Pilonidal sinus is an abnormal tract under the skin in the natal cleft area, commonly caused by hair penetrating the skin and leading to infections. Surgical management is essential for recurrent cases, with procedures ranging from incision and drainage to more complex flap procedures like the Bascom cleft lift and Karydakis flap, aimed at removing the sinus tract and preventing recurrence. Postoperative care includes wound care, potential use of antibiotics, hair removal at the surgical site, and regular follow-ups to monitor healing.

1. PILONIDAL SINUS OR JEEP
DRIVERS DISEASE
SURGICAL MANAGEMENT
Sahil tariq
Intern GMC
Handwara
Department of
surgery

2. PILONIDAL SINUS IS A SMALL, ABNORMAL TUNNEL
OR TRACT THAT FORMS UNDER THE SKIN IN THE
NATAL CLEFT (THE AREA BETWEEN THE BUTTOCKS).
IT OFTEN CONTAINS HAIR, DEBRIS, AND CAN
BECOME INFECTED, LEADING TO PAIN, SWELLING,
AND DISCHARGE OF PUS OR BLOOD.
MC SITE : NATAL CLEFT ,ALSO SEEN IN
INTERDIGITAL AREAS OF BARABERS

3. ETIOLOGY:THOUGHT TO BE CAUSED BY HAIR
PENETRATING THE SKIN, LEADING TO A FOREIGN
BODY REACTION. DUE TO FRICTION THERE IS INWARD
GROWTH OF HAIR WHICH LEADS TO THE FORMATION
OF ABSCESS
AND SINUS
Pilonidal sinus most commonly
presents as a discharging and
intermittently painful
sinus in the sacrococcygeal
region
Diagnosis is typically based on a
physical examination. In some
cases, imaging studies like
ultrasound or MRI may be used to
evaluate the extent of the sinus.

4. SURGICAL MANAGEMENT
• Surgical management of a pilonidal sinus is a critical aspect of treatment,
especially for recurrent or complex cases. The main goal is to remove the
sinus tract(s), prevent recurrence, and promote healing
1. Incision and Drainage
Indication: Primarily used in the acute setting for
infected pilonidal abscesses.Procedure: A
small
incision is made over the abscess to allow pus and
infected material to drain out. The cavity is then
cleaned, and a drain may be placed to
prevent re- accumulation.
2. Excision and Healing by Secondary Intention
Procedure: Complete excision of the sinus tract
and surrounding tissue, leaving the wound
open
to heal from the base upwards.
3. Excision with Primary
ClosureProcedure: The sinus
tract is excised, and the wound
is closed primarily with sutures.

5. . FLAP PROCEDURES THESE ARE MORE COMPLEX SURGICAL OPTIONS, OFTEN
USED FOR RECURRENT OR COMPLICATED CASES
* BASCOM CLEFT LIFT:
PROCEDURE: THE SINUS TRACT IS EXCISED, AND THE CLEFT IS FLATTENED BY
LIFTING AND REATTACHING THE SKIN
ADVANTAGES: LOW RECURRENCE RATES AND RELATIVELY QUICK
RECOVERY.
DISADVANTAGES: REQUIRES MORE SURGICAL EXPERTISE.
* KARYDAKIS FLAP:PROCEDURE: A LARGE ELLIPTICAL INCISION IS MADE TO
EXCISE THE SINUS, AND THE WOUND IS CLOSED WITH A LATERAL FLAP
TO SHIFT THE MIDLINE.
ADVANTAGES: LOW RECURRENCE RATES.
DISADVANTAGES: COSMETIC ISSUES DUE TO THE LATERAL SCAR.

6. LIMBERG FLAP:PROCEDURE: A RHOMBOID-SHAPED FLAP OF
SKIN IS ROTATED TO COVER THE DEFECT AFTER EXCISION.
ADVANTAGES: LOW RECURRENCE RATES, DURABLE
RESULTS.
DISADVANTAGES: MORE COMPLEX SURGERY WITH
POTENTIAL FOR WOUND
COMPLICATIONS.
. Postoperative CareWound Care: Daily dressings,
maintaining cleanliness, and monitoring for signs of
infection.
Antibiotics: If infection is suspected, antibiotics may be
prescribed.
Hair Removal: Regular hair removal around the
surgical site to prevent recurrence.
Follow-up: Regular follow-up to monitor healing and
detect any early signs of recurrence.