Pilonidal Sinus

Question 1

Define Pilonidal Sinus

Answer 1

Forceful insertion of hairs into the skin of the natal cleft in the sacra-coccygeal area, promoting a chronic inflammatory reaction to cause an epithialised sinus

i.e. abnormal epithelium-lined tract filled with hair that opens to the skin surface

Question 2

Aetiology of Pilonidal Sinus

Answer 2

Hair in the natal cleft
Acquired broke hair is driven into the skin of the natal cleft (intergluteal) by rolling action of the buttocks
This leads to a foreign body type reaction -> chronic inflammation -> mature sinus formation

Question 3

Risk factors for Pilonidal Sinus

Answer 3

Male
16-40
Family history
Stiff hair and hirsutism

Question 4

Symptoms of Pilonidal Sinus

Answer 4

Pain and welling, particularly on sitting
Skin maceration in the natal cleft
Discharge (often offensive + staining of underwear)
Fever

Question 5

Signs of Pilonidal Sinus

Answer 5

Sacrococcygeal sinus tracts (one or several tracts seen at or around the midline)

Question 6

Investigations for Pilonidal Sinus

Answer 6

Clinical diagnosis

Question 7

Management for asymptomatic Pilonidal Sinus

Answer 7

Hair removal (shaving, laser depilation)
\+ local hygiene

Question 8

Management for Symptomatic Pilonidal Sinus with and without abscess

Answer 8

Without abscess

1. Surgery (primary closure or healing by secondary intention) e.g. Karydaki’s technique, excission
2. Antibiotics
3. Hair removal via laser depilation

WIth abscess

1. Surgery - incision and drainage
2. Antibiotics
3. Analgesia

Question 9

Complications of Pilonidal Sinus

Answer 9

Suppurative post-op collection deep to sutures

Necrotising fasciitis