Pilonidal sinus diseases by Dr.K.AmrithaAnilkumar

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. e n love da Homoeopathy PILONIDAL SINUS/DISEASE (Jeep Bottom/ Driver’s Bottom)

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

3. 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.

4. It forms granuloma/unhealthy granulation tissue in the deeper plane. It is of infective origin and occurs in sacral region between the buttocks, umbilicus, axilla. It is common in hair dressers (seen in 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 hairs collected, acuteness of root end of hairs type of hair—tough/silky, shape of hair—straight/curled, scaliness of hair are the deciding features of hair. Cut hairs from above descend into cleft and stay there to get buried deep into pilonidal sinus. Depth, narrowness, friction movements in the natal cleft

6. soft/macerated skin 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 common in males and mostly affects hairy men . PATHOLOGY Hair penetrates the skin ↓ Dermatitis ↓ Infection ↓ Pustule formation ↓ Sinus formation ↓ Hair gets sucked into the sinus by negative pressure in the area

7. ↓ Further irritation and granulation tissue formation - Pus forms ↓ Multiple discharging sinus ↓ Primary sinus occurs in the midline. ↓ Secondary sinus occurs laterally ( paramedian ). 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)

8. Tuft of hairs may be seen in the opening of the sinus. Presentation may be as an acute exacerbation (abscess), or as a chronic one. It causes recurrent infection, abscess formation which bursts open forming recurrent sinus with pain, discharge and discomfort COMPLICATIONS Chronic pilonidal sinus can cause occasionally sacral osteomyelitis, necrotising fasciitis rarely meningitis. It is not a life-threatening condition but often it can be a morbid disease because of high recurrence rate.

9. TREATMENT In acute phase drainage of the abscess antibiotics later definitive treatment is undertaken Excision and skin grafting—has got high recurrence rate. Excision with Z plasty —good result. Excision with multiple Z plasty Karydakis excision through a semilateral incision and lateralised suturing of the wound away from the midline gives good V-Y gluteal advancement flap. Bascom technique of excision through lateral approach is a good method result

10. REFERENCE SRB's Manual of Surgery by Sriram Bhat M 2. A Manual on Clinical Surgery by Das 3. A C oncise textbook of Surgery by Das

11. A Special Thanks To A Very Special Doctor