A pilonidal sinus (PNS) is a small cyst or abscess that occurs in the cleft at the top of the buttocks over the sacral bone. It causes severe pain and often gets infected. If it got infected, you may find some pus and blood and emit a foul smell.

What are the reasons for pilonidal problem?

Though the exact cause is not known, it can be be a combination of:

  • Harmonic problems(frequent problem after teenager ages)
  • hairs on that area
  • friction
  • (by the time pilonidal sinus gets infected …)

Symptoms and signs of disease and infection as complication

You may not have symptoms at first other than a small, dimple-like depression on the skin. Occasionally it contains visible hair .

Symptoms of infection :

  • pain
  • swelling of skin
  • skin changes on the affected area
  • pus or blood from the abscess, with a foul smell
  • formation of more than one sinus tract
  • low-grade fever

What is the newest surgical solution for pilonidal sinus?Concept of treatment.

Conservative Treatment:

In case of serious or mild infection we should use for couple of days or weeks.

It includes I+D for small abscesses and antibiotics for treatment of acute infection. Once pilonidal sinus diagnosed the surgical plan should be placed. We do surgical intervention once infection has settled.

In terms of surgical solutions we have two different way of treatment:

Old fashioned way is sure surgical removal of infected cyst and sinuses, tracts from skin and subcutaneous area. Overall we have to refresh the pilonidal sinus area by surgical excision.

Once the bad unhealthy tissue was removed we have two options :

-leaving open (means surgical wound , cavity will be healed by itself by granulation in two –three month). In this case patient needs daily dressings during this period.

-closure of skin and deeper structures with sutures, plastic surgery solutions with flapping technique.(this way of closure takes relatively higher risk of having infectious complications.)when this surgical wound gets infected should be opened and treated as open wound management) infection rate can reach 45 %.

Newest endoscopic technique:

Phenol Injection

This new endoscopic method gives a chance on minimal invasive treatment of fistula without extensive tissue damage and quick wound healing, without post operative high grade pain. After this type of surgery patients dont require many post operative dressing also.

In terms of cosmetic result a lot better than open surgeries. Much less scar.

Advantages of VAFT(endoscopic pilonidal sinus treatment)

-quick recovery period(two weeks only)

-less pain after surgery

-change of dressings not required many times for couple of month

-better cosmetic result, preferable for female patients.

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