True about pilonidal sinus is:
|A||Common in females|
|C||Treatment of choice is excision|
|D||Conservative treatment is preferred.|
a. Pilonidal infections and chronic pilonidal sinuses typically occur in the midline of the sacrococcygeal skin of young men.
b. Exact pathogenesis of pilonidal disease remains elusive and controversial. Hair seems to play a central role in the process of infection and in the perpetuation of granulation tissue in sinuses.
c. Clinical features: painful fluctuant abscess or a draining infected sinus.
d. Abscess can be drained in the office or emergency department using local anesthesia. Typically, the fluctuance extends to either side of the midline cleft, and incision and drainage down to the subcutaneous tissues off the midline provides for the best drainage and fastest healing.
e. For both abscesses and sinuses, hair should be removed from the wound, and local skin should be shaved weekly to prevent the reintroduction of hair.
f. Most other procedures described for pilonidal disease focus on off-midline procedures such as the Bascom or a plastic flap reconstruction like the Limbergor Karydakis.
g. The Bascom procedure involves the excision of the midline pits coupled with a lateral incision for off-midline drainage of the underlying abscess. With minimal postoperative care, these wounds heal in 4 weeks, and recurrence rates are as low as 10%.
h. The rhomboid excision and Limberg flap are one example of a flap technique for complete removal of the site of disease and subsequent primary tissue closure.
i. The disadvantage of the flap techniques include the complexity of the procedures; the necessity for inpatient hospitalization, typically less than a week; and the fact that recurrences can still occur in 5% of cases.