Pilonidal sinus: Some basic information.

A pilonidal sinus is a common condition and usually affects people at the bottom of their spine just above the anus. The term comes from the latin pilo~, meaning hair and nidus~ meaning nest. A sinus is a track or tunnel. A pilonidal sinus is therefore a tunnel leading to a nest of hairs buried under the skin.

There is still much debate as to how the hairs get under the skin. One theory is that the hairs dig their way into the skin by rubbing and pressure and because of their shape (like a fir tree under the microscope) continue to move in one direction only - inwards.  The other theory is that the hair forming cells, form too deeply under the skin as an embryo, and eventually grow up from the deep layer of the skin, piercing the skin and letting in bacteria.

Either way, in so doing they take bacteria under the skin with them which eventually flares up into an abscess, a pilonidal abscess, which requires urgent surgical drainage, usually in hospital.

Once an abscess has formed one of two situations result. Complete healing or the formation of a sinus which does not heal and discharges continuously. Even if the abscess heals, it can form another abscess which is a sign that there are still numerous hairs trapped under the skin. The development of a sinus or recurrent abscesses usually indicates that the situation will not heal of its own accord and surgery is required.

Many internet searches will show that the most common operation for pilonidal sinus is excision with healing by packing and dressing. This requires daily dressings and about six to twelve weeks of healing. It can be three months until normal duties resume. The recurrence rate is very high as by the time healing has occurred more hairs have grown into the wound starting the whole process again. This type of surgery is outdated and no longer necessary.

Modern surgical approaches for pilonidal sinus allow for primary healing (by stitches) with over 95% healing fully at two weeks. The recurrence rate is in the order of only 2%. However, the surgery is complicated and highly specialised and it does require experience in this type of surgery to achieve these results. If you would like to know more about this type of surgery please contact Dr Gold for a more detailed explanation.

 

 

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