Role of Kshar-sutra in Pilonidal sinus
Dr. Praveen Kumar Choudhary
Deptt. of Shalya Tantra,
A & U Tibbia College, Delhi govt.
History of pilonidal sinus disease
Pilonidal sinus was first described by Hodges in
It is diagnosed by the finding of a characteristic
epithelial track (the sinus) situated in the skin of the
It generally contains hair hence named pilonidal
taken from the latin meaning ‘nest of hair’.
During the second world war the condition was
common among jeep drivers; therefore, named as
jeep driver’s disease.
What is Pilonidal sinus
Pilonidal sinus is a midline post anal sinus commonly
seen in young adults usually without any
communication with rectum and anal canal.
Pilus means hair, Nidus means nest, so Pilonidal
sinus means Nest with hair inside, where hair is
invaginated in subcutaneous tissue as a Bulbous
Diverticula with branching and bifurcating from side.
Pilonidal sinus is lined by squamous epithelium and
hair lies loose or embeded in the granulation tissue.
They are responsible for persistent infection and
sinus fails to heal.
Pilonidal sinus is common in the Gluteal cleft.
While sitting, the buttocks move and the hair is
broken off by friction.
The hair collects in gluteal cleft.
The hair penetrates the soft and moist skin of this
region. May enter in the open mouth of sudoriferous
It causes the pilonidal sinus. The hair tuft is present
in the sinus.
Hormones: At the onset of puberty sex
hormones increases the activity of
sebaceous glands of natal cleft.
Infection: Anaerobic infections predominates
on the aerobic infections.
Extension of Pilonidal Sinus
Pilonidal sinus extends into the
subcutaneous tissue from the surface of the
It ends blindly in the subcutaneous tissue
and doesn’t reach to the bone.
It contains hair, infected material, debris etc.
Sometimes it may extends into anus.
Mostly occurs in the persons having abundance of
hair in the buttocks.
There is a chronic sinus about the level of first
A tuft of hair is seen projecting from its mouth.
Blood stained foul discharge from the sinus.
Pain and tenderness. May have some secondary
openings on either side of the middle or a little away
from the main sinus.
Sinus have ramifications and sometimes midline pits
which are having hair follicles.
Recurrent infections causes pus discharge
and foul smell.
It is prone to recurrence after surgical
Rarely malignant changes may occur.
Antibiotics and anti-inflammatory drugs.
Maintenance of local hygiene such as
shaving, application of antiseptic lotion etc.
Injection of Phenol in almond oil caused
sclerosis of the sinus track. However
underlying pathology of impaction of hair
Incision and drainage.
Excision (wide) and healing by secondary
Excision and primary closure (recurrence
rates are high)
Excision with grafting (flap plasty)
Excision of sinus track
The outline of the sinus
cavity may be done.
tissue may be involved
The fibrous tissue is
removed and packing
of wound is done.
Extensive excision is
carried out. It takes
long time to heal.
The healing takes place
with the formation of
The picture is taken
four weeks after the
excision of the track.
Scar following surgery
The scar is extensive
after healing of the
The picture is taken
eight weeks after the
excision of the track.
Post operative wound infection
Early sign of wound infection includes
increased pain and an abnormal dark ‘beefy’
red appearance to the granulation tissue
which is friable, bleeds on contacts and
exhibits superficial bridging.
Usually due to failure to identify one
or more sinuses at incision and drainage.
Residual hair or debris.
Inadequate wound care.
Union of wound edges without healing from
Need For Alternative Treatment
To get rid of this troublesome disease as
patient’s socio-economic status is also
disturbed due to prolonged immobilisation
, there is a need of alternative treatment and
that is KSHAR SUTRA.
Certainly, Kshar sutra has got supremacy
over other treatments.
Kshar-sutra: Treatment of choice
Kshar-sutra (Alkaline thread) therapy is ideal
in the management of Pilonidal sinus.
It ensures complete healing without
It removes hair from the tract in subsequent
changing of the thread.
There is little discomfort to the patient.
There is a small scar left after the application.
Material and method: Patient selection
Patients were selected from the O.P.D. and I.P.D. of
the hospital in random manner.
Exclusion: Patients of D.M. and osteomyelitis of
coccyx/Sacrum. (We have not received such
Routine investigations were carried out like
hematological and Radiological.
Primary threading was performed under local
anaesthesia. Thread was changed on weekly basis
by railroad method.
Steps of threading
Since sinus has only one opening we have to
make second opening at its other end.
A probe is passed in the track.
Secondary opening is formed.
The track is threaded with a kshar-sutra.
Bandaging is performed.
Benefits of kshar-sutra
Minimum tissue loss in comparison to the
No bleeding, no hospital stay and no need to
put huge dressings.
Procedure takes not more than five minutes.
Minimum discomfort. Pain is very less.
Kshar-sutra is very good to treat sinus. It is also
better in terms of patients acceptibility as well as
The pain is very less during and after application.
Discharge was noticed to be reduced in early
U.C.T is more or less same.
Kshar-sutra is also very useful even in cases of
Our patients are more than satisfied with the
We have been receiving many patients by mouth to
It is concluded that kshar-sutra therapy is best mode
of treatment in pilonidal sinus.
Ramification: cause of reccurence in
Ramifications in the pilonidal sinuses are
comon causes of recurrence.
Such types of pilonidal sinuses should be
dealt with care and all ramifications should
be opened or cut with kshar sutra.
A case of recurrent pilonidal sinus
after three surgeries Treated by Kshar
sutra (Mr Verma from A.I.R)
A complex condition that causes both discomfort and
embarrassment to sufferers.
Causing Direct costs to healthcare system
Causing indirect cost through absence from work.
Kshar sutra is recommended for treatment in
Besides surgical technique, principles of wound care
including repeated depilation of the natal cleft,
removal of hair, any debris from wound bed, keeping
the wound edges separated using an appropriate
dressing are also essential.