Pilonidal sinus

Pilonidal Sinus

A pilonidal sinus is a small tract or cavity that forms under the skin near the tailbone, usually containing hair, debris, or fluid. 
It commonly occurs in young adults and may present as pain, swelling, or repeated discharge in the buttock crease.

Causes

• Ingrown hair
• Prolonged sitting
• Friction and sweating
• Deep natal cleft anatomy
• Previous skin infection

Symptoms

1. Pain near the tailbone
2. Swelling or a tender lump
3. Pus or blood discharge
4. Bad smell from the wound
5. Recurrent infections or abscess formation

When to Seek Medical Help

1. Increase in pain
2. Recurrent swelling
3. Continuous discharge
4. Fever or spreading redness
5. Difficulty sitting or walking

Diagnosis

• Clinical examination
• Assessment of sinus openings
• Evaluation for abscess formation
• Ultrasound

Treatment Options

1. Incision and drainage for abscess
2. Minimally invasive procedures (pit picking)
3. Laser ablation of sinus tracts
4. Excision with open healing
5. Excision with flap procedures (Karydakis, Limberg flap)

How Is the Surgery Done

The procedure depends on the severity and number of sinus tracts. Minor cases can be treated with minimally invasive techniques by removing hair and cleaning the tracts. 
Advanced or recurrent disease may require surgical excision of the sinus along with surrounding infected tissue. 
In some cases, flap reconstruction is performed to flatten the cleft and prevent recurrence. 
The procedure is usually done under spinal or general anaesthesia, and most patients can return home the same day.

Recovery

• Return to routine activities in 3–5 days (minimally invasive)
• Wound healing time varies depending on method
• Avoid prolonged sitting initially
• Maintain hygiene and hair removal in the area
• Regular follow-up to prevent recurrence