease

Risk factors for postoperative wound healing troubles and recurrence of fistula formation after coccyx fistula surgery

Exact evaluation of the extension of pilonidal fistula and cyst with ultrasound

Family History of Pilonidal Sinus: Earlier Onset of Disease and 50 % Long-Term Recurrence Rate

Pilonidal cyst – what is it?

noreply@blogger.com (Unknown) — Thu, 05 Apr 2018 13:34:00 +0000

The pilonidal cyst ("pilus": hair) is an acute or chronic inflammation in the subcutaneous fatty tissue, predominantly in the region of the coccyx, i.e. at the upper end of the bottom fold. Commonly, the disease is usually referred to as tailbone fistula; less common terms are pilonidal sinus, pilonidal disease, hair nest pits and hair fistula. The disease was first described in 1833. The frequency of the pilonidal cyst and tailbone fistula shows an increasing tendency for unknown reasons.

Three types of fistula are distinguished: the accidentally discovered form, which does not cause any discomfort, the acute abscess formation and the chronic form. Usually granulation tissue, which is inferior connective tissue, hair and cell detritus, is found in the cyst-shaped sinus. The latter is a mushy, unstructured and usually greasy mass that develops due to an inflammatory melting of tissue.

For the development of a pilonidal cyst several factors must coincide, whereby the hair roots in the area of the gluteal fold play a decisive role. More details can be found in the chapter "Causes off pilonidal cysts". Young men of dark hair type develop a coccyx fistula disproportionately frequently.

There are a variety of treatment methods for the pilonidal cyst and its fistula. The most common method is to generously cut out the affected area with an open wound treatment. This means that the wound is not sutured, but provided with tamponades that have to be changed daily. The procedure is safe, but for those affected it means months of healing with correspondingly long restrictions for leisure activities and, if necessary, time off work. "Safe" means that the procedure is not risky and also quick, but it does not protect against recurrences, i.e. the recurrence of the pilonidal cyst and fistula.

Literature sources:

Anderson NP (1947) Cysts, sinuses and fistulas of dermatologic interest. J Am Med Assoc 135:607– 612
Da Silva JH (2000) Pilonidal cyst: cause and treatment. Dis Colon Rectum 43:1146–1156
Hull TL, Wu J (2002) Pilonidal disease. Surg Clin North Am 82: 1169-1185

Frequency of pilonidal cysts and tailbone fistulas

noreply@blogger.com (Unknown) — Wed, 04 Apr 2018 13:59:00 +0000

In 2012, the incidence of pilonidal cysts and tailbone fistulas in Germany was around 48/100,000 inhabitants. For unknown reasons, the number of people affected by fistulas is increasing. This is shown by figures collected from the German Armed Forces (mainly young men): in 1985 the figure was 30/100,000, but rose to a remarkable 240/100,000 in 2007.

The tailbone fistula is usually noticeable between the 2nd and 3rd decade of life, mainly in men below the age of 40. Men are affected 2.2 times as often as women. In 2013, a study was conducted to determine whether hormone levels might play a role as risk factors for the development of a fistula. Hormone levels were compared in men with and without tailbone fistula, and no differences were found. However, women with a tailbone fistula had elevated prolactin levels (prolactin is produced in the pituitary gland, especially during pregnancy and lactation).

Pilonidal cysts and tailbone fistulas do not necessarily cause symptoms such as pain, abscesses or leakage of wound secretion or pus. Sometimes the cysts and fistulas are simply present, do not cause any symptoms and are discovered by chance. There are also figures for this: During the Second World War, over 77,000 American soldiers underwent pilonidal sinus surgery, and another 9000 were found to have tailbone fistulas without any symptoms. A more recent study from Turkey showed that 8.8% of 1,000 soldiers had a fistula during the initial examination, 4.8% had symptoms and 4.0% had no symptoms.

The pilonidal cyst occurs predominantly in people of European descent, rarely in black-skinned people. In Asian countries the disease pattern is rarely observed, in China it is said to be completely unknown.

Literature sources:

Akinci OF, Bozer M et al (1999) Incidence and aetiological factors in pilonidal sinus among Turkish  soldiers. Eur J Surg 165:339–342

Casberg, MA (1949) Infected pilonidal cysts and  sinuses. Bull U S Army Med Dep 9:493–496

Chijiwa T, Suganuma T et al (2006) Pilonidal sinus  in Japan maritime self-defense force at Yokosuka.  Mil Med 171:650–652

Da Silva JH (2000) Pilonidal cyst: cause and treatment. Dis Colon Rectum 43:1146–1156

Doll D, Friederichs J et al (2008) Surgery for asymptomatic pilonidal sinus disease. Int J Colorectal  Dis 23:839–844

Evers T, Doll D et al (2011) Trends in incidence  and long-term recurrence rate of pilonidal sinus  disease and analysis of associated influencing  factors. Zhonghua Wai Ke Za Zhi 49:799–803

Lee HC, Ho YH et al (2000) Pilonidal disease in  Singapore: clinical features and management.  Aust N Z J Surg 70:196–198

Özkan Z, Aksoy N et al (2013) Investigation of the relationship between serum hormones and pilonidal sinus disease: a cross-sectional study. Colorectal Dis 16:311–314

Sondenaa K, Andersen E et al (1995) Patient characteristics and symptoms in chronic pilonidal sinus disease. Int J Colorectal Dis 10:39–42

Causes of pilonidal cysts and tailbone fistulas

noreply@blogger.com (Unknown) — Tue, 03 Apr 2018 14:36:00 +0000

Until the middle of the 20th century, it was assumed that the pilonidal cyst was congenital and the development of the fistula already took place in the embryo.

Congenital fistulas of the coccyx do indeed occur:
In rare cases, a pilonidal cyst in the fetus can be visualized by ultrasound as part of a prenatal examination.
Newborns born with spinal cord and spinal canal anomalies often show a pilonidal cyst.
Some medications taken during pregnancy can cause a pilonidal cyst in the newborn. These include, for example, the high-dose intake of phenytoin, a drug for the treatment of epilepsy.
Another argument in favour of a genetic predisposition would be that a family history of pilonidal cyst can be observed. In a family history, the first symptoms often appear very early and the fistulas of the tailbone tend to reappear after treatment.
Another congenital problem is that the pilonidal cyst is always located in or immediately near the midline of the buttocks region, where problems in the development of the fetus often occur during the embryonic period.

However, there is also some evidence against the assumption that the pilonidal cyst is exclusively congenital:

An inflamed pilonidal cyst is rarely observed before puberty, and if it does, it occurs 4.5 times more frequently in boys than in girls.
Another argument against this is that in the case of malformations of the spinal cord and spinal canal, the hair nest of the pilonidal cyst does not contain any scattered skin appendages such as sweat or sebaceous glands, as one might expect with a congenital problem.
Nor does the theory of congenital tailbone fistula explain why in the majority of cases the disease only becomes apparent during puberty and then predominantly occurs in men with a stronger fat cushion over the coccyx

Acquired disease with a questionable genetic predisposition

Pilonidal cysts and tailbone fistulas are nowadays regarded as a disease acquired during puberty in which there may be a genetic predisposition. The fistula formation is triggered by the rubbing movements of the buttocks, which causes broken hair to twist into the skin. This creates depressions in the skin that can contain hair, the so-called pits.

Nartoun, SinusPilonidalis, marked as public domain

The horny scales of the hair act like barbs, whereby the hair can penetrate deeper and deeper into the subcutaneous fatty tissue. This is where a foreign body granuloma develops.

Foreign body granulomas do not heal spontaneously. They do not necessarily cause symptoms (asymptomatic form) but can become infected. The consequences are discomfort when sitting, a feeling of pressure or even small, bloody secretions (chronic form) as well as the abrupt development of abscesses (acute form).

The development of the tailbone fistula is favoured by additional factors. These include strong hairiness, overweight, excessive sweating, a strong fat cushion over the tailbone as well as a deeply absorbed bottom fold. A predominantly sedentary activity also has a favourable effect. This has led to the designation "jeep´s disease" among soldiers since during the Second World War between 1942 and 1945 more than 77,000 American soldiers fell ill with a tailbone fistula.

It is often claimed that a lack of personal hygiene is an additional risk factor. However, studies have shown that hygiene behaviour has no influence on the formation, abscess formation or recurrence of the tailbone fistula.

Literature sources:

Doll D, Petersen S (2008) Trauma is not a common origin of pilonidal sinus. Dermatol Surg  34:283–284

Efrat Z, Perri T et al (2001) Early sonographic detection of a ‚human tail’: a case report. Ultrasound  Obstet Gynecol 18:534–535

Spivak H, Brooks VL et al (1996) Treatment of  chronic pilonidal disease. Dis Colon Rectum  39:1136–1139

Badawy EA, Kanawati MN (2009) Effect of hair removal by Nd: YAG laser on the recurrence of pilonidal sinus. J Eur Acad Dermatol Venereol  23:883–886

Goldberg RB, Fish B et al (1978) Bilateral femoral  dysgenesis syndrome: a case report. Cleft Palate J  15:1263–1268

Yang TS, Chi CC et al (1978) Diphenylhydantoin  teratogenicity in man. Obstet Gynecol 52:682– 684

Akinci OF, Bozer M et al (1999) Incidence and aetiological factors in pilonidal sinus among Turkish  soldiers. Eur J Surg 165:339–342

Sondenaa K, Andersen E et al (1995) Patient characteristics and symptoms in chronic pilonidal sinus disease. Int J Colorectal Dis 10:39–42

Doll D, Matevossian E et al (2009) Family history  of pilonidal sinus predisposes to earlier onset of  disease and a 50% long-term recurrence rate. Dis  Colon Rectum 52:1610–1615

Chamberlain JW, Vawter GF (1974) The congenital origin of pilonidal sinus. J Pediatr Surg 9:441– 444

Golladay ES, Wagner CW (1990) Pediatric pilonidal disease: a method of management. South  Med J 83:922–924

Dahl HD, Henrich MH (1992) Light and scanning  electron microscopy study of the pathogenesis  of pilonidal sinus and anal fistula. Langenbecks  Arch Chir 377:118–124

Stelzner F (1984) Die Ursache des Pilonidalsinus und der Pyodermia fistulans sinifica. Langenbecks Arch Chir 362:105–118

Balik O, Balik AA et al (2006) The importance of local subcutaneous fat thickness in pilonidal disease. Dis Colon Rectum 49:1755–1757

Bascom J (1980) Pilonidal disease: origin from follicles of hairs and results of follicle removal as treatment. Surgery 87:567–572

Patey DH (1969) A reappraisal of the acquired  theory of sacrococcygeal pilonidal sinus and an  assessment of its influence on surgical practice.  Br J Surg 56:463–466

Benedetto AV (2010) Commentary: hair and pilonidal sinus disease. Dermatol Surg 36:92–93

Sondenaa K, Andersen E et al (1995) Patient characteristics and symptoms in chronic pilonidal sinus disease. Int J Colorectal Dis 10:39–42

Arda IS, Guney LH et al (2005) High body mass index as a possible risk factor for pilonidal sinus disease in adolescents. World J Surg 29:469–471

Bolandparvaz S, Moghadam Dizaj P et al (2012)  Evaluation of the risk factors of pilonidal sinus:  a single center experience. Turk J Gastroenterol  23:535–537

Conroy FJ, Kandamany N et al (2008) Laser depilation and hygiene: preventing recurrent pilonidal sinus disease. J Plast Reconstr Aesthet Surg  61:1069–1072

Sievert H, Evers T et al (2013) The influence of lifestyle (smoking and body mass index) on wound healing and long-term recurrence rate in  534 primary pilonidal sinus patients. Int J Colorectal Dis 28:1555–1562

Favre R, Delacroix P (1964) Apropos of 1,110 cases of pilonidal disease of coccy-perineal localization. Mem Acad Chir (Paris) 90:669–676

Akinci OF, Kurt M et al (2009) Natal cleft deeper  in patients with pilonidal sinus: implications for  choice of surgical procedure. Dis Colon Rectum  52:1000–1002

Corman M (1982) Classic articles in colonic and  rectal surgery. Louis A. Buie, M.D. 1890–1975:  jeep disease (pilonidal disease of mechanized  warfare). Dis Colon Rectum 25:384–390

Casberg, MA (1949) Infected pilonidal cysts and  sinuses. Bull U S Army Med Dep 9:493–496

Pilonidal cysts not only occur on the buttocks

noreply@blogger.com (Unknown) — Mon, 02 Apr 2018 15:32:00 +0000

The pilonidal cyst usually occurs in the region of the coccyx, but occasionally also in other regions of the body: in the belly button, the armpit, on the penis, between the fingers (in hairdressers) and toes, in the area of the chest and also behind the ears.

Barber´s disease

In hairdressers, the pilonidal cyst between the fingers is recognised as an occupational disease. This disease, also known as "interfinger hair pocket disease", hairdresser's disease or interdigital sinus pilonidalis (interdigital = between the fingers) is very rare.

The reason for this is the penetration of cut foreign hair into the finger gaps with the formation of granulomas, cysts and fistula ducts. The most frequently affected is the space between the 3rd and 4th fingers of a hand, but other spaces and both hands can also be affected at the same time. A similar occupational disease is known in sheep shears due to the penetration of wool and in milking cow hair.

Only the complete surgical removal of granuloma and fistula system can be considered as a treatment measure. The most important preventive measures are regular checks of the spaces between the fingers and the removal of any foreign hair that may be present.

Literature sources:

Colapinto ND (1977) Umbilical pilonidal sinus. Br  J Surg 64:494–495

Eryilmaz R, Sahin M et al (2005) Umbilical pilonidal sinus disease: predisposing factors and treatment. World J Surg 29:1158–1160

Fazeli MS, Lebaschi AH et al (2008) Evaluation of the outcome of complete sinus excision with reconstruction of the umbilicus in patients with umbilical pilonidal sinus. World J Surg 32:2305– 2308

Kareem T (2013) Outcomes of conservative treatment of 134 cases of umbilical pilonidal sinus.  World J Surg 37:313–317

McClenathan JH (2000) Umbilical pilonidal sinus.  Can J Surg 43:225

Khan AB, Scott RN (1992) Pilonidal abscess of the  penis. Br J Urol 69:437–438

Ballas K, Psarras K et al (2006) Interdigital pilonidal sinus in a hairdresser. J Hand Surg Br 31:290– 291

Eryilmaz R, Okan I et al (2012) Interdigital pilonidal sinus: a case report and literature review. Dermatol Surg 38:1400–1403

Patey DH, Scarff RW (1948) Pilonidal sinus in a barber’s hand with observations on postanal pilonidal sinus. Lancet 2:13

Stern PJ, Goldfarb CA (2004) Interdigital pilonidal  sinus. N Engl J Med 350:e10

Grant I, Mahaffey PJ (2001) Pilonidal sinus of the  finger pulp. J Hand Surg Br 26:490–491

Ferdinand RD, Scott DJ et al (1997) Pilonidal cyst  of the breast. Br J Surg 84:784

Yokoyama T, Nishimura K et al (2007) Pilonidal sinus of the supraauricle area. J Eur Acad Dermatol Venereol 21:257–258

Diseases that can appear like a pilonidal cyst or tailbone fistula

noreply@blogger.com (Unknown) — Sun, 01 Apr 2018 15:44:00 +0000

The pilonidal cyst and tailbone fistula can be confused with a number of other diseases. These primarily include fistula formation from the anus (anal fistulae) and fistulae that can occur in chronic inflammatory intestinal diseases such as Crohn's disease. Fistula diseases in the buttocks can also be caused by acne inversa. This is a chronic skin disease based on inflammation of the sebaceous glands and hair roots.

Rhagades can also imitate a pilonidal disease. These are narrow, slit-shaped tears in the skin due to overstretching. Psoriasis is also one of the differential diagnoses.

Literature sources:

Steinemann D, Dindo D et al (2011) Pilonidalsinus und Analfistel. Coloproctology 33:160–170

Breuninger H (2004) Treatment of pilonidal sinus  and acne inversa. Hautarzt 55:254–258

Stelzner F (1984) Die Ursache des Pilonidalsinus und der Pyodermia fistulans sinifica. Langenbecks Arch Chir 362:105–118

Laffert M von, Stadie V et al (2011) Morphology  of pilonidal sinus disease: some evidence of its  being a unilocalized type of hidradenitis suppurativa. Dermatology 223:349–355

Jansen T, Wolff H et al (1996) Eruptive vellus hair  cysts. Hautarzt 47:378–381

Alrawashdeh W, Ajaz S et al (2008) Primary anal  pilonidal disease. Colorectal Dis 10:303–304

Accarpio G, Davini MD et al (1988) Pilonidal sinus  with an anal canal fistula. Report of a case. Dis  Colon Rectum 31:965–967

Marra B, Fantini C et al (2005) Management of sacrococcygeal chordoma mimicking a pilonidal sinus: report of a case. Int J Colorectal Dis 20:388– 389

Fitzgerald JE, Lepore M (2012) Idiopathic calcinosis cutis infection as an unusual mimic of pilonidal abscess. ANZ J Surg 82:758–759

Gupta PJ (2008) Tubercular infection in the sacrococcygeal pilonidal sinus – a case report. Int  Wound J 5:648–650

Anscombe AR, Hofmeyr J (1954) Perianal actinomycosis complicating pilonidal sinus. Br J Surg  41:666

Alexiou GA, Sfakianos G et al (2012) Myxopapillary ependymoma of the sacrococcygeal region  presenting as a pilonidal sinus. Pediatr Neurosurg  48:64–65

Symptoms of pilonidal disease

noreply@blogger.com (Unknown) — Fri, 30 Mar 2018 16:14:00 +0000

Pilonidal cyst and tailbone fistula can occur in three different forms with correspondingly different symptoms:

asymptomatic
chronic
acute

Asymptomatic pilonidal cyst

The symptom-free tailbone fistula is characterized by the presence of one or more pits in the bottom fold. There are no signs of inflammation and no secretions. Since it does not cause any discomfort or secretion, this form of pilonidal sinus is often discovered by chance. Once the fistula is there, it does not heal spontaneously, normally it will last a lifetime.

Nartoun, SinusPilonidalis, marked as public domain

Since the spontaneous progression of the fistula disease is not inevitable, there are now two possibilities: Those affected have a fistula for a lifetime without ever developing symptoms. Or the fistula disease eventually changes into one of the following two forms and then requires treatment.

It is not possible to predict when an existing tailbone fistula will develop symptoms for the first time. Often there are several years between the occurrence of pits and the first symptoms. The MVZ St. Marien Cologne, Germany recently reported a tailbone fistula that existed for more than 30 years until it developed symptoms. The fistula was removed by minimal-invasive surgery.

Chronic pilonidal disease

Typical for the chronic pilonidal disease is the presence of pits with bloody purulent secretion. Secretion can be permanent or recurrent, i.e. occasional rest. Often a further fistula opening develops near the pits towards the buttock, the so-called secondary fistula, which indicates an inflammatory process that has existed for a long time.

GiggsHammouri, Pilonidal cyst, CC BY 3.0

Acute Pilonidal disease

This has led to the formation of an abscess in the pilonidal cyst. The abscesses almost always lie to the side of the gluteal fold, rarely in the area of the pits that are located in the gluteal fold. These abscesses are recognizable by a painful, reddened swelling that often develops within a short time. If the abscesses break open outwards (this is called spontaneous perforation) or if they are surgically opened, pus is drained.

Jonathanlund, Pilonidal abscess, CC BY-SA 4.0

Literature sources:

Sondenaa K, Andersen E et al (1995) Patient characteristics and symptoms in chronic pilonidal sinus disease. Int J Colorectal Dis 10:39–42

Doll D, Friederichs J et al (2008) Time and rate of  sinus formation in pilonidal sinus disease. Int J  Colorectal Dis 23:359–364

Brook I (1989) Microbiology of infected pilonidal  sinuses. J Clin Pathol 42:1140–1142

Pearson HE, Smiley DF (1968) Bacteroides in pilonidal sinuses. Am J Surg 115:336–338

How is a pilonidal cyst diagnosed?

noreply@blogger.com (Unknown) — Thu, 29 Mar 2018 16:35:00 +0000

The diagnosis of a tailbone fistula is an eye diagnosis. This means that the visible and palpable changes of the pilonidal disease are so typical that experienced examiners can usually make the diagnosis without major technical effort.

The pits or fistula openings in the gluteal fold are relatively easy to find and can be recognised by small, funnel-shaped retractions of the skin, possibly with sprouting hairs. If a chronic pilonidal cyst is present, depending on its size, it is already visible by a slight protrusion in the immediate vicinity of the gluteal fold; smaller ones are usually palpable as a circumscribed hardening under the skin. Depending on the inflammatory state of the cystic sinus, bloody-purulent secretion empties from the pits when pressure is applied to it.

Simple X-ray examination does not play a role in imaging procedures. Computed tomography and magnetic resonance imaging are generally dispensable, but can occasionally be helpful for surgical planning in complex plastic surgery.

A fast and uncomplicated, radiation-free imaging for the representation of the pilonidal cyst is possible with an ultrasound examination. The localisation and extent of a pilonidal cyst can be easily visualised with it, usually also the connection to the pits under the skin in the subcutaneous fatty tissue.

Pilonidal cyst in ultrasound image (c) MVZ St. Marien Cologne, Germany

Literature sources:

Taylor SA, Halligan S, Bartram CI. Pilonidal sinus disease: MR imaging distinction from fistula in ano. Radiology. 2003;226 (3): 662-7

Mentes O, Oysul A, Harlak A et-al. Ultrasonography accurately evaluates the dimension and shape of the pilonidal sinus. Clinics (Sao Paulo). 2010;64 (3): 189-92

Imanishi H, Tsuruta D, Nomura N et-al. Clinical usefulness of ultrasonography in interdigital pilonidal sinus. J Cutan Med Surg. 2012;16 (3): 194-6

Adams CI, Petrie PW, Hooper G. Interdigital pilonidal sinus in the hand. J Hand Surg Br. 2001;26 (1): 53-5

Stage-adapted treatment of the pilonidal disease

noreply@blogger.com (Unknown) — Wed, 28 Mar 2018 17:19:00 +0000

Treatment of the pilonidal disease depends on the stage of the disease.

Asymptomatic form

The tailbone fistula does not cause any discomfort but does not heal spontaneously. Instead, it normally persists for life and can go into the acute form (abscess formation) or into the chronic stage. However, a precautionary surgical removal of the tailbone fistula is not recommended. Anyone who has tailbone fistula or pilonidal cyst that does not cause any discomfort does not need surgical treatment.

Acute form (abscess)

If the pilonidal disease leads to abscess formation, a rapid surgical opening of the abscess is necessary, with which the infection situation including pain and possibly also fever is controlled. However, the surgical abscess opening does not lead to healing of the tailbone fistula; it remains after the surgical wound has healed. The final removal of pilonidal cyst and fistula should not be performed as part of an abscess operation, but only after the inflammatory environmental reaction has subsided, i.e. after 2 to 3 weeks at the earliest.

Those who have to undergo an abscess opening will certainly not be pleased if they have to go to the surgeon again a few weeks later to remove cyst and fistulas. However, the two-phase concept - abscess opening and only in a 2nd operation removal of the cyst and fistulas - has some advantages:

The emergency abscess opening can be carried out quickly and easily at any time of the day or night. Depending on the chosen procedure, the final renovation is much more time-consuming.
The abscess is usually opened on an outpatient basis; the surgical removal of fistula, on the other hand, requires an inpatient stay, depending on the surgical technique.
Another advantage is that the surgical removal of the fistula and, if necessary, the plastic coverage of the defect over the coccyx region can be better planned.
After the inflammatory soft tissue changes caused by the abscess have subsided, the extent of surgical fistula removal is usually smaller.
The risk of new fistula formation is lower with the two-phase concept.

Chronic pilonidal disease

The chronic pilonidal disease only very rarely heals spontaneously. The treatment is carried out surgically, whereby the time is freely selectable in contrast to the abscess opening, which usually does not tolerate a long time delay.

Literature sources:

Doll D, Friederichs J, Boulesteix AL et al (2008) Surgery for asymptomatic pilonidal sinus disease. Int J Colorectal Dis 23(9):839–844 4

Lauterbach HH, Konrad U (1999) Zweiphasenkonzept zur Therapie des infizierten Sinus pilonidalis. Chirurg Praxis 55:623–628 5

Doll D, Matevossian E, Hoenemann C et al (2013) Incision and drainage preceding definite surgery achieves lower 20-year long-term recurrence rate in 583 primary pilonidal sinus surgery patients. J Dtsch Dermatol Ges 11(1):60–64

Webb PM, Wysocki AP (2011) Does pilonidal abscess heal quicker with off-midline incision and drainage? Tech Coloproctol 15(2):179–183

Doll D, Friederichs J et al (2008) Surgery for asymptomatic pilonidal sinus disease. Int J Colorectal  Dis 23:839–844

Hussain ZI, Aghahoseini A et al (2012) Converting emergency pilonidal abscess into an elective procedure. Dis Colon Rectum 55:640–645

Jensen SL, Harling H (1988) Prognosis after simple incision and drainage for a first-episode acute  pilonidal abscess. Br J Surg 75:60–61

Treatment methods for pilonidal cysts

noreply@blogger.com (Unknown) — Tue, 27 Mar 2018 17:47:00 +0000

There are many recommendations for the treatment of pilonidal cysts and tailbone fistulas, which can be divided into two large groups. The classification is based on the controversial views regarding the development of fistulas of the coccyx.

From the consideration that pilonidal disease is a chronic inflammatory disease of the skin and subcutaneous fatty tissue results the excision of the entire area with subsequent open wound healing or plastic procedures of the large soft tissue defects, which has been practised in many places for over 70 years.

The other consideration sees in the chronic pilonidal disease a problem of the hair in healthy skin, why procedures are used whose goal is the removal of the hair or hair roots. These include minimally invasive procedures such as pit picking, which is performed under local anaesthesia without major soft tissue defects.

Although minimally invasive procedures are not standard in Germany, it is remarkable that the less traumatic procedures are often used in many countries as a first measure for symptomatic tailbone fistula. The results of these procedures are promising.

Overview of the different treatment procedures

Minimally invasive procedures

Phenol injection according to Maurice and Greenwood
Lord and Millar procedure
Pit picking according to Bascom (Bascom I)
Moshe Gips procedure
Sinusectomy

Traditional procedures

Excision with open wound treatment
Excision, marsupialization and open wound treatment
Excision with primary midline suture (gluteal fold)

Plastic procedures

Plastic closure with Z-plastic
Plastic closure according to Karydakis
Plastic closure according to Limberg
Cleft-lift procedure (Bascom II)

Laser application

How is the quality of results measured?

A surgical method is measured, among other things, by how successful it is, i.e. whether the health problem is permanently eliminated by the procedure. Thus, disease recurrence, which here means the recurrence of fistulas and inflammation is an important quality criterion for the surgical method.

As fistulas of the tailbone occur frequently, there are correspondingly many studies on the various treatment methods. The problem is that no uniform definition is used for the criterion "fistula recurrence" - renewed fistula formation after surgery - and this is also missing in many studies. Many second surgical procedures are also not performed because of a fistula recurrence, but because the wound causes problems after the first procedure or does not want to heal. From the patient's point of view, it is irrelevant if a second surgical procedure is performed due to new fistula formation or chronic wound healing disorder - it always represents a burden.

Literature sources:

Bascom J (1980) Pilonidal disease: origin from follicles of hairs and results of follicle removal as treatment. Surgery 87(5):567–572

Iesalnieks I, Deimel S, Kienle K et al (2011) Pit-picking surgery for pilonidal disease. Chirurg 82(10):927–931

Gips M, Melki Y, Salem L et al (2008) Minimal surgery for pilonidal disease using trephines: description of a new technique and long-term outcomes in 1,358 patients. Dis Colon Rectum 51(11):1656–1662 (discussion 1662– 1653)

Rao MM, Zawislak W et al (2009) A prospective randomised study comparing two treatment modalities for chronic pilonidal sinus with a 5-year  follow-up. Int J Colorectal Dis

Sondenaa K, Anderson E et al (1992) Morbidity and short term results in a randomised trial of  open compared with closed treatment of chronic  pilonidal sinus. Eur J Surg 158:351–355

Sondenaa K, Nesvik I et al (1996) Recurrent pilonidal sinus after excision with closed or open treatment: final result of a randomised trial. Eur J  Surg 162:237–240

Gencosmanoglu R, Inceoglu R (2005) Modified  lay-open (incision, curettage, partial lateral wall  excision and marsupialization) versus total excision with primary closure in the treatment of chronic sacrococcygeal pilonidal sinus: a prospective,  randomized clinical trial with a complete two-year follow-up. Int J Colorectal Dis 20:415–422

Othman I (2010) Skin glue improves outcome after excision and primary closure of sacrococcygeal pilonidal disease. Indian J Surg 72:470–474

Can MF, Sevinc MM et al (2009) Comparison of  Karydakis flap reconstruction versus primary  midline closure in sacrococcygeal pilonidal disease: results of 200 military service members. Surg  Today 39:580–586

Guner A, Boz A et al (2013) Limberg flap versus bascom cleft lift techniques for sacrococcygeal pilonidal sinus: prospective, randomized trial.  World J Surg 37:2074–2080

Iesalnieks I, Deimel S et al (2013) Karydakis flap  for recurrent pilonidal disease. World J Surg  37:1115–1120

Iesalnieks I, Fürst A et al (2003) Erhöhtes Rezidivrisiko nach primärem medianen Wundverschluss  bei Patienten mit Pilonidalsinus. Chirurg 74:461– 468

Doll D, Krueger CM et al (2007) Timeline of recurrence after primary and secondary pilonidal sinus  surgery. Dis Colon Rectum 50:1928–1934

Phenol injections according to Maurice and Greenwood

noreply@blogger.com (Unknown) — Mon, 26 Mar 2018 09:20:00 +0000

The injection of phenol (carbolic acid) is one of the oldest methods of treating the tailbone fistula and was first described in a publication in 1964.

The mostly 80 % phenolic solution is injected into the fistula and should lead to scarring and healing of the fistula due to an inflammatory reaction. According to the literature, the procedure is said to have healing rates between 30 and 92 %. The treatment is carried out on an outpatient basis under local anaesthetic and is only associated with a short period of absence from work and leisure activities.

In the last 15 years, numerous studies on this procedure have appeared, mainly from Turkey. However, the studies hardly permit a meaningful evaluation of the procedure on the basis of the quality criterion "fistula recurrence", i.e. recurrence of a fistula after phenol instillation. This is because the disease stages differed from study to study: Sometimes patients with purulent secretion or previous operations were excluded, in other studies they were also considered. Some patients were treated with phenol only once, others several times. In others, in addition to phenol injection, additional surgical measures were performed on the fistulas. Differences probably also result from the use of phenol in liquid or crystalline form as in the following film example:

The term "fistula recurrence" was also defined inconsistently or was completely absent. The proportion of patients for whom the fistulas did not heal after the first injection and further injection treatments had to be carried out is strikingly high at 70%. After multiple injections, the recurrence rate (however defined) was 5%. However, the varying length of follow-up periods, which ranged from 14 to 56 months depending on the study, is problematic, which hardly allows a reliable statement on the quality of the procedure and explains recurrence rates of between 9 and 40 %.

Studies in which phenol injection was compared with other treatment methods of the tailbone fistula hardly exist. In two older studies from 1975 and 1989, the phenol treatment performed significantly worse than other treatment methods. However, a recent American guideline recommends phenol injection for selected cases.

Phenol injection is one of the oldest treatment methods for tailbone fistula. Compared to the low burden on the patient (outpatient treatment under local anaesthesia, low downtime), the procedure can be considered for selected cases, as the cure rate is acceptable in these selected cases ("small findings").

Phenol is not approved in Germany because of its high toxicity and possible absorption into the body.

Literature sources:

Maurice BA, Greenwood RK (1964) A conservative treatment of pilonidal sinus. Br J Surg 51:510– 512

Dogru O, Camci C et al (2004) Pilonidal sinus treated with crystallized phenol: an eight-year experience. Dis Colon Rectum 47:1934–1938

Kaymakcioglu N, Yagci G et al (2005) Treatment of pilonidal sinus by phenol application and factors affecting the recurrence. Tech Coloproctol  9:21–24

Olmez A, Kayaalp C et al (2013) Treatment of pilonidal disease by combination of pit excision and  phenol application. Tech Coloproctol 17:201–206

Aygen E, Arslan K et al (2010) Crystallized phenol in nonoperative treatment of previously operated, recurrent pilonidal disease. Dis Colon Rectum 53:932–935

Shorey BA (1975) Pilonidal sinus treated by phenol injection. Br J Surg 62:407–408

Stansby G, Greatorex R (1989) Phenol treatment of pilonidal sinuses of the natal cleft. Br J Surg  76:729–730

Steele SR, Perry WB et al (2013) Practice parameters for the management of pilonidal disease. Dis  Colon Rectum 56:1021–1027

Bruce RM, Santodonato J et al (1987) Summaryreview of the health effects associated with phenol. Toxicol Ind Health 3:535–568

Proceeding according to Lord and Millar

noreply@blogger.com (Unknown) — Sun, 25 Mar 2018 09:47:00 +0000

Over the last 60 years, numerous surgical methods have been developed for the treatment of pilonidal cysts and tailbone fistula, many of which are minimally invasive techniques. Nevertheless, most surgeons, especially in Germany, prefer generous excision of the soft tissue with open wound healing - despite long, complication-prone healing phases and recurrence rates of up to 35%.

Against the background of general dissatisfaction with the results of this traditional procedure, surgeons Peter H. Lord and Douglas M. Millar presented the first minimally invasive surgical technique for the treatment of the pilonidal sinus in 1965. The introduction of this method and all other minimally invasive techniques go back to the realization that the pits in the gluteal fold are the cause for the development of the pilonidal disease, which is by no means exclusively congenital.

original release

With the Lord and Millar method, the pits are cut out very sparingly, the resulting skin wounds are usually less than 5 millimetres. If chronic abscesses or fistula ducts are present next to the wrinkle, these are opened by an additional skin incision and cleaned with a curette. Hair and inflammatory tissue are removed from the fistula ducts via the cut-out pits with small brushes. The procedure is performed under local anaesthesia.

After the operation, the wounds are not sutured but only provided with a hemostatic dressing. Suturing the wounds should increase the risk of wound healing disorders, inflammation and also the recurrence of fistulas. For wound treatment, showering several times a day is recommended, followed by blow-drying. Sitting baths are ineffective and not recommended, as is the application of ointments. Simple dressings or bandages are sufficient to cover wounds. During wound healing, which takes an average of 3-4 weeks, the hair around the wounds must be carefully removed, e.g. by shaving weekly.

A recurrence of tailbone fistulas was observed in studies in 3-4% of cases, especially when the wounds had been sutured. Most fistula recurrences occur within the first 6 months after the operation.

Literature sources:

Lord PH, Millar DM (1965) Pilonidal sinus: a simple treatment. Br J Surg 52:298–300

Kooistra HP (1942) Pilonidal sinuses. Am J Surg  55:3–17

Patey DH, Scarff RW (1946) Pathology of postanal  pilonidal sinus; its bearing on treatment. Lancet  2:484–486

Allen-Mersh TG (1990) Pilonidal sinus: finding the  right track for treatment. Br J Surg 77:123–132

Edwards MH (1977) Pilonidal sinus: a 5-year appraisal of the Millar-Lord treatment. Br J Surg  64:867–868

Pit Picking according to Bascom (Bascom I)

noreply@blogger.com (Unknown) — Sat, 24 Mar 2018 11:19:00 +0000

In the early 1980s, the American surgeon John Bascom developed the so-called follicle-removal operation, a minimally invasive procedure better known as pit picking. Further terms for the Bascom procedure are "minimally invasive surgery", "Bascom surgery", "pit pick" or "ambulatory surgery of pilonidal disease".

Paul Bascom, Photo of Dr. John Bascom, CC BY-SA 3.0

Bascom later developed another surgical method for the treatment of the tailbone fistula, the so-called cleft-lift procedure. Pit picking is therefore also known as "Bascom I", the cleft-lift method as "Bascom II".

The method is very similar to the Lord and Millar method, but the pits are cut out with an extremely narrow hem of just 1 millimetre and also only 2-3 millimetres deep. Pit-picking is performed on an outpatient basis under local anaesthesia. The wounds are not sutured but only covered with a dressing. Until healing, which usually takes only 2-3 weeks, the wounds have to be showered several times a day. Sitting baths and ointment treatments are not recommended.

Lord Lucan, Trephine surgery 1, CC BY-SA 4.0

The principle of the Bascom technique is based on the assumption that the pits lying in the gluteal fold are lined with a layer of skin that prevents the spontaneous closure of the pits, while at the same time providing a permanent entry point for bacteria, sweat and skin flakes. The pits are "picked out" by the pit picking method and can then heal. The procedure by which different variants are known is suitable only for manageable findings.

The recurrence rate for new fistulas of the pit picking method is between 10 - 20 %. It depends on how carefully the patients were selected for pit picking (only small findings, if possible without previous surgery), whether the findings are inflammation-free or accompanied by suppuration. Obesity and smoking are also risk factors for the recurrence of the tailbone fistula. Men develop a recurrence more frequently than women, for whom pit picking is almost ideal.

The big advantage of pit picking is the low strain on the patient. It can be performed on an outpatient basis under local anaesthesia, takes only a few minutes, requires no extensive wound care and enables a rapid resumption of professional and leisure activities.

Literature sources:

Bascom J (1980) Pilonidal disease: origin from follicles of hairs and results of follicle removal as treatment. Surgery 87:567–572

Gips M, Melki Y et al (2008) Minimal surgery for  pilonidal disease using trephines: description of a  new technique and long-term outcomes in 1,358  patients. Dis Colon Rectum 51:1656–1662 (discussion 1662–1663)

Majeski J, Stroud J (2011) Sacrococcygeal pilonidal disease. Int Surg 96:144–147

Senapati A, Cripps NP et al (2000) Bascom’s operation in the day surgical management of symptomatic pilonidal sinus. Br J Surg 87:1067–1070

Colov EP, Bertelsen CA (2011) Short convalescence and minimal pain after out-patient Bascom’s  pit-pick operation. Dan Med Bull 58: A4348

Maghsoudi H, Nezami N et al (2011) Ambulatory treatment of chronic pilonidal sinuses with lateral incision and primary suture. Can J Surg 54:78– 82

Lord PH, Millar DM (1965) Pilonidal sinus: a simple treatment. Br J Surg 52:298–300

Bascom J (1983) Pilonidal disease: long-term  results of follicle removal. Dis Colon Rectum  26:800–807

Thompson MR, Senapati A et al (2011) Simple  day-case surgery for pilonidal sinus disease. Br J  Surg 98:198–209

Procedure according to Moshe Gips

noreply@blogger.com (Unknown) — Fri, 23 Mar 2018 11:43:00 +0000

In the early 1990s, Moshe Gips, an Israeli surgeon, introduced another minimally invasive surgical technique for the treatment of pilonidal cysts and tailbone fistulas, based on the techniques of Lord/Millar and Bascom (pit picking), which is also suitable for advanced findings.

In his process, Gips used punches with an annular knife at the end, which are commonly used in dermatology and dentistry. Before the procedure, which can be performed under local anesthesia in selected cases, all fistula openings are examined with 0.5 to 1.0 mm thin probes to determine the extent of the inflammatory area under the skin. With the punches, which can be up to 9 millimetres in diameter, all fistula openings are removed deep into the subcutaneous fatty tissue, the sinus pilonidalis is opened and the inflammatory tissue and hairs are removed with curettes.

Procedure according to Moshe Gips (c) MVZ St. Marien, Cologne, Germany

The wounds are dressed with tampon bandages, they are not sutured. Due to the risk of postoperative bleeding, which should not be underestimated, patients undergoing the operation as outpatients must be followed for at least one hour and lie consistently on their back during this time in order to compress the surgical area.

Lord Lucan, Trephine surgery 2, CC BY-SA 4.0

Wound treatment consists of showering several times a day, followed by the application of a new dressing. During the healing phase, which can last several weeks, the wound area should be shaved regularly. If a wound healing disorder is foreseeable, the procedure is repeated in a similar manner and the wound cavities under the skin are cleaned again.

Between 1993 and 2003, Moshe Gips treated about 1400 patients with tailbone fistulas using his method with a follow-up time of up to 80 months. His study, published in 2003, is thus the largest and most comprehensive study on the treatment methods for fistulas of the coccyx. The recurrence rate of his technique was 16 %, another 4 % had not healed wounds at the time of the last contact.

The procedure according to Moshe Gips for the treatment of pilonidal cysts and tailbone fistulas is thus a simple procedure which, like all other minimally invasive methods, leads to a relatively rapid healing and an aesthetically pleasing result. The advantage is that, in contrast to the method of Lord/Millar or Bascom (pit picking), it can also be performed for more extensive findings. The long-term cure rate is higher than that of traditional methods. If recurrences occur, the procedure can be repeated if necessary.

Literature sources:

Thompson MR, Senapati A et al (2011) Simple  day-case surgery for pilonidal sinus disease. Br J  Surg 98:198–209

Lord PH, Millar DM. Pilonidal sinus: a simple treatment. Br J Surg 1965;52:298–300

Sinusectomy

noreply@blogger.com (Unknown) — Thu, 22 Mar 2018 12:02:00 +0000

One of the minimally invasive surgical procedures for the treatment of the pilonidal cyst and tailbone fistula is a method from Switzerland, which was reported for the first time in 2012.

The principle consists of a small cut-out ("limited excision") of the fistula. To mark the fistula ducts, a colouring solution is injected over the pits. The pits are cut sparingly and the corresponding fistula ducts in the subcutaneous fat tissue are carefully cut out. This is the difference between the traditional, generous removal of the fistula area in one piece, which leads to large soft tissue defects. Sinusectomy is performed under local anaesthesia in appropriate cases.

Immediately after sinusectomy (c) MVZ St. Marien Cologne, Germany

Lord Lucan, Pilonidal cyst and fistula, CC BY-SA 4.0

After the surgical procedure, the wounds remain open. They are not sutured, as this often leads to wound healing disorders and increases the probability of new fistulas. The wounds must be showered several times a day until they heal and then treated with a dressing. The wound area must be shaved regularly until it heals. The healing process takes several weeks, an incapacity to work of approx. 1 week must be expected.

It is recommended to perform the sinusectomy only with manageable local findings with a maximum of 3 pits, whereby these should be as close to each other as possible. Occasionally, the fistula ducts cannot be located exactly, which can result in a larger excision than originally planned. In a follow-up study, a relapse rate of 7 % is reported 5 years after the procedure.

Sinusectomy is, therefore, a minimally invasive procedure that is suitable for manageable findings. In suitable cases, it can be done on an outpatient basis under local anaesthetic and leads to good long-term results.

Literature sources:

Soll C, Dindo D et al (2012) Sinusectomy for  primary pilonidal sinus: less is more. Surgery  150:996–1001

Mohamed HA, Kadry I et al (2005) Comparison between three therapeutic modalities for  noncomplicated pilonidal sinus disease. Surgeon  3:73–77

Oncel M, Kurt N et al (2002) Excision and marsupialization versus sinus excision for the treatment  of limited chronic pilonidal disease: a prospective, randomized trial. Tech Coloproctol 6:165–169

Excision with open wound treatment

noreply@blogger.com (Unknown) — Wed, 21 Mar 2018 12:43:00 +0000

The generous excision of the entire fistula system and the subsequent open wound treatment is the most frequently performed treatment method for the pilonidal disease worldwide, also in Germany. The technology has been in use for decades and has not changed over the years.

peacekiller. Original uploader was Peacekiller at German Wikipedia, Pinomidalzyste, CC BY-SA 3.0

The procedure is performed under general anesthesia, usually under inpatient conditions. Many surgeons mark the fistula ducts with a dye solution and then perform the complete excision of the marked tissue. Often wound cavities larger than a man's fist result. Open wound treatment means that the wounds are not sutured; instead, they are provided with tamponades and a cover dressing. The wounds must be showered and re-tied daily, which requires an assistant. Wound healing disorders and stagnation of wound healing are not uncommon. The surgical procedure is easy to perform, low in complications and safe for the patient.

However, the lengthy open wound treatment after the procedure is a major burden for the patient. This is between 1.5 and 3 months and leads to an average inability to work of one month. Thus, the complete excision followed by open wound treatment with regard to healing phase and incapacity for work performs significantly worse than the procedures with plastic covering (e.g. Karydakis, Limberg) and in particular the minimally invasive techniques.

There are numerous studies on the recurrence rate of fistulas after excision and open wound treatment, which is said to be up to 35%. Patients who have already undergone surgery on a tailbone fistula at an earlier point in time and have to undergo another procedure have high recurrence rates.

Literature sources:

Holmebakk T, Nesbakken A (2005) Surgery for pilonidal disease. Scand J Surg 94:43–46

Kronborg O, Christensen K et al (1985) Chronic pilonidal disease: a randomized trial with a complete 3-year follow-up. Br J Surg 72:303–304

Baier PK, Baumgartner U et al (2002) Therapy of the pilonidal sinus - Primary wound closure or open wound after excision. Zentralbl Chir  127:310–314

Gupta PJ (2003) Radiofrequency incision and lay open technique of pilonidal sinus (clinical practice paper on modified technique). Kobe J Med Sci  49:75–82

Ommer A, Pitt C et al (2004) Sinus pilonidalis primärer Verschluss auch beim Abszess? Zentralbl Chir 129:216–219

Al-Homoud SJ, Habib ZS et al (2001) Management of sacrococcygeal pilonidal disease. Saudi  Med J 22:762–764

Fazeli MS, Lebaschi AH et al (2008) Evaluation of the outcome of complete sinus excision with reconstruction of the umbilicus in patients with  umbilical pilonidal sinus. World J Surg 32:2305– 2308

Füzün M, Bakir H et al (1994) Which technique for  treatment of pilonidal sinus - open or closed? Dis  Colon Rectum 37:1148–1150

McCallum IJ, King PM et al (2008) Healing by primary closure versus open healing after surgery  for pilonidal sinus: systematic review and metaanalysis. BMJ 336:868–871

Mohamed HA, Kadry I et al (2005) Comparison between three therapeutic modalities for noncomplicated pilonidal sinus disease. Surgeon  3:73–77

Testini M, Piccinni G et al (2001) Treatment of  chronic pilonidal sinus with local anaesthesia: a  randomized trial of closed compared with open  technique. Colorectal Dis 3:427–430

Gidwani AL, Murugan K et al (2010) Incise and lay open: an effective procedure for coccygeal pilonidal sinus disease. Ir J Med Sci 179:207–210

Jamal A, Shamim M et al (2009) Open excision with secondary healing versus rhomboid excision with Limberg transposition flap in the management of sacrococcygeal pilonidal disease. J  Pak Med Assoc 59:157–160

Matter I, Kunin J et al (1995) Total excision versus non-resectional methods in the treatment  of acute and chronic pilonidal disease. Br J Surg  82:752–753

Excision, marsupialisation of wound edges and open wound treatment

noreply@blogger.com (Unknown) — Tue, 20 Mar 2018 12:54:00 +0000

In order to reduce the extent of the wound after the excision of the fistula system in the pilonidal disease with subsequent open wound treatment, the so-called marsupialisation of the wound edges was introduced in the 1950s.

Marsupialization is a surgical technique that is normally used to treat cysts. The cyst is cut open lengthwise and its two incisal margins are sutured to the surrounding soft tissue. After cutting out the fistula system in the pilonidal disease, the edges of the skin are mobilized and sutured to cover the coccyx, which means that the wound in the fistula fold is usually no wider than 2 centimetres. As with excision, it must then heal on its own with open wound treatment. The procedure is performed under anaesthesia and requires a short stay in the hospital. As with excision with open wound treatment, wound care is performed by daily showering.

original release

The incidence of new tailbone fistulas following marsupialization in follow-up studies was 10 %, the average healing time was 3 to 4 weeks with an incapacity to work of 0.5 to 1.5 months.

Compared to excision with open wound treatment, marsupialisation reduces wound healing time and also the duration of incapacity to work at low recurrence rates. However, the wound care that is not very pleasant for the patient. The cosmetic result is also not necessarily appealing. Sewing the edges of the skin to cover the coccyx always leads to severe pain. In Germany, therefore, marsupialization plays no role in the treatment of the pilonidal sinus and is not recommended.

Literature sources:

Abramson DJ, Cox PA (1954) The marsupialization operation for pilonidal cysts and sinuses under local anesthesia with lidocaine; an ambulatory method of treatment. Ann Surg 139:341–349

Aydede H, Erhan Y et al (2001) Comparison of  three methods in surgical treatment of pilonidal  disease. ANZ J Surg 71:362–364

Ersoy OF, Karaca S et al (2007) Comparison of different surgical options in the treatment of pilonidal disease: retrospective analysis of 175 patients. Kaohsiung J Med Sci 23:67–70

Solla JA, Rothenberger DA (1990) Chronic pilonidal disease. An assessment of 150 cases. Dis Colon Rectum 33:758–761

Meban S, Hunter E (1982) Outpatient treatment  of pilonidal disease. Can Med Assoc J 126:941

Watters N, Macdonald IB (1958) Marsupialization of pilonidal sinus and abscess: a report of 50 cases. Can Med Assoc J 79:236–240

Füzün M, Bakir H et al (1994) Which technique for  treatment of pilonidal sinus  open or closed? Dis  Colon Rectum 37:1148–1150

Excision with primary midline suture

noreply@blogger.com (Unknown) — Mon, 19 Mar 2018 13:22:00 +0000

In order to shorten wound healing after generous excision of the pilonidal cyst and fistula, the wound was sutured immediately in the 1940s, usually through two rows of sutures (subcutaneous fatty tissue and skin suture).

Primary midline suture

The time until the wound healed could indeed be shortened in many patients - as long as there were no wound healing disorders. According to numerous follow-up studies after the midline suture, these increased significantly and could be observed in up to 74 % of patients. The healing disorders were mainly due to wound infections, which were hoped to be fought by placing antibiotic carriers inside the wound in the subcutaneous fatty tissue. However, the results of these measures were not very convincing.

Assuming problem-free wound healing, the midline suture leads to a shorter time out of work compared to open wound treatment. However, if the long-term results after excision of the fistula area with open wound treatment are compared with the incision including the midline suture, the suture technique shows a higher recurrence rate of fistula formation.

Comparing Limberg plastic and midline suture, Limberg plastic gives better long-term results with little-renewed fistula formation. In direct comparison, fewer wound healing disorders are also observed with Limberg plastic.

The excision of the fistula area with subsequent midline suture thus leads to significantly more wound healing disorders and renewed fistula formation, so that it cannot be recommended for the treatment of pilonidal cyst and tailbone fistula.

Literature sources:

Kooistra HP (1942) Pilonidal sinuses. Am J Surg  55:3–17

Holmebakk T, Nesbakken A (2005) Surgery for pilonidal disease. Scand J Surg 94:43–46

Abu Galala KH, Salam IM et al (1999) Treatment of pilonidal sinus by primary closure with a transposed rhomboid flap compared with deep suturing: a prospective randomised clinical trial. Eur J  Surg 165:468–472

Baier PK, Baumgartner U et al (2002) Therapy of the pilonidal sinus-Primary wound closure or open wound after excision. Zentralbl Chir  127:310–314

Brieler HS (1997) Infected pilonidal sinus. Langenbecks Arch Chir Suppl Kongressbd 114:497– 500

Denkers D, Girona J (1996) Der abszedierte Sinus pilonidalis der Steißbeinregion -Möglichkeiten der chirurgischen Versorgung. Coloproctology 18:257–259

Doll D, Evers T et al (2011) Does gentamycin affect long term recurrence rate in pilonidal sinus  surgery. Eur Surg 1–8

Dudink R, Veldkamp J et al (2011) Secondary healing versus midline closure and modified Bascom natal cleft lift for pilonidal sinus disease.  Scand J Surg 100:110–113

Lee SL, Tejirian T et al (2008) Current management of adolescent pilonidal disease. J Pediatr  Surg 43:1124–1127

Muzi MG, Milito G et al (2010) Randomized comparison of Limberg flap versus modified primary  closure for the treatment of pilonidal disease. Am  J Surg 200:9–14

Muzi MG, Milito G et al (2009) A modification of primary closure for the treatment of pilonidal disesae in day-care setting. Colorectal Dis 11:84–88

Nursal TZ, Ezer A et al (2010) Prospective randomized controlled trial comparing V-Y advancement flap with primary suture methods in pilonidal disease. Am J Surg 199:170–177

Tavassoli A, Noorshafiee S et al (2011) Comparison of excision with primary repair versus Limberg flap. Int J Surg 9:343–346

Vogel P, Lenz J (1992) Behandlung des Sinus pilonidalis durch Excision und Primärverschluß unter Verwendung eines lokalen, resorbierenden Antibiotikaträgers. Ergebnisse einer prospektiven  randomizierten Studie. Chirurg 63:748–753

AlHassan HK, Francis IM et al (1990) Primary closure or secondary granulation after excision of pilonidal sinus? Acta Chir Scand 156:695–699

AlSalamah SM, Hussain MI et al (2007) Excision with or without primary closure for pilonidal sinus disease. J Pak Med Assoc 57:388–391

Kronborg O, Christensen K et al (1985) Chronic pilonidal disease: a randomized trial with a complete 3-year follow-up. Br J Surg 72:303–304

Lorant T, Ribbe I et al (2011) Sinus excision and  primary closure versus laying open in pilonidal  disease: a prospective randomized trial. Dis Colon  Rectum 54:300–305

Akca T, Colak T et al (2005) Randomized clinical  trial comparing primary closure with the Limberg  flap in the treatment of primary sacrococcygeal  pilonidal disease. Br J Surg 92:1081–1084

Plastic closure with Z-plastic

noreply@blogger.com (Unknown) — Sun, 18 Mar 2018 13:38:00 +0000

If the resulting tissue defect is covered and sutured by a flap of tissue from the immediate vicinity of the wound after the incision of the tailbone fistula, this surgical technique is called "plastic". The tissue flap mobilized to cover the defect usually consists of skin and subcutaneous fatty tissue. Since the incision for mobilization of the tissue flap lies outside the midline (gluteal fold), the various plastic procedures are also referred to as "asymmetrical". The wound also comes almost completely to the side of the gluteal fold, which is why the English literature speaks of "off-midline procedures".

In 1946, surgeon David H. Patey and pathologist R.W. Scarff questioned for the first time in a renowned English journal the assumption that pilonidal disease is congenital. Through investigations, they came to the conclusion that pilonidal cyst and tailbone fistula are mainly due to the penetration of hair into the skin of the gluteal fold. The dreaded wound healing disorders and the recurrence of fistulas were therefore not due to insufficient radical cutting of the fistula system, but to the surgical wound itself in the depth of the gluteal fold.

In the 1950s, based on Patey and Scarff's investigations, initial attempts were made to leave the extensive, radical soft tissue resections and instead to cause an anatomical flattening of the gluteal fold and not to place the surgical wound in the depth of the fold. One of the surgical techniques that meets these requirements is the so-called "Z-plasty". In an initial Z-plasty study involving 30 patients, Monro and McDermott reported in the 1960s that no patient developed a new fistula.

Despite further positive reports, Z-plasty was hardly used to cover defects and to raise the gluteal fold. It was not until 1988 that another study was published on the experience with Z-plasty, which led to wound healing disorders in over 67% of patients operated on using the procedure. The dying of skin in the corners of the Z-plasty and the recurrence of fistulas at the crossing points of the surgical wound with the bottom fold was described as problematic, which sealed the "end" for the Z-plasty.

Even if Z-plasty has no or only a subordinate role in the surgical treatment of fistulas of the tailbone, it is historically of great importance, as it paved the way for more modern plastic surgical procedures. In the 1950s and 60s, Z-plasty was the first attempt to counter wound healing disorders and renewed fistula formation with an anatomical flattening of the butt fold and not with more radicality.

Literature sources:

Allen-Mersh TG (1990) Pilonidal sinus: finding the  right track for treatment. Br J Surg 77:123–132

Petersen S, Koch R et al (2002) Primary closure techniques in chronic pilonidal sinus: a survey of  the results of different surgical approaches. Dis  Colon Rectum 45:1458–1467

Kooistra HP (1942) Pilonidal sinuses. Am J Surg  55:3–17

Patey DH (1969) A reappraisal of the acquired theory of sacrococcygeal pilonidal sinus and an  assessment of its influence on surgical practice.  Br J Surg 56:463–466

Patey DH, Scarff RW (1946) Pathology of postanal pilonidal sinus; its bearing on treatment. Lancet  2:484–486

Monro RS (1967) A consideration of some factors in the causation of pilonidal sinus and its treatmentby Z-plasty. Am J Proctol 18:215–225

Monro RS, McDermott FT (1965) The elimination of causal factors in pilonidal sinus treated by Z-plasty. Br J Surg 52:177–181

Tschudi J, Ris HB (1988) Morbidity of Z-plasty in the treatment of pilonidal sinus. Chirurg 59:486– 490

Karydakis GE (1992) Easy and successful treatment of pilonidal sinus after explanation of its  causative process. Aust N Z J Surg 62:385–389

Plastic closure according to Karydakis

noreply@blogger.com (Unknown) — Sat, 17 Mar 2018 14:06:00 +0000

In 1973, the Greek military physician G. Karydakis introduced a new surgical technique for the treatment of pilonidal cysts and tailbone fistulas, which is still performed under his name today. In developing his surgical technique, he referred to the research results of Patey and Scarff in the 1940s (see Z-plastic) that the pilonidal disease was by no means exclusively congenital, but rather predominantly due to hair that grows into the bottom fold and leads to a foreign object irritation under the skin, as a result of which inflammatory reactions can develop.

Karydakis´ technique is based on the idea of making the butt fold flatter through wound closure after cutting out the fistula system through the wound closure. This is to reduce the tendency of the hair to grow into the skin, thus minimizing the risk of renewed fistula formation. Another important aspect of the Karydakis´ technique is that the wound closure or skin suture is located to the side next to the bottom fold. This is intended to prevent the dreaded wound healing disorders that can be triggered, for example, by the midline suture.

Karydakis Technique

In the Karydakis technique, the soft tissues are cut out asymmetrically and ovally, taking along the fistulas. The soft tissue defect is then covered by a tissue flap that is mobilized near the butt fold. After the procedure, the skin sutures lie next to the bottom fold, which is flatter than before the procedure.

Karydakis published his experiences with the surgical technique named after him, which he performed on approximately 1700 patients, in 1973 in a renowned scientific journal. Wound healing disorders occurred in 8.5 % and recurrences (renewed fistula formation) in only 1.3 % of patients. Karydakis´ study, however, had one flaw: it could only examine 40 % of the patients so that there was a certain number of unreported cases of wound healing disorders and fistula recurrences. His follow-up work from 1992 is also not very credible: He claims to have observed a recurrence rate of < 1 % in 5876 operated patients, allegedly observed all (!) patients, whereby the follow-up period was 2 to 20 years.

Here you can see the performance of the surgery on a video. Warning, original surgical footage!

Karydakis Operation for Sinus pilonidalis

Nevertheless, the Karydakis technique has been adopted by many surgeons, correspondingly many field reports have been published. Particularly noteworthy is the 1996 study by Kitchen, which reported a credible rate of wound healing disorder of 9% and recurrent fistulas of 4% in 141 patients operated on after Karydakis. Over the last 15 to 20 years, recurrent fistulas between 0 and 6 % and a rate of wound healing disorders of 8 to 23 % after Karydakis surgery have been reported throughout.

In comparison with the Karydakis technique and other plastic procedures, e.g. Limberg plastic surgery, there are no significant differences in wound healing disorders and renewed fistula formation. The recurrence rate after Karydakis plastic surgery is low at 0 to 6% and wound closure allows a quick return to everyday life. If the restoration of a tailbone fistula is planned with a plastic procedure, the Karydakis sculpture can certainly be considered.

Literature sources:

Karydakis GE (1973) New approach to the problem of pilonidal sinus. Lancet 2:1414–1415

Karydakis GE (1992) Easy and successful treatment of pilonidal sinus after explanation of its  causative process. Aust N Z J Surg 62:385–389

Lord PH, Millar DM (1965) Pilonidal sinus: a simple treatment. Br J Surg 52:298–300

Patey DH, Scarff RW (1946) Pathology of postanal  pilonidal sinus; its bearing on treatment. Lancet  2:484–486

Kitchen PR (1996) Pilonidal sinus: experience  with the Karydakis flap. Br J Surg 83:1452–1455

Akinci OF, Coskun A et al (2006) Surgical treatment of complicated pilonidal disease: limited  separate elliptical excision with primary closure.  Colorectal Dis 8:704–709

Bessa SS (2007) Results of the lateral advancing  flap operation (modified Karydakis procedure)  for the management of pilonidal sinus disease.  Dis Colon Rectum 50:1935–1940

Bessa SS (2013) Comparison of short-term results between the modified Karydakis flap and  the modified Limberg flap in the management of  pilonidal sinus disease: a randomized controlled  study. Dis Colon Rectum 56:491–498

Moran DC, Kavanagh DO et al (2011) Excision and  primary closure using the Karydakis flap for the  treatment of pilonidal disease: outcomes from a  single institution. World J Surg 35:1803–1808

Morden P, Drongowski RA et al (2005) Comparison of Karydakis versus midline excision for treatmentof pilonidal sinus disease. Pediatr Surg Int  21:793–796

Sözen S, Emir S et al (2011) Are postoperative drains necessary with the Karydakis flap for treatment of pilonidal sinus? (Can fibrin glue be replaced to drains?) A prospective randomized trial. Ir  J Med Sci 180:479–482

Arslan K, Said Kokcam S et al (2014) Which flap  method should be preferred for the treatment of  pilonidal sinus? A prospective randomized study.  Tech Coloproctol 18:29–37

Aslam MN, Shoaib S et al (2009) Use of Limberg  flap for pilonidal sinus-a viable option. J Ayub  Med Coll Abbottabad 21:31–33

Ersoy E, Devay AO et al (2009) Comparison of  the short term results after Limberg and Karydakis procedures for pilonidal disease: randomized  prospective analysis of 100 patients. Colorectal  Dis 11:705–710

Cleft-lift procedure (Bascom II)

noreply@blogger.com (Unknown) — Fri, 16 Mar 2018 14:22:00 +0000

A modification of the Karydakis technique is the cleft-lift method introduced by Bascom in the 1980s, the aim of which is also to flatten or lift the bottom fold ("cleft" = column, "lift" = lift). The cleft-lift incision differs slightly from the Karydakis technique, but the main difference is that the tissue flap mobilized to cover the defect measures only 2 to 3 mm instead of 1 cm (for Karydakis).

Another difference to the Karydakis technique is that in the original Bascom technique the cyst and fistula system under the skin is not completely removed. Instead, the cavity is simply cleaned of inflammatory tissue. The idea behind this is to keep the tissue defect, which then has to be covered by a mobilized skin flap, relatively small.

In 2007 Bascom published the results of 69 cleft-lift operations. All patients had wounds healed at the end of the 30-month follow-up period and no patient had reoccurred with fistula. However, 12% of patients had to undergo two surgeries.

Other studies also confirmed low recurrence rates (0 to 5%) and a rapid return to daily activities after 2 to 3 weeks. However, the relatively high rates of wound healing disorders between 18 and 40% after cleft-lift surgery must be pointed out.

If the cleft-lift procedure is compared with minimally invasive surgical measures in pilonidal disease e.g. pit picking (Bascom I), fewer recurrences occur during the cleft-lift. Compared to the Limberg procedure, the recurrence rate (renewed fistula formation) and the frequency of wound healing disorders are approximately the same.

The cleft-lift procedure according to Bascom leads to approximately the same results as the Karydakis technique but tends to show a higher rate of wound healing disorders. The recurrence rate is comparable to that after Limberg plastic surgery. In practice, therefore, the cleft-lift technique for the treatment of pilonidal disease can be considered as one of the plastic procedures.

Literature sources:

Bascom JU (1987) Repeat pilonidal operations.  Am J Surg 154:118–122

Bascom J (2008) Surgical treatment of pilonidal  disease. BMJ 336:842–843

Bascom J, Bascom T (2007) Utility of the cleft lift  procedure in refractory pilonidal disease. Am J  Surg 193:606–609 (discussion 609)

Bascom J, Bascom T (2002) Failed pilonidal surgery: new paradigm and new operation leading  to cures. Arch Surg 137:1146–1150 (discussion  1151)

Karydakis GE (1992) Easy and successful treatment of pilonidal sinus after explanation of its  causative process. Aust N Z J Surg 62:385–389

Gendy AS, Glick RD et al (2011) A comparison of the cleft lift procedure vs wide excision and packing for the treatment of pilonidal disease in  adolescents. J Pediatr Surg 46:1256–1259

Morden P, Drongowski RA et al (2005) Comparison of Karydakis versus midline excision for treatment of pilonidal sinus disease. Pediatr Surg Int  21:793–796

Plastic closure according to Limberg

noreply@blogger.com (Unknown) — Thu, 15 Mar 2018 14:37:00 +0000

Limberg's technique dates back to the Soviet oral and maxillofacial surgeon Alexander Limberg, who began performing his surgical technique in the 1960s to treat soft tissue defects in the face. The technique was first used in 1986 in a patient with a pilonidal fistula.

In Limberg plastic surgery, the fistula system is cut out in the shape of a rhomboid and the defect is covered with an adjacent tissue flap, which is also mobilized in the shape of a rhomboid, thus closing the wound. As with the Karydakis and cleft-lift procedures, the gluteal fold is flattened, the sutures are located outside the fold.

Limberg´s technique

Limberg's technique is the best-analysed plastic surgical technique for the treatment of the pilonidal disease. Wound healing disorders are not uncommon in the original Limberg technique, which is why the procedure is nowadays usually performed in a slightly modified form, which has reduced the rate of healing disorders to 5 to 15%. The recurrence of pilonidal cyst and tailbone fistula is observed in about 6% of cases. The duration of incapacity to work is 1 to 3 weeks in most studies.

A major disadvantage of Limberg´s technique is the extensive permanent scarring, which more than 60% of patients in studies claim to be cosmetically disturbing. Here, the Karydakis technique performs much better.

Typical scar formation after Limberg´s technique

In practice, Limberg's technique can be used for the surgical treatment of pilonidal disease, as it has a relatively low recurrence rate (renewed fistula formation) and an acceptable frequency of wound healing disorders. It performs better than traditional fistula cutting techniques. However, there are no clear advantages over the Karydakis technique and the cleft-lift procedure according to Bascom.

Literature sources:

Chijiwa T, Suganuma T et al (2006) Pilonidal sinus  in Japan maritime self-defense force at Yokosuka.  Mil Med 171:650–652

Gwynn BR (1986) Use of the rhomboid flap in pilonidal sinus. Ann R Coll Surg Engl 68:40–41

Altinli E, Koksal N et al (2007) Impact of fibrin sealant on Limberg flap technique: results of a randomized controlled trial. Tech Coloproctol 11:22– 25

Cihan A, Mentes BB et al (2004) Modified Limberg flap reconstruction compares favourably  with primary repair for pilonidal sinus surgery.  ANZ J Surg 74:238–242

Hegele A, Strombach FJ et al (2003) Plastisch-chirurgisches Therapiekonzept des infizierten Sinus  pilonidalis. Chirurg 74:749–752

Jaschke CW, Mährlein R et al (2002) Ergebnisse der Behandlung des Sinus pilonidalis durch  Schwenklappenplastik nach Limberg. Zentralbl  Chir 127:712–715

Jonas J, Blaich S et al (2000) The Limberg transposition flap in surgical therapy of chronic pilonidal sinus. Zentralbl Chir 125:976–981

Müller K, Marti L et al (2011) Prospective analysis of cosmesis, morbidity, and patient satisfaction following Limberg flap for the treatment of  sacrococcygeal pilonidal sinus. Dis Colon Rectum  54:487–494

Ates M, Dirican A et al (2011) Short and longterm results of the Karydakis flap versus the Limberg flapfor treating pilonidal sinus disease: a prospective randomized study. Am J Surg  202:568–573

Karakayali F, Karagulle E et al (2009) Unroofing  and marsupialization vs. rhomboid excision and  Limberg flap in pilonidal disease: a prospective, randomized, clinical trial. Dis Colon Rectum  52:496–502

Cihan A, Ucan BH et al (2006) Superiority of  asymmetric modified Limberg flap for surgical  treatment of pilonidal disease. Dis Colon Rectum  49:244–249

Eryilmaz R, Sahin M et al (2003) Surgical treatment of sacrococcygeal pilonidal sinus with the  Limberg transposition flap. Surgery 134:745–749

Laser application in pilonidal disease

noreply@blogger.com (Unknown) — Wed, 14 Mar 2018 14:49:00 +0000

Laser applications in medicine are often regarded as particularly modern and advanced. With regard to the laser treatment of pilonidal disease, a differentiation must be made between 3 forms of application:

sole treatment of the tailbone fistula by laser
Laser application during a tailbone fistula surgery
postoperative hair removal to avoid a new fistula

Only a few publications on points 1 and 2 can be found in medical databases. If at all, these are personal experience reports with correspondingly small numbers of patients, which do not allow definitive statements to be made about the usefulness of laser application in the treatment of pilonidal disease. However, laser treatment is an advantage to prevent the recurrence of a fistula postoperatively by hair removal.

Literature sources:

Klin B, Heller ON et al (1990) The use of the CO2 laser in pilonidal sinus disease: preliminary results ofan ambulatory prospective study. J Clin  Laser Med Surg 8:31–37

Landa N, Aller O et al (2005) Successful treatment  of recurrent pilonidal sinus with laser epilation.  Dermatol Surg 31:726–728

Palesty JA, Zahir KS et al (2000) Nd: YAG laser surgery for the excision of pilonidal cysts: a comparison with traditional techniques. Lasers Surg Med  26:380–385

Yeo MS, Shim TW et al (2010) Simultaneous laser  depilation and perforator-based fasciocutaneous  limberg flap for pilonidal sinus reconstruction. J  Plast Reconstr Aesthet Surg 63:e798–e800

Recurrence prophylaxis - Preventing new tailbone fistula

noreply@blogger.com (Unknown) — Tue, 13 Mar 2018 15:10:00 +0000

Despite the multitude of surgical techniques for the treatment of the pilonidal disease, there is no procedure with which a recurrence of cysts and fistulas can be safely ruled out despite problem-free surgery and healing. If the fistula reappears, this is called a "recurrence", which should not be confused with a protracted, prolonged wound healing disorder after fistula surgery. A "real" recurrence occurs when new pits and complaints occur after the surgical wound has completely healed. According to long-term observations, fistula recurrence occurs in more than 20% of cases after initially successful surgery, almost 30% of which occurs more than 4 years after the first surgery.

Hair removal performed regularly (once a week) immediately before fistula surgery and during the healing phase has a positive effect on wound healing, especially after radical excision and open wound treatment.

However, so-called blade shaving (e.g. with a disposable razor) during wound healing and for subsequent prevention of recurrence is controversial. Hair removal takes place in an area of the body that is difficult to access and hair breaks and cuts are produced during shaving. During open wound healing, these can fall into the wound and lead to a foreign object irritation, which either hinders wound healing or leads to a later recurrence after healing. Also, with regular shaving after healing, it is hardly possible to safely remove all broken and cut hair from the bottom fold, which can also lead to recurrences.

Permanent depilation for recurrence prevention appears to be easier with depilatory creams or lasers. The disadvantage of the creams with the regular application is the change of the skin pH-value so that the healthy barrier function of the skin is disturbed. Regular use can also cause allergies. Laser depilation can be performed before, during or after fistula surgery.

Whether the risk of a fistula recurrence can actually be significantly reduced by hair removal is unclear according to current studies, but it appears to be advantageous.

Literature sources:

Doll D, Petersen S (2008) Recurrence and wound  healing disorders-two pairs of shoes. Am J Surg  195:556

Doll D (2013) 5- and 10-year recurrence rate is  the new gold standard in pilonidal sinus surgery  benchmarking. Med Princ Pract 19:216–217

Doll D, Friederichs J et al (2008) Time and rate of  sinus formation in pilonidal sinus disease. Int J  Colorectal Dis 23:359–364

Armstrong JH, Barcia PJ (1994) Pilonidal sinus disease. The conservative approach. Arch Surg  129:914–917 (discussion 917–919)

Kandamany N, Mahaffey PJ (2008) The importance of hair control and personal hygiene in preventingrecurrent pilonidal sinus disease. J Plast  Reconstr Aesthet Surg 61:986–987

Swinton NW, Wise RE (1955) The significance of epilation as an adjunct in the treatment of pilonidal sinus disease. Am J Surg 90:775–779

Petersen S, Wietelmann K et al (2009) Longtermeffects of postoperative razor epilation in pilonidal sinus disease. Dis Colon Rectum 52:131–134

Lindemayr H (1984) Eczema in hairdressers.  Derm Beruf Umwelt 32:5–13

Pilonidal cyst on the butt

Get rid of the pilonidal cyst!

Standard surgery - the big hole on the buttocks

Surgery of the pilonidal cyst as 70 years ago or rather minimally invasive?

Table of contents

Minimally invasive procedures

Traditional procedures

Plastic procedures

Updates

Pilonidal cyst – what is it?

Frequency of pilonidal cysts and tailbone fistulas

Causes of pilonidal cysts and tailbone fistulas

Acquired disease with a questionable genetic predisposition

Pilonidal cysts not only occur on the buttocks

Barber´s disease

Diseases that can appear like a pilonidal cyst or tailbone fistula

Symptoms of pilonidal disease

Asymptomatic pilonidal cyst

Chronic pilonidal disease

Acute Pilonidal disease

How is a pilonidal cyst diagnosed?

Stage-adapted treatment of the pilonidal disease

Asymptomatic form

Acute form (abscess)

Chronic pilonidal disease

Treatment methods for pilonidal cysts

Overview of the different treatment procedures

Minimally invasive procedures

Traditional procedures

Plastic procedures

Laser application

How is the quality of results measured?

Phenol injections according to Maurice and Greenwood

Proceeding according to Lord and Millar

Pit Picking according to Bascom (Bascom I)

Procedure according to Moshe Gips

Sinusectomy

Excision with open wound treatment

Excision, marsupialisation of wound edges and open wound treatment

Excision with primary midline suture

Plastic closure with Z-plastic

Plastic closure according to Karydakis

Cleft-lift procedure (Bascom II)

Plastic closure according to Limberg

Laser application in pilonidal disease

Recurrence prophylaxis - Preventing new tailbone fistula