The History Of Pilonidal Sinus: What Is It? Refuted
Picture Your Pilonidal Sinus is a very frequent dermatological problem among the Spanish population (26 cases per 100,000 inhabitants) and it mainly affects young people of working age.
Its name can be confusing, but it is a “cyst that usually appears in the intergluteal fold, between the buttocks (at the level of the coccyx or rump), and that contains skin and hair follicles, that is, hair”, describes Eugenio Freire, general and digestive surgeon at the Medical-Surgical Center for Digestive Diseases (CMED). This is the most common area in which these lesions appear but they can also appear “in other parts of the body with abundant hair follicles such as the face or the interdigital folds,” adds the expert.
Hair on the body is one of the triggers for this injury and that is why the pilonidal sinus occurs mainly in “men between 15 and 30 years of age, with dark skin and abundant hair,” according to Freire, although it may also appear in women. Another risk factor is “having a family or personal history of Hidradenitis suppurativa”, according to Antonio Martorell, member of the Spanish Academy of Dermatology and Venereology (AEDV) and specialist in the Dermatology Service of the Hospital de Manises, in Valencia.
Those who have suffered from this problem know that it is not serious but it is very painful and annoying, especially due to the location of the injuries. As for the symptoms, “the pilonidal sinus manifests itself in the form of a lump or suppurative area, which occurs with episodes of inflammation and pain,” explains Martorell. “Redness of the skin, suppuration of pus or blood in an opening of the skin and unpleasant odor of the pus” are usually other signs of this dermatological ailment, as Freire indicates, who also adds that “there are cases in which patients may have a fever. ”
The problem with this cyst is that “the patient tends to suffer recurrent infections that are manifested by the appearance of an abscess in the area of existence,” says Manuel Argüello, head of the General Surgery and Digestive Diseases Service at the Sanitas La Moraleja University Hospital , in Madrid.
In this state of infection, treatment is exclusively surgical. In fact, “there are no effective non-invasive techniques to treat it,” clarifies Martorell. It is true that surgery is the only treatment option, but it is important to highlight that there are different types of more or less conservative surgeries. As Freire points out, “a more conservative alternative can be applied, but always bearing in mind that the risk of recurrence in these cases is greater”.
Small Changes That Will Have A Huge Impact On Your Pilonidal Sinus: What Is It?
This first treatment or drainage option “consists of opening the abscess, generally with local anesthesia, to drain the pus and allow the infection to heal,” Argüello describes, but with this “the total disappearance of the pilonidal sinus is not achieved, so with each new infection it can grow in size and complicate the injury, “he warns. Therefore, the best solution, from his point of view, is the total removal “that becomes more complex”.
This second surgical option involves “draining the wound, removing pus and cystic hair, and cutting the skin and tissue surrounding the wound,” Freire describes. In general, it is an intervention that “requires sedation and, depending on the size and depth of the sinus, the operation will last more or less, although approximately 45 minutes,” reports Martorell. “The larger the sinus, the wider the removed area and, therefore, its scar,” says Argüello.
It is important to bear in mind that, sometimes, “the sinus spreads through the fat of the rump, affecting a wide area, which requires large extensions of tissue to be resected,” reports the Sanitas expert. This, he adds, “usually occurs in patients who have had it for a long time who have had several attacks of infection.”
Once the sinus has been removed and depending on the extension, location and state of inflammation, “the reconstruction of the area will be chosen.” For this, according to Argüello, there are three techniques: primary closure, which consists of closing the wound completely; marsupialization or closure of the partial wound, and closure according to intention, that is, leaving the wound open completely.
One of the problems of the treatment of the pilonidal sinus is the post-surgery care, which will depend on the type of technique used. Since it is a delicate area (the coccyx) and that prevents lying or sitting, it is very common for the wound to take time to completely close, so the care will last for weeks or months. In addition, the location of the lesion complicates the care of the patient himself, who cannot see the area well and, in cases, cannot easily reach it to clean it.
As Martorell observes, “the postoperative period is a bit bothersome, given that in most cases the defect resulting from the removal will require closure by second intention, that is, the surgeon will leave the area unclosed with stitches so that the wound heal from the inside out. ” According to Freire, “the post-intervention care must be indicated in detail by the doctor at the time of hospital discharge.”
Depending on the type of reconstruction technique, the postoperative period will be different. Thus, “the closure by first intention will be the one with the most comfortable postoperative period,” says Argüello. Here “there are points on the inside and others on the outside (which are usually removed from the 12th postoperative day).”
In these cases, if there is no infection (which is relatively frequent), after removing the stitches, an aesthetic wound will remain, but with which you can carry out work and personal life in all aspects, after 15 days of the operation “, Argüello reports: here there is no need for special cures for the surgeon.
In the case of marsupialization, things change since, in this case, the wound is partially open, so “the complete healing period is usually extended to four weeks,” warns the Sanitas expert. During this time “the patient must go to the nursing consultation for cures and with a certain degree of priority to that of surgery” for surveillance. The wound in this case does have to be covered since it exudes and takes longer to recover (between 4 and 6 weeks).
The patient should know that the postoperative period is complicated in the case of surgery by intention. In these cases, “the wound must be closed completely before removing the dressing coverage and sometimes requires special dressings and antibiotics.” Both medications (pain relievers and antibiotics) and products (hydrogel / alginate dressings or petrolatum gauze) “will be prescribed by the surgeon depending on each patient,” says Martorell.
In principle, “the affected person will need daily cures using hydrocolloid dressings during the time the wound closes, which will range between 1 and 3 months,” says Martorell. The area should be washed with soap and water and “later antiseptic substances such as chlorhexidine will be recommended,” adds the AEDV expert.
On the question of whether it is better to leave the wound area outdoors or covered for a faster treatment, Martorell advises “always cover it with foam hydrocolloid patches and adhesives”, yes, “making the necessary daily changes”. As for whether or not patients can move or engage in physical activity, both experts advise against excessive physical effort during the healing phase of the sinus wound. Another tip from Freire is “do not subject the wound to immersion”, that is, he advises “avoid the bathtub or the pool until two weeks after the wound has healed”.
All these tips are fundamental for a successful wound healing but also to prevent it from reappearing, since, according to Freire, “after a wide and radical removal the recurrence rate in these patients can be 13%”. For this reason, among these care measures, another advice from experts is laser hair removal on the scar and margins of the intergluteal fold. This “can help to avoid the formation of new fistulizing processes in the problem area,” concludes Martorell.