Surgical treatment of pilonidal disease
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Surgical treatment of pilonidal disease
- 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
Notas del editor
- This may be caused by hair becoming trapped in moist, damaged skin between a hairdresser's fingers.During the Second World War, thousands of army jeep drivers developed pilonidal sinuses. The condition became so widespread that it was nicknamed "jeep seat", or "jeep disease".The fact that so many men doing the same sort of job developed pilonidal sinuses suggests that environmental factors must play a role in the development of the condition. These factors could include:wearing restrictive clothing, such as army uniformsrepetitive motion, such as bouncing around in the seat of a jeep
- which may be why more men are affected than women
- – more than one-third of people have a family member with the condition
- This operation involves cutting out (excision of) the sinus but also cutting out a wide margin of skin which surrounds the sinus. The wound is not closed but just left open to heal by natural healing processes (healing by 'secondary intention'). This usually requires several weeks of regular dressing changes until it heals fully. The advantage of this method is that all inflamed tissue is removed and the chance of the condition coming back (recurrence) is low
- This means taking out the section of skin which contains the sinus. This is done by cutting out an oval-shaped (ellipse) flap of skin either side of the sinus, which takes out the sinus, and stitching together the two sides of the ellipse. The advantage for this is, if successful, the wound heals quite quickly. The risk of a recurrence or of developing a wound infection after the operation is higher than the above procedure. This risk may be reduced by using a wound technique in which the line of stitches was moved away from between the buttocks
- In some cases, where the sinus is extensive or recurs, plastic surgery may be advised to remove the sinus and refashion the nearby skin(flap reconstruction)Too many of flaps can be done e.g. oval , rhomboid and many othersAdvantages of this method include low recurrence rate , rapid healing, short hospital stay time.