Pilonidal sinus is an infection near the upper part of the natal cleft, commonly affecting males, particularly those who are overweight or have prolonged sitting jobs. Symptoms include pain, swelling, and foul smell, with potential complications like abscess formation. Treatment involves excision of the sinus, with options for open or closed wound management, and may lead to recurrence due to various factors such as overlooked diverticula or new hair entry.

1. - DrAnil Chaudhary

2.  Definition: Infection of the skin and
subcutaneous tissue at or near the upper part
of the natal cleft of the buttocks.
 The term pilonidal is derived from the
Latin pilus (hair) and nidus (nest)
 Jeep-bottom because it was very common
in jeep drivers.

3. SITES
 Midline over the coccyx
 Umbilicus
 lnterdigital in barbers
RISK FACTORS
 Male gender (3rd decade)
 Overweight
 Occupational: prolonged
sitting
 Excessive body hair (Coarse
or stiff hair)
 Previous injury in the area

5.  Hairs broken off by
vibration and friction tend
to accumulate in the nates.
Thus, it accumulates in the
gluteal cleft and enters the
opening of the
sudoriferous glands.
 Pointed end of the dead
hair is inside (blind end of
the sinus)
 The hair follicle is never
demonstrated in the wall
of the pilonidal sinus but
hair is the content of
pilonidal sinus.

6.  Low grade fever
 Swelling of cyst
 Pain during sitting or standing
 Soreness and reddish skin around the
depression
 Foul smell in the pocket
 Hair protruding from the affected area

7.  External opening of the sinus
seen just above the anal
verge in the midline over the
coccyx.
 These cavities will
often discharge serous
fluid and can periodically
become acutely infected to
form a pilonidal abscess
(when infected it can leak pus
blood and have a foul odour)
 A secondary opening may be
present on either side of the
midline often far out on the
buttocks or in the perineum.

8.  Inject methylene blue to
demonstrate branches
of the sinus followed by
excision of the sinus.
 The patient is
positioned prone with
buttocks elevated (Jack
knife position).
 After excision there are
two methods to treat the
wound -Open and
Closed methods

9.  The wound is left open
after excision followed
by regular packing
with iodine or eusol
gauze pieces.

10.  The wound is closed by
'z' plasty.This method
carries 10-20% chances
of recurrence.
 V-Y Advancement Flap
 Rhomboid flap
(Limberg flap) can be
raised to close the
defect also.

11.  Karydakis believed that hair insertion was the cause for
pilonidal sinus
 Low recurrence rates due to wound placed away from mid-
line
 Resulting new natal cleft was shallower
PROBLEMS:
 Sutures taken over the pre-sacral fascia cause pain

12.  Use of shallow cleft
 Causes less pain as
presacral fascia not
included

13.  Patients with acute pilonidal sinus – I & D
 Chronic pilonidal sinus – an excision of the
sinus and all tracts
 A primary closure is associated with faster
wound healing – however, a delayed closure
is associated with less recurrence
 Patients undergoing primary wound closure –
off midline closure recommended

14.  Recurrent pilonidal sinuses.
i. Diverticulum of main channel has been
overlooked at primary operation
ii. New hair may enter through the scar
iii. Tearing of scar resulting in the formed
crevice to get infected
iv. Very, very rarely carcinoma can arise in a
chronic pilonidal sinus.