For Medical professional

1. PILONIDAL SINUS
LT COL SM SHAHADAT HOSSAIN
MCPS,FCPS( Surgery),FCPS(Thoracic Surgery)
Adv Trg on Thoracoscopy,CNUH,South Korea

2. INTRODUCTION
Pilus—hair; Nidus—nest
 Pilonidal found in the natal cleft overlying the
coccyx.
 Consisting of one or more, usually non- infected,
midline openings.
 Which communicate with a fibrous track lined by
granulation tissue.
 Containing hair lying loosely within the lumen.

3. Aetiology
 Interdigital pilonidal sinus is an occupational
disease of hairdressers.
 Pilonidal sinuses also present in axilla and
umbilicus.
 Age 20 and 29 years.
 Hair follicles are absent in the walls of the sinus.
 Hairs projecting from the sinus are dead.
 Mostly affects men, in particular hairy men.
 Recurrence is common.

4. Pathology
Hair penetrates the skin
↓
Dermatitis
↓
Infection
↓
Pustule formation
↓
Sinus formation
↓
Hair gets sucked into the sinus by negative pressure
↓
Pus forms
↓
Multiple discharging sinus.
Primary sinus occurs in the midline. Secondary sinus occurs laterally.

5. Clinical features
 Discharge—either sero-sanguinous or purulent.
 Pain—throbbing and persistent type.
 A tender swelling seen just above the coccyx in
the midline (primary sinus); and on either sides
of the midline (secondary sinus).
 Tuft of hairs in the opening of the sinus.

6. TREATMENT
Conservative treatment:
• Cleaning out of the tracks and removal of all
hair.
• Regular shaving of the area.
• Strict hygiene.
Acute exacerbation (abscess):
 Abscess should be drained.
 Antibiotics.

7. Surgical treatment
Karydakis’s operation:

8. Options
Rhomboid-Limberg flap:

9. Recurrent pilonidal sinus
 Part of the sinus complex has been overlooked
at the primary operation.
 New hairs enter the skin or the scar.
 Persistence of a midline wound caused by
shearing forces and scarring.