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PILONIDAL DISEASE    

Pilonidal disease is an infection in the crease of a person’s buttocks, from the bottom of the spine to the anus. Pilonidal disease can refer to a one-time cyst or a chronic condition. If not treated, chronic pilonidal disease can lead to abscesses and sinus cavities. It may need to be treated surgically.


PEOPLE PRONE FOR PILONIDAL DISEASE
- Three to four times more common in men than women.
- Common in people who are overweight, or those with coarse body hair.
- Occurs between the ages of puberty and 40, with the average age between 20 and 35.
- It is more common in people who sit often, such as truck drivers.

 
CAUSES OF PILONIDAL DISEASE
Caused by hairs becoming embedded into the skin. The ingrown hairs cause the body to react by forming a pit and causing inflammation. This can lead to a cyst, and possibly into an abscess (pockets of infection) or a sinus (a cavity underneath the skin).


SYMPTOMS
- Pain worse when you are sitting and putting pressure on your buttocks.
- Small dimple or large swollen mass in the area between your buttocks.
- Cloudy or bloody fluid draining from the affected area.

 








DIAGNOSIS
Made by physical examination.

HAIR REMOVAL STRATEGIES
Use of depilatory creams, laser or frequent shaving of the midline buttock region have all been shown to prevent recurrence of pilonidal sinus in those who have experienced a previous attack.

SURGERY FOR PILONIDAL SINUS
There are many operations for pilonidal sinus, indicating that none are 100% effective. Most have a success rate of greater than 90%, with wound breakdown occurring in up to 5-10% of cases.

MARSUPIALISATION
De-roof the cavity, clean it out of hairs, and suture the skin at the edges to the posterior cavity wall (called marsupialization), thus creating a superficial ulcer that heals over 6 weeks. This procedure has the advantage of needing relatively little time off work, but the disadvantage of taking more than 6-12 weeks to completely heal.

KARYDAKIS FLAP
Cutting the entire sinus out, and closing skin in such a manner, that the incision is off the midline.

LIMITED EXCISION WITH PRIMARY CLOSURE
Very small sinuses can be excised and closed primarily with small incisions and improved cosmesis.


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