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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.

1 comment:

  1. I've had more than thirty of these things since I was sixteen years old, and I'm forty one now. The article says the recurrence rate is very high, I'm curious to know what is the largest recorded amount of recurrences?

    ReplyDelete

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