Interdigital pilonidal sinus in a dog groomer

Pilonidal sinus is an acquired condition that usually develops in the sacrococcygeal area or other hair-bearing areas. It has also been described as an occupational disease, especially when present interdigitally. We describe the case of a 47-year-old dog groomer with interdigital pilonidal sinus and briefly review the postulated pathogenesis, clinical characteristics, differential diagnosis, and treatment.

Lack of evidence that obesity is a cause of pilonidal sinus disease

OBJECTIVE

To find out whether pilonidal sinus is more common among obese people.

DESIGN

Retrospective study from hospital records.

SETTING

Two university hospitals, Turkey.

SUBJECTS

419 patients who were operated on for pilonidal sinus disease; and 213 age and sex matched patients with benign diseases other than pilonidal sinus disease and who were not morbidly obese acted as controls.

MAIN OUTCOME MEASURES

Comparison of body mass index (BMI) in the two groups.

RESULTS

Patients with BMI of 25-30 were classified as overweight (61/419, 15% compared with 28/213, 13%), and those with BMI of 30 or more as obese (7/419 compared with 4/213, 2% in each group). Mean (SD) BMI of patients with pilonidal sinus disease was 26.0 (3.9) compared with 25.6 (3.9) in the control group (p = 0.4).

CONCLUSION

Obesity alone is not an important factor in the aetiology of pilonidal sinus disease.

Subungual pilonidal sinus of the hand in a dog groomer

Interdigital pilonidal sinus of the hand is an occupational hazard in barbers, sheep shearers and cow milkers. We present a case of a subungual pilonidal sinus of the thumb of a dog groomer, complicated by the development of osteomyelitis in the distal phalanx.

Interdigital pilonidal sinus in the hand

We report three cases of interdigital pilonidal sinus including a case of a woman with this condition. Previous reports that surgical excision is curative in all cases are not supported by our experience.

Pilonidal cyst: cause and treatment

PURPOSE

The treatment of sacrococcygeal pilonidal cyst, despite being considered a well-defined clinical entity and opinion as to its acquired origin being almost unanimous, has some controversial aspects. Surgery is the principal method of treatment, and several techniques have been proposed. All of them try to reduce morbidity, to offer conditions of fast cicatrization, to have a low recurrence rate, and to offer cure. This study was undertaken to review the available data in the literature about the cause of the disease and to determine the current optimal method of treatment, evaluating morbidity, healing, recurrence, and cure.

METHODS

Data available on the topic of pilonidal cyst in the English-language literature were obtained from Index Medicus and MEDLINE and were reviewed and analyzed.

RESULTS

There is nearly a consensus that pilonidal cyst is acquired, hair being the agent that causes the disease. Presently, the most-used surgical procedure is excision of the cyst, with open or closed wound for healing. However, many authors prefer to use the method of incision and curettage. New surgical techniques are being proposed.

CONCLUSION

The majority of authors conclude that sacrococcygeal pilonidal cyst is an acquired disease, although a minority believe it is congenital. Although excision is the method of choice for most surgeons, in our experience the incision and curettage procedure is the best surgical treatment with regard to morbidity, healing, recurrence, and cure of the disease.

Simple and effective surgical treatment of pilonidal sinus: asymmetric excision and primary closure using suction drain and subcuticular skin closure

PURPOSE

This study was planned to evaluate prospectively the results of 112 pilonidal sinus cases treated surgically by using asymmetric excision and primary closure with suction drain and subcuticular skin closure. It is aimed at elimination of the causative factors of pilonidal sinus.

METHOD

The patient's age, profession, weight and height, symptoms and signs, duration of symptoms, previous treatments, operation time and cost, hospital stay, return to normal activity, complications, pathologic and microbiologic examinations, and recurrences were noted. All pilonidal sinus cases except pilonidal abscess and extensive gluteal involvement were treated surgically. The procedure consists of an eccentric, elliptical excision of the affected tissue, mobilization of the flap to the sacrococcygeal fascia and the suturing of its edge to the lateral one. Penrose drains were placed in the first eight (7.14 percent) cases, but suction drains were placed in others. The cases were followed up for a mean of 2.4 years.

RESULTS

Twenty-eight (25 percent) cases had undergone previous operative procedures. Of 112 patients 106 (94.6 percent) were male. Mean age was 22.1 years. Mean history of disease was 4.2 years. The overall complication rate was 7.14 percent. Two (1.8 percent) wound infections, two wound breakdowns, three (2.7 percent) collections, and one (0.9 percent) recurrence were recorded. The collections were reduced to zero after first eight cases by using a suction drain. Sixty-eight of the patients (60.7 percent) had body weight over 90 kg, and the mean body mass index was 24.8. The mean hospital stay was 2.6 days, and the mean time off work was 12.4 days. The average healing time was 13.2 days. There were no anesthetic or surgical deaths.

CONCLUSION

The natal cleft is flattened and the incision scar and the incision line is transferred from the midline to the lateral side by performing the asymmetric excision and primary closure, and thus the essential cause of pilonidal sinus is eliminated. The procedure is simple, the complications and recurrences are very low, and it is seen to be an excellent procedure in the surgical treatment of uncomplicated pilonidal sinus disease.

Pilonidal cyst on the vault. Case report

Pilonidal cysts and sinuses are described as dermoid cysts which contain follicles of hairs and sebaceous glands. They clinically present as a classic case of inflammation which comes with pain, local infection and redness. The origin of pilonidal disease remains controverse. There are many hypothesis as lack of hygiene on the affected area and a penetration and growth of a hair in the subcutaneous tissue caused by constant friction or direct trauma on the damaged area. The option for clinical treatment is very frequent. However, taking into consideration the incidence and the possibility of recidive, surgical treatment is presently recommended. Complications include cellulitis and abscess formation. Pilonidal cysts are mostly found on the sacral region. In the literature is found description of pilonidal cysts on the penis, interdigital region on the hands as well as on the cervical region. We present a case of pilonidal cyst located on the vault biparietal region, without malignant degeneration.

The aetiology and management of pilonidal sinus

Although there are various treatment regimens and dressing techniques for the management of pilonidal disease, we recommend the 'open' technique for patients with an uncomplicated sinus. Patients with more complex sinuses or recurrent pilonidal disease should be treated by plastic surgeons.

Incidence and aetiological factors in pilonidal sinus among Turkish soldiers

OBJECTIVE

To study the incidence and causes of pilonidal sinus in Turkish soldiers.

DESIGN

Open study by questionnaire.

SETTING

Military and University hospitals, Turkey.

SUBJECTS

1000 soldiers who presented for their first medical examination.

MAIN OUTCOME MEASURES

Correlation between factors known to be associated with pilonidal sinus, and incidence of pilonidal sinus.

RESULTS

88/1000 soldiers had pilonidal sinuses; in 48 they were symptomatic and in 40 asymptomatic. The factors associated with the presence of a pilonidal sinus were: family history of pilonidal sinus (18/88 compared with 32/912, p < 0.0001); obesity defined as weight over 90 kg (34/88 compared with 32/912, p < 0.0001); being the driver of a vehicle (58/88 compared with 308/912, p < 0.0001); and the incidence of folliculitis or a furuncle at another site on the body (22/88 compared with 64/912, p < 0.0001).

CONCLUSIONS

Pilonidal sinus is an acquired condition, penetration of hair is the main cause, and the disease can be prevented if the aetiological factors are understood.

[Sacrococcygeal cyst or "pilonidal sinus"]

The acquired theory of puncture of hairs on the side of natal cleft is popular. There is still controversy on "pilonidal sinus" surgical treatment. A modification in the natal cleft cicatrization should be the correct surgical therapy. Postoperative treatment as hairs removal, infection control, wound healing are mandatory.

Pilonidal sinus: management objectives

In spite of a number of ingenious operative and non-operative techniques in the management of pilonidal sinus no single technique can be relied upon to prevent recurrence of this benign yet troublesome condition. Once thought to be a congenital condition it is now appreciated that pilonidal sinus most often an acquired condition due to accumulation of tough, bristly hair penetrating the skin, or local hair growing into a skin crevice, pit or abnormal follicle. The most common site is the upper natal cleft but the condition may occur in other sites especially where there is a crevice or irregularity of skin surface with pressure or suction applied to that region. Most surgical procedures have been designed to eradicate the existing sinus and the crevice in which hair tends to accumulate. However, without the presence of hair there can be no pilonidal sinus and, in the past, little attention has been given to preventing the re-accumulation of hair in the troublesome site; hence the risk of recurrence. Management objectives should be directed not only at eradicating the obvious lesion present but also to preventing recurrence of aetiological factors; especially the re-accumulation or re-growth of hair.

[Therapy of pilonidal sinus with the Limberg transposition flap]

Pilonidal sinus can not be mentioned as a minor surgery procedure because of high recurrence rate, high morbidity and long disability period. In our clinic between the years of 1988-1991, 92 pilonidal sinus cases were treated primarily with Limberg's flap technique. Only in two cases, late wound healing was detected, no other complications and no recurrences were seen. Compared with other primary treatment methods, Limberg's flap technique was observed to be much more convenient for pilonidal sinus cases.

[Retrospective study 10 years after plastic surgery for sacrococcygeal pilonidal sinus]

The authors give a brief summary on the etiology and pathomechanism of the sacrococcygeal pilonidal sinus. They have distinguished the congenital, cystic deformation (dermoid cyst) from the pilonidal sinus which is considered to be an adventitious illness. During ten years (1976-1985) 208 patients were operated on with the method the authors applied. Only one early recurrence was registered and 7.2% of the patients recovered from secondary healing. Delayed recurrences were analysed according to questionnaires. From 151 of the questionnaires only three male patients complaints referred to delayed recurrence.

[Pilonidal sinus]

Pilonidal sinus, acute or chronic suppuration of the sacrococcygeal region, is a common benign disease. Its treatment, usually surgical, remains controversial, between wide excision and limited excision and between primary closure and secondary closure. On the basis of our experience and a review of the literature, we propose limited excision with immediate closure for non-infected operations and exposure with immediate resection for pilonidal abscesses. Regardless of the technique used, the morbidity is high, associated with a recurrence rate of between 5 and 40%.

Patient characteristics and symptoms in chronic pilonidal sinus disease

Three hundred and twenty two patients with pilonidal sinus disease were studied to determine factors for the development and maintenance of the disease. A calculated incidence of the disease of 26 per 100,000 inhabitants was found. It occurred 2.2 times more often in men than in women. Age at presentation was 21 years for men and 19 for women. Patients had two years (median) disease history before being referred for treatment. A family history could be found in 38% of the patients. 50% had normal body weight, and 37% were overweight. Local trauma or irritation preceded the condition in 34%, and a sedentary occupation was reported by 44%. Male sex, adolescence or youth, and a familial disposition seem to be associated with the development of pilonidal sinus. Local trauma and overweight are the most important conditioning factors for development of symptomatic pilonidal sinus disease.

[The umbilical pilonidal cyst: a case report. Comments on its etiopathogenesis and treatment]

A rare case of umbilical pilonidal sinus is reported. Epidemiology and symptoms of this disease are analyzed and possible mechanisms of formation are discussed. Clinical as well as pathological patterns observed seem to support the hypothesis of a congenital etiopathogenesis. Total omphalectomy is proposed as definitive treatment in order to avoid recurrences.

Easy and successful treatment of pilonidal sinus after explanation of its causative process

Hair insertion causes pilonidal sinus, it prevents spontaneous recovery, delays healing of any wound in the depth of the natal cleft, and is the cause of recurrence. An understanding of the hair insertion process made it possible to avoid hair insertion in 6545 cases of the condition with the use of the advancing flap operation. Results have proved this to be an easy and successful way of treating and preventing recurrence of pilonidal sinus. Furthermore, that understanding has introduced the possibility of preventing pilonidal sinus, through ways simpler than the simplest operation.