Tuesday, January 8, 2013

Pilonidal sinus




  • It is of infective origin and occurs  in sacral region between the buttocks, umbilicus, axilla.
  • It is also common in hair dressers (seen in interdigital clefts), jeep drivers.
  • Common in third decade of life. It is common in males and mostly hairy males.
  • Most common site: Interbuttock sacral region



Pathology

  • The sinus extends into the subcutaneous planes as an infected track. There may be branching side channels.
  • Stratified Squamous epithelial lining of varying degree of integrity can be found in many cases.
  • Hair shafts are found lying loose in the sinus, embedded in granulation tissue or deep in mature scar tissue.
  • Foreign body giant cell maybe present.





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)
  • Tuft of hairs may be seen in the opening of the sinus.
  • Presentation may be as an acute exacerbation, or as a chronic one.

Treatment
  • Initially drainage of an abscess (acute phase), and later t/t for the sinus.
  • Definitive t/t is excision of all sinus tracks with removal of hairs and unhealthy granulation tissues under G/A (In Jack knife posotion)
  • Methylene blue is injected to demonstrate the branches of the sinus.
  • Secondary closure or delayed skin grafting is done or left to heal by granulation.
  • Recurrence rate is very high.
  • Bascom technique: Through lateral approach, sinus is reached and excised.

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