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Pilonidal Sinus and Treatment (article 3/7) Have a comment or question? Submit it using the form below. There are many forms of treatment for pilonidal sinus disease and it can be overwhelming at first in understanding the differences between the types of surgery and procedures available, and what these differences will mean to you. This article aims to increase that understanding by providing practical information and advice that anyone considering pilonidal sinus treatment should know. It is important to start by saying that the decision of which treatment to choose will in nearly all cases be made by a medical professional. Your GP (General Practitioner) or surgeon may sometimes take into account certain factors relating to your lifestyle but the most influential factor will always be what has the most chances of success. Nevertheless, it is certainly still advantageous to learn more about what has been, or will be, performed. Before you are referred to hospital for treatment, whether it be your first operation or your tenth, you should be aware that it is up to you which hospital you want to go to. Normally you will be referred to your local hospital but, if for any reason you would prefer to have your surgery elsewhere, you can simply state your desired location. This applies to "emergency" referrals, such as if you have an abscess (or cyst) for example. If on the other hand you have the time to properly organise your surgery, you can often also choose who you would like to operate on you. In these cases, you should inform your GP of this preference as soon as possible as this process may take some time. Lancing One of the types of treatment available is called "lancing". This is a minor procedure which will normally be carried out by your GP. The procedure is used only for those with an abscess (red lump), and not for a sinus (narrow tunnel connecting the source of infection to the skin surface). Lancings are common in the USA but are seldom performed in the UK. One of the reasons for this is because they are not seen as being a permanent solution. Instead, they are often a temporary measure used to relieve immediate pain. This is because a lancing does not remove any of the diseased tissue underneath the skin surface. For this reason, the main infection will remain present, so a more traditional operation will be required at some stage to fully remove the infection. Some people having had a lancing have reported no problems since, so it is possible but not likely that the procedure can work in the long-term. So what does a lancing involve exactly? The abscess will first be treated with an antiseptic such as iodine. This will help combat any bacteria and reduce the risk of further infection. A small incision will then be made to puncture the abscess and thus allow the fluid within to escape. Where the incision was made, some packing will usually be inserted. This will need to be taken out either that same day or the day after. Depending on the extent of the incision, new packing may need to be re-inserted (after old packing is taken out) every day until the area heals. In most cases, providing there are no problems, healing will usually take around a week or two. Packing Packing is used following operations whenever an area has been "left open" to heal naturally, as opposed to it being stitched. Packing is an absorbent material which is inserted into where the incision is made. This serves three purposes: to debride the wound bed of dead tissue during healing, to absorb any exudate, and to keep the sides of the wound from touching and mending together. Two popular packing products are "Aquacel" and "Sorbsan". These are both available on prescription. A nurse will need to carry out the packing procedure each day until the area heals. Some surgeons like patients to pack wounds themselves but this can be difficult considering the location of the pilonidal sinus. Sometimes the packing can be dipped into betadine (antiseptic) to further help prevent infection. You will want to bathe or shower shortly before each re-packing takes place (be sure to dry the wound in between). Having the wound packed can be painful to begin with so it can be a good idea to take painkillers until the area starts to become less tender. As healing progresses, the amount of packing required will get smaller and smaller. As the wound begins to close, packing will usually stop due to the packing being too small to apply, and to let the area scab over. Rarely, packing will be advised against during healing. This is often a last resort when healing has stopped prematurely. By not packing the wound, there is an increased chance of infection, and bleeding will typically increase as there is no absorbent. Open Healing The most popular type of surgery available is called "wide excision and healing by secondary intention", otherwise known as "open healing". This is carried out under general anaesthetic. This operation is suitable for those with either an abscess or a sinus. For those with an abscess, similar to the lancing technique, the abscess will first be punctured to allow drainage. The difference being that the diseased tissue underneath will also be removed. For those with a sinus, the sinus will be cut out along with the surrounding infected tissue underneath the surface. In both cases, packing will be inserted which will need to be changed each day until healing occurs. The advantage of this type of operation is that a large amount of tissue can be removed, so there is more chance that any infection will be completely gone. A disadvantage of this operation is that, with the wound being left open to heal naturally, there is an increased chance of the area getting infected during healing. As such, it is vital to keep the area really clean and dry during this process. Providing there are no problems, healing will typically take around eight weeks. Closed Healing Another common type of surgery is called "excision and primary closure", or "closed healing". This is also carried out under general anaesthetic. This operation is not suitable for those with an abscess, but it is suitable for those with a sinus. Similar to the above procedure, the sinus and its surrounding tissue will be removed, except the area will be stitched together instead of being left open to heal naturally. This type of operation has less chance of success than the above. One of the reasons for this is, due to the need to stitch, not as much tissue can be removed so it is possible for infected tissue to still remain. One of the advantages of this operation is that, providing there are no problems, healing time is much shorter, typically lasting around two weeks. With these operations, it is very important to keep movement restricted following surgery because the stitching can easily "come apart". In fact, movement will need to be restricted for around four to six weeks following surgery. This differs to the above operation where movement is not restricted at all. In most cases, stitches will be dissolvable and will usually disappear in a week or two. With this type of operation, because the site is stitched together and infected tissue can still be present, it is possible that an abscess may form. This is because the infection will have nowhere to escape. With the open healing process, if infection occurs, abscesses are rare as a new sinus will often be able to form for infection to escape from. Plastic Surgery Sometimes the pilonidal sinus may be very troublesome and the above types of operations do not work. In these cases, a plastic surgery technique may be advised to remove the sinus, refashion the nearby skin, and stitch the site together. Options here include the Cleft Lift and the Z-plasty. Again, these operations are carried out under general anaesthetic. Often these operations involve moving the wound out of the midline so that they have a greater chance of healing. The midline can be a difficult healing environment due to the tension, debris and bacteria that the area receives but, with these operations, the wound can be better exposed to air and receive less strain. Considering these benefits, although these types of operations are usually reserved for more problematic cases, some people choose to have these as their first operation. It is important to note that not all surgeons are qualified in these types of operations. Also it is rare for them to be carried out where an abscess is present. Healing times are similar to that of "excision and primary closure". One of the disadvantages of having these types of operations is significant, permanent scarring. With the pilonidal sinus plastic surgery techniques and, to an extent, "excision and primary closure", certain risks need to be considered. There are possible complications such as flap necrosis (dead skin), and hematoma (blood collection) formations. Although such problems are rare, they should be taken into account before committing to having these types of surgery performed. Comments No comments yet. Add Comment