Management of sacrococcygeal pilonidal sinus disease

Abstract

The ideal treatment for patients who suffer from pilonidal sinus disease should lead to a cure with a rapid recovery period allowing a return to normal daily activities, with a low level of associated morbidity. A variety of different surgical techniques have been described for the primary treatment of pilonidal sinus disease and current practice remains variable and contentious. Whilst some management options have improved outcomes for some patients, the complications of surgery, particularly related to wound healing, often remain worse than the primary disease. This clinical review aims to provide an update on the management options to guide clinicians involved in the care of patients who suffer from sacrococcygeal pilonidal sinus disease.

Keywords: pilonidal abscess; pilonidal sinus; pilonidal sinus excision; pilonidal sinus surgery; wound healing.

Figure 1

Unhealed wound following midline primary closure

Figure 2

Schematic diagram of Bascom procedure. Pit‐picking excisions combined with a lateral abscess drainage incision

Figure 3

Schematic diagram of rotational flap. A full‐thickness (extending down to presacral fascia) rhomboid‐shaped flap that is rotated into the remaining defect

Figure 4

Healed rotational flap for chronic pilonidal sinus disease

Figure 5

Schematic diagram of advancement flap. An elliptical asymmetrical wide excision of the skin, abscess, and sinus, then mobilisation of the skin edge closest to the midline to create a flap, which is secured deep at the underlying sacrococcygeal fascia and superficially at the other skin edge, thus flattening the natal cleft and avoidance of midline incisions