PILONIDAL SINUS2.pptx

A pilonidal sinus is a small hole or tunnel in the skin at the top of the buttocks, where they divide (the cleft). It does not always cause symptoms and only needs to be treated if it becomes infected.

1. PILONIDAL SINUS - Dr Anil Chaudhary

2. PILONIDAL SINUS 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 OF PILONIDAL SINUS Sites Midline over the coccyx Umbilicus lnterdigital in barbers Risk factors Male gender (3 rd decade) Overweight Occupational: prolonged sitting Excessive body hair (Coarse or stiff hair) Previous injury in the area

4. CAUSES 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.

5. Signs and symptoms 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

6. On Examination 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.

7. Surgical Treatment 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

8. Open Method The wound is left open after excision followed by regular packing with iodine or eusol gauze pieces.

9. Closed Method 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.

10. Karydakis Surgery 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

11. Modified Karydakis Surgery Use of shallow cleft Causes less pain as presacral fascia not included

12. IN SUMMARY 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

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

14. Thankyou