Pilonidal disease

Abstract

Pilonidal disease is a common anorectal problem that typically affects young people. Numerous surgical procedures have been described, but treatment failure and disease recurrence are frequent, leading to considerable morbidity in these otherwise healthy patients. To manage this problem successfully, surgeons must consider the pathogenesis and presentation of the disease and weigh the advantages and disadvantages of any operation. Discussed in this article are the pathogenesis of pilonidal disease and basic treatment options for acute pilonidal abscesses, sinus tracts, and chronic or recurrent pilonidal disease.

Keywords: Pilonidal; pathogenesis; review; treatment.

Figure 1

Pathogenesis. Hair invading skin at the natal cleft causes a pilonidal abscess and sinus tracts. Figure used by permission of Mayo Foundation for Medical Education and Research. All rights reserved.

Figure 2

Incision and drainage. The incision should be made lateral to midline. Figure used by permission of Mayo Foundation for Medical Education and Research. All rights reserved.

Figure 3

Incision and drainage. Midline pits and sinus tracts are laid open toward the lateral incision, and the cavity is curetted. Figure used by permission of Mayo Foundation for Medical Education and Research. All rights reserved.

Figure 4

Marsupialization. The skin edge is sutured to the base of the wound. Figure used by permission of Mayo Foundation for Medical Education and Research. All rights reserved.

Figure 5

Karydakis procedure. (A) An asymmetric elliptical incision is carried down to the postsacral fascia. (B) The wound is undermined and (C) closed off midline. Figures used by permission of Mayo Foundation for Medical Education and Research. All rights reserved.

Figure 6

Cleft closure. (A) The line of contact between the buttocks is marked. (B) The buttocks are taped apart and an asymmetric elliptical incision is drawn around the unhealed midline wound. (C) The incision is carried into the subcutaneous fat to wedge out the unhealed wound. (D) A dermal flap is raised, undermining the skin to the marked line of contact. (E) The skin flap is closed over a suction drain. Figures used by permission of Mayo Foundation for Medical Education and Research. All rights reserved.

Figure 7

Negative pressure wound therapy. (A) Complex pilonidal disease. (B) Excision of all involved tissue. (C) Primary V.A.C. device placement. Figures used by permission of Mayo Foundation for Medical Education and Research. All rights reserved.