1. By
MOHAMED TAG EL-DIN
Resident Physician at
General Surgery Department
Sohag Faculty of Medicine

2. Definition
 "pilonidal" is Latin for "nest of
hairs".
 A pilonidal sinus is a the
presence of one or more,
midline openings in the natal
cleft , which communicate
with a fibrous track lined by
granulation
tissue
and
containing loose hairs.

3. Etiology and pathology
 T h e e x a c t c a u s e u n c l e a r.
 Mo s t l y, l o o s e h a i r s p u s h i n g i n t o t h e s k i n .
 How … . ? s e ve ra l t h e o r i e s .

4. 1. Hair follicles
 pressure and friction on a hair follicle could somehow damage it,
causing a pilonidal sinus.
 If a hair follicle becomes blocked, it can become enlarged and
then burst.
 A broken hair may push into the skin, leading to an infection.
 This may explain why :
pilonidal sinuses are common around the buttocks, as sitting
and driving will cause pressure and friction on this area.
pilonidal sinuses were reported in the hands of hairdressers .

5. 2. Infection of the pilonidal sinus
 moist and warmth.
 If a broken hair pushes into the skin, the skin
becomes irritated, red and swollen.
 an abscess.

6. 3. Increased risk
Some things are known to increase your risk of pilonidal
sinuses, including:



obesity – having a body mass index (BMI) of 30 or
above
age – pilonidal sinuses can occur at any age, but are
more common in young adults between the ages of 20
and 40
body hair

7. 


having a deep cleft between
the buttocks
having a family history of
the condition
jobs that involve sitting
down or driving for long
periods

8. Clinical features
intermittent pain.
swelling and discharge at the base
of the spine.
Little or no constitutional
symptoms(??).
often a history of recurrent abscess
formation.
 Examination: a single or multiple
sinus openings in the midline.

9. Tr e a t m e n t

10. 1. If patients have no symptoms
 p e r s o n a l hyg i e n e
 c l e a r t h e a f fe c te d
a re a o f h a i r s ( by
s h av i n g, e tc )

11. 2. If patients have abscess or
infected sinus
Medical treatment is form of
antibiotics and painkillers.
Incision and drainage

12. 3. If patients have chronic symptoms
 I n m o s t c a s e s , a n o p e ra t i o n w i l l b e a d v i s e d .
 v a r i o u s o p e ra t i o n s a re av a i l a b l e .

13. A.Wide excision and healing by secondary
intention
Technique
Advantages
Disadvantages

14. B. Excision and primary closure
 Technique
 Advantages
 Disadvantages

15. A plastic surgery technique
(flap reconstruction)
 Advantages
 disadvantages

16. Technique

17. Technique

19. Aim of my research
 The aim of this prospective analytic
study is to compare between the
outcome of management of pilonidal
sinuses by primary excision versus
excision and reconstruction by flap in
terms of duration of hospital stay,
healing time, recurrence rate ,
postoperative complications and
period off work.

20. Methodology
 Study design: Prospective comparative study.
 Study Setting: Department of General Surgery,
Sohag University .
 Duration of Study: October 2013 to October 2014.
 Data analysis tool: SPSS 19 will be used for statistical
analysis. No test of significance was used; frequencies
were used to present the data.

21.  Data collection procedure: An informed consent
was taken with detailed explanation of all possible
treatment options available. Patients were briefed
about the purpose of study and after obtaining
informed consent they were included in the study. A
predesigned proforma was used to collect all study
variables (sinus in terms of duration of hospital stay,
healing time, recurrence rate, postoperative
complications and period off work.)

22. THANK YOU