Surgery - Pilonidal Sinus
Introduction A pilonidal sinus, which translates to "nest of hair" from Latin, is an atypical hair-filled epithelium-lined tract that opens to the skin's surface. It is typically found in natal clefts. Etiology It is hypothesized that the source is sheared or shed hairs that pierce the skin, causing an inflammatory response and the formation of sinuses; the cycle is then continued by intermittent negative pressure, which draws in additional hair. Epidemiology Common, with a yearly incidence of 26 cases per 100,000, a male to female ratio, and a mean presentation age of 19 for women and 21 for males. Certain professions may predispose, such as hairdressers, to the development of interdigital pilonidal sinus, which is linked to hirsute persons. Known as "jeep bottom" because World War II soldiers experienced this illness. History a painful natal cleft, particularly if there is an infection that is overlaid or inflamed, and the patient may complain of swelling or discharge in addition. frequently a persistent issue. Examination There are midline pits or gaps between the buttocks where hairs may stick out. A sore swelling that may fluctuate or release pus or bloodstained fluid upon compression appears if there is an accompanying infection or abscess. Pits or secondary entrances are frequent. Pathogenesis Squamous epithelium lines the sinus tract, which extends into subcutaneous tissue over a variable distance and frequently has branching side channels. In the granulation tissue that is connected, hair shafts and foreign body giant cells are visible. Following the trail of germs, an abscess composed of pus, hair, and granulation tissue eventually forms along with inflammation. Investigations Not required for a diagnosis. Check glucose if the infection increased WCC (for diabetes). Management Acute pilonidal abscess: In order to remove pus and hair, an incision and drainage are typically necessary. If the abscess is minor, local anesthesia may be used. Up to secondary closure, the cavity is packed, irrigated, and has its dressings changed on a regular basis. Post-operative antibiotic cover is typically not required. Principles of treatment for chronic pilonidal sinus include excision of the sinus tract, skin healing, and recurrence prevention. Under general anesthesia, excision involves examination, laying open, and removal of tracts, which can be recognized by methylene blue staining. It is possible to split the fibrous tissue tracts that are joined to the sacrococcygeal bone.primary closure of the wound, either on or off the midline, or secondary goal of leaving the wound open and healing. Closed wounds heal faster overall, but there's a higher chance of recurrence. Injuries to the midline heal more quickly and are less likely to recur. Karydakis's procedure: The midline cleft is lateralized and flattened by asymmetric excision with a lateral closure. Bascom technique: evacuation of the chronic abscess cavity with lateral incision, leaving the lateral wound open, followed by the excision of midline pits and closure. Recurrence can be avoided by paying attention to local hygiene; shaving or depilation is crucial. Complications Infection, pain, abscess, and recurrence. Prognosis Perform well under proper supervision. Recurrent infections can be a problem associated with complicated diseases. typically goes away by the age of 40.
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