A pilonidal sinus is a small hole or “tunnel” in the skin. It usually develops at the top of the cleft of the buttocks, where the buttocks separate. Most people associate the word sinus with the nose, but sinuses can occur anywhere in the body. Sinus is simply a medical term for channel or cavity.
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Usual symptoms and signs are:
- redness of the skin
- blood draining from the sinus
- pus draining from the sinus (the pus usually smells unpleasant)
Pilonidal sinus surgery involves cutting into the abscess to allow it to drain and removing the sinus altogether once the inflammation goes down. In this procedure the abscess and sinuses are completely removed. The resulting wound is left open to heal and fill in naturally from the bottom. This technique is typical for cavity wounds as it allows the body to replace the removed tissue. This is the slowest form of healing (8 weeks) but has a lower rate of infection and recurrence (5-15%) compared to traditional closed wound healing. During healing the wound is normally cleaned out and re-packed with gauze at least twice daily. Some surgeons do not believe in packing – as long as the wound bed is flushed with water twice daily we support this technique as well. The important part is to remove the by-products of healing from the wound bed to keep the healing area as clean as possible, “packing” is simply one method of doing this.
Risks involved in pilonidal sinus excision are:
- Stiff or coarse hair
- Inactive lifestyle
- Excess body hair
- Occupation or sports requiring prolonged sitting
- Poor hygiene
- Excess sweating
Your surgeon will usually advise that the wound should be kept clean and any hair growing near to the wound be shaved or removed by other means. Some surgeons recommend that, even when the wound is healed, you should keep the area free of hair growing by shaving every few weeks, or by other methods to remove the hair. This reduces the chance or a recurrence of the problem.