Pilonidal disease: 25 cases treated by the Dufourmentel technique

Twenty-five patients with pilonidal disease were treated by the Dufourmentel technique between 1984 and 1989. In this series, 18 patients (72 percent) were women and 7 (28 percent) were men (mean age, 24 years); hospital stay averaged 4 days. There were no recurrences and no reports of surgical wound infection. Diagnosis was confirmed histologically in all cases.

Pilonidal sinus in an amputee

A pilonidal sinus developed in the superio-medial aspect of the thigh of an above-knee amputee. This is an unusual site for the condition to develop. We suggest that the same aetiological factors that were responsible for the "Jeep Bottom" of World War II were also responsible for this problem in the amputation stump of a Falklands campaign casualty.

Pilonidal disease of the umbilicus--a report of two cases

Two cases of umbilical pilonidal sinus are reported herein. Both patients were young adult males aged 21 and 27 years, respectively. The predisposing factors are briefly discussed, however, the exact etiology of this disease remains unknown. Umbilectomy is the most commonly offered treatment and although it is rare, this entity probably goes undiagnosed in the majority of cases.

Barber's interdigital pilonidal sinus of the hand: a foreign body hair granuloma

Interdigital pilonidal sinus of the hand is an occupational disease of male barbers. Customers' hairs penetrate the supple interdigital skin, cause a sinus, and later a cyst. Through the sinus, the hairs get entrapped and may occasionally be expressed. Excision of the sinus or the cyst is curative.

[Interdigital pilonidal sinus in barbers]

Three cases of barber's hair sinus of the hand are presented. The lesion is produced by the penetration of extraneous short hairs into the interdigital spaces of the hand. The hairs produce an inflammatory reaction and foreign body granuloma. The clinical picture is usually benign but can be complicated by repeated infection which may require surgery. The structure of the lesions varies from epithelial-lined tract, cyst with surrounding foreign body reaction, to fibrotic cicatricial tissue. The exact reasons for the lesion are not known, but several theories are offered. It is, however, clear that since the 1970's Italian barbers have changed their methods of cutting hair, using their hands more than the customary instruments, i.e., combs, brushes, etc. The authors discuss the occupational problems due to the complications of disabling lesions.

Pilonidal sinus: finding the right track for treatment

Management of pilonidal sinus is frequently unsatisfactory. No method satisfies all requirements for the ideal treatment--quick healing, no hospital admission, minimal patient inconvenience, and low recurrence--but greater awareness of the strengths and weaknesses of existing methods would lead to improved management. Early excision of the pilonidal pit at the time of treatment of pilonidal abscess reduces the high (40 per cent) risk of subsequent sinus. Treatments for pilonidal sinus that flatten the natal cleft halve the risk of recurrence. En block excision of pilonidal sinus with secondary healing should be abandoned and emphasis given to development of treatments, such as primary asymmetric closure, which have more potential. Some treatments are operator-dependent and, to achieve the best results, junior surgeons must be correctly trained and supervised. Future treatment studies must be prospective and randomized, and should compare healing time, recurrence rates beyond 3 years, nurse and hospital visits, patient inconvenience and loss of income.

Umbilical sepsis

Pilonidal sinus of the umbilicus is rarely reported, and there are only 17 reported cases. On reviewing the records from Jordan University Hospital, 24 patients who were treated surgically for a discharging umbilical sinus were found. Three patients had known causes for their umbilical sepsis, namely stitch sinus, urachal remnant and an umbilical polyp. Of the remaining 21 patients, seven had clinical and pathological evidence of hair in their umbilicus. Most of our patients were young men who presented with discharge, soreness or pain, swelling, and cellulitis. Treatment by umbilical excision, leaving the skin defect to heal by secondary intention, proved satisfactory. The resultant scar resembles a normal umbilicus.

Periareolar pilonidal abscesses in a hairdresser

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[Interdigital pilonidal sinus or barber's disease]

A case of barbers disease is presented. The pathogenesis, clinical course and therapy is reviewed. This rare occupational disease must be regarded separate from the postnatal sinus pilonidalis. Therefore the authors suggest a revalorization of the distinguishing name of fistula interdigitalis crinogenita given by G. J. N. Vleugels Schutter in 1963.

Treatment of pilonidal sinus disease with the Z-plasty procedure (modified)

This article points out the significance of the internatal cleft for the formation of pilonidal sinus. Elimination of the internatal cleft by means of Z-plasty carries the smallest recurrence rate. The author, in an attempt to eliminate this small recurrence rate, applied a modified Z-plasty which is described in the present communication, and which was successfully applied in a series of cases of pilonidal sinus.

Pilonidal sinus. Excision--marsupialization--phenolization?

Too often still this disease is called sacrococcygeal cyst, pointing into the direction of congenital etiology. With this paper (and a review of the literature) we try to proof that the theory of acquired origin of pilonidal sinus is the only one logically to be accepted. We indicate that extensive surgical procedures such as Z-plasty rotated flap or broad excision--are really unnecessary and that a simple and accurate technique--marsupialization--gives excellent results with a minimum of recurrences. The last few years phenolization of the pilonidal sinus has become a popular, and eventually a worthwhile alternative.

Symposium on outpatient anorectal procedures. Pilonidal disease

Many procedures have been advocated to treat pilonidal disease, suggesting that no one method is highly efficacious. In the office, the surgical approach is directed towards three aspects of the condition: pilonidal abscess, recurrent pilonidal disease following surgery and chronic pilonidal disease following spontaneous rupture of an abscess or secondary to incision and drainage. In managing the acute pilonidal abscess, an intradermal injection is given over the indurated, fluctuant area as well as the midline orifice which can almost always be identified. The midline orifice is incised and the incision carried into the abscess cavity. The edges of the cavity are excised. Healing takes place secondarily. A second procedure is rarely needed.

[Causes of pilonidal sinus and pyoderma fistulans sinifica]

Pilonidal sinus is of the same origin as the Pyodermia fistulans sinifica . Both diseases are retention dermatopathies . These sinuses are not of congenital origin. Our observations have made an acquired origin seem more likely. Deep skin folds in the rima ani, the stiffness of the body hairs, the rolling movement of naturally separated hairs push the hair through the skin like a pin. If a hair is rubbed, it moves in the direction of its root with the peripherally directed hair scales. Excision of the sinus area and transplantation of an epithelial flap is the best therapy.

The natural history of the post anal (pilonidal) sinus

Forty-two military hospital patients with post anal (pilonidal) sinus disease who had returned a questionnaire were studied retrospectively. Overall recurrence rate after various treatments was high, and it is suggested this be considered a chronic disease with a natural regression. Seldom this point seems to be after the 30th birthday. However, there appears to be a small group that develop the condition for the first time in their fourth decade. Sitting down at work appears to be a significant (p = less than 0.05) factor in aetiology.

Pilonidal sinuses of the anal canal

Pilonidal sinuses which open through a primary communication into the anal canal are extremely uncommon. We here report 3 cases. The pathogenesis of these and other hair-containing sinuses in the anal region is discussed.

Pilonidal sinus caused by cutting trauma

The implantation of hair in the deep corium is responsible for the production of pilonidal sinus. The mechanism responsible may be the drilling of hair, suction, implantation, or sequestration. Cutting trauma can be responsible for the production of pilonidal sinus, if the hair fragments are implanted in the deep corium of the skin.

Pilonidal disease: origin from follicles of hairs and results of follicle removal as treatment

Contrary to current concepts, shafts of hairs apparently are not the source of most pilonidal disease. Instead, follicles of hairs seem to be the source. Pilonidal disease progresses through five stages. Accumulation of hair within a chronic pilonidal abscess is a late and secondary phenomenon. The acute abscess is drained only. Over the chronic abscess the distended hair follicles are removed individually from the gluteal cleft. In addition, the cavity of the chronic abscess is cleaned out through incisions placed parallel to, but to one side of, the cleft. Acute abscesses are similary treated 5 days after drainage. Cavity walls are not excised. They are allowed to fall closed and to heal. An epithelial tube, when found, is dissected out through incisions beside the cleft. Nonhealing wounds are effectively treated with Monsel's Salt. Fifty patients were treated in the author's office under local anesthesia. Disability averaged 1 day. Healing time, without disability, averaged 3 weeks. Recurrences in four patients were healed in an average of 2 weeks.

Treatment of pilonidal sinus and cyst by conservative excision and W-plasty closure

We present the use of a W-plasty for closure after conservative excision of pilonidal cysts and sinuses. In the past 3 years we have done 12 cases this way, and to date there has been only one recurrence.