it is disease that occurs in human dye collection of hair in sinus at back

2. Pilonidal sinus
Lecture by
MAJ® DR. MUHAMMAD AFZAL CHAUDHARY
MBBS (Dow). FCPS.
Consultant Gen & Laparoscopic Surgeon

3. DEFINITION
Infection of the skin
and subcutaneous
tissue at or near the
upper part of the natal
cleft of the buttocks

4. History of pilonidal sinus
1833- Mayo. First time described hair
containing cyst.
1880- Hodge coined the term of “pilonidal”
19-20th century. congenital disease.
1940 Patey and Scarf. acquired disease. .

5. Epidemiology
• Incidence of this disease is 26 person per
100,00 people.
• Mean age is 19 years for women and 21 years
for men.
• M : F ratio 4:1
• Equal incidence of acute:chronic disease both
genders.

6. Pathogenesis
• infection of hair follicles in natal cleft area
occurs .
• Suction is created by buttock movements
which allows hairs to enter in sinus wound.

7. Risk factors
• Obesity.
• Local trauma or irritation .
• Sedentary lifestyle.
• prolonged sitting .
• Deep natal cleft .
• Family history .

8. Pathogenesis
• On sitting and bending natal cleft stretches in
causes breakage of swollen hair follicles and
formation hair pit.
• collection of debris occur in pit forming
pilonidal sinus ,later on converting into
abscess.

9. Clinical features
• In acute onset mild to severe pain on sitting
or bending.
• Intermittent purulent/bloody discharge from
sinus.
• Fever or malaise.

10. Clinical features
• PILONIDAL
ABSCESS
• Abscess
formation

11. DISCJHARGING SINUS
DISCHARE
FROM
SINUS

12. CLINICAL FEATURES
• sinus opening cephalad and lateral to cleft.
• One/more pits in the natal cleft.
• Tender mass or sinus draining mucoid/bloody
or purulent fluid.

13. DIAGNOSIS
• Finding a hole or sinus in the natal cleft is
diagnostic.
• Diagnosis is done purely done on clinical
examination.

14. DIFFERENTIAL DIAGNOSIS
• Perianal abscess or fistula .
• Hidradenitis suppurativa.
• Crohn’s disease.
• Skin carbuncle .
• Folliculitis .

15. TREATMENT FOR ACUTE PILONIDAL DISEASE
• Incision and drainage of abscess is performed lateral
to midline over area of maximum fluctuation.
• Packing of the wound after surgery.

16. Chronic or recurrent pilonidal disease
• Excision with primary closure.
• Excision with grafting.
• Sinus extraction.
• Sclerosing injections.

17. Treatment
Chronic pilonidal sinus
• Primary closure in midline or off midline.
• reconstruction can be done by
Z plasty.
V-Y advancement flap.
Rhomboid flap.

18. Chronic or recurrent pilonidal disease
• In Karydakis operation after excision of tracts
Flap is raised and wound is closed away from
midline using the flap.
• Technically demanding operation.
Merits
recurrence rates are low.
Demerits
• Back pain is more Common–requiring long
hospital stay.

19. Karydakis procedure

20. Bascom operation
• Used for shallow pit pilonidal disease.
• can be done under Local anesthesia.
• It less pain as presacral fascia not incl in
suturing.

21. Bascom operation

22. Postoperative treatment
• nil by mouth till full recovery from
anaesthesia.
• iv fluids.
• inj metronidazole and ceftriaxone.
• iv/im ketorolac and nalbuphine.
• nursing care.
• warm sitz bath from next day.

23. Post operative complications
Bleeding.
slow wound healing.
recurrence of disease .
Dehiscence of wound.
Reformation of abscess.
Backache.

24. conclusion
acute pilonidal sinus
• Patients with acute pilonidal sinus – I & D
chronic pilonidal sinus
• excision of the sinus and all tracts with primary
closure has faster wound healing.
• However delayed closure is associated with less
recurrence.