PILONIDAL SINUS/DISEASE (Jeep Bottom; Driver’s Bottom) Pilus—hair; Nidus—nest It is epithelium lined tract, situated short distance behind the anus, containing hairs and unhealthy diseased granulation tissue. It is due to penetration of hairs through the skin into subcutaneous tissue.

1. en love da Homoeopathy
PILONIDAL
SINUS/DISEASE
(Jeep Bottom/
Driver’s Bottom)

2. PILONIDAL
SINUS/DISEASE
(Jeep Bottom/
Driver’s Bottom)

3. PILONIDALSINUS/DISEASE
(JeepBottom; Driver’s Bottom)
• Pilus—hair; Nidus—nest
• It is epitheliumlined tract,
situatedshort distance
behindthe anus, containing
hairsand unhealthy
diseasedgranulationtissue.
• It is due to penetrationof
hairsthroughthe skininto
subcutaneous tissue.

4. • It forms
granuloma/unhealthy
granulation tissue in the
deeper plane.
• It is of infective origin and
occurs in sacral region
betweenthe buttocks,
umbilicus, axilla.
• It is common in hair dressers
(seenin interdigital clefts),
jeep drivers.

5. CAUSES
• Types of hair (H)
• force of hair insertion
into subcutaneous tissue
(F)
• vulnerability of the skin
(V)
are the three factors that
cause pilonidal sinus.
• Number of hairscollected,
acuteness of root end of
hairs
• type of hair—
tough/silky, shape of
hair—straight/curled,
scalinessof hair are the
deciding features of hair.
• Cut hairs fromabove
descendinto cleft and
stay there to get buried
deep into pilonidal sinus.
• Depth, narrowness,
friction movements in the
natal cleft

6. • soft/maceratedskin with
erosions, splits, wide skin
pores, wounds, presence of
moisture and sweat are
other factors.
INCIDENCE
• It is common in 20–30
years of age.
• It is commonin males and
mostlyaffects hairy men
.
PATHOLOGY
Hair penetrates the skin
↓
Dermatitis
↓
Infection
↓
Pustule formation
↓
Sinus formation
↓
Hair gets suckedinto the sinus
by negative pressure in the
area

7. ↓
Further irritationand
granulation tissue formation-
Pus forms
↓
Multiple discharging sinus
↓
Primary sinus occurs in the
midline.
↓
Secondarysinus occurs laterally
(paramedian).
CLINICALFEATURES
• Discharge—either sero
sanguinous or purulent.
• Pain—throbbing and
persistent type.
• A tender swelling seen
just abovethe coccyx in
the midline (primary
sinus)
• and on either sides of
the midline (secondary
sinus)

8. • Tuft of hairs may be seenin
theopening of the sinus.
• Presentation may be as an
acuteexacerbation
(abscess), or as a chronic
one.
• It causes recurrent
infection, abscessformation
whichbursts open forming
recurrent sinus withpain,
discharge and discomfort
COMPLICATIONS
• Chronic pilonidal sinus
can cause occasionally
• sacral
osteomyelitis,
• necrotising
fasciitis
• rarely meningitis.
• It is not a life-threatening
conditionbut oftenit can
be a morbiddisease
becauseof high recurrence
rate.

9. TREATMENT
In acutephase
• drainage of the abscess
• antibiotics
• later definitive treatmentis
undertaken
• Excision and skin
grafting—has got high
recurrence rate.
• Excision with Z plasty—
good result.
• Excision with multiple Z
plasty
• Karydakis excisionthrough
a semilateral incision and
lateralised suturing of the
wound away fromthe
midline gives good V-Y
gluteal advancement flap.
• Bascomtechnique of
excision through lateral
approachis a good method
result

10. REFERENCE
1. SRB's Manual of Surgery
by SriramBhat M
2. A Manual on Clinical
Surgeryby Das
3. A Concise textbookof
Surgeryby Das

11. A
Special Thanks
To A Very
Special Doctor