Operations for Pilonidal Disease

Abstract

In past decades it was thought that a pilonidal sinus was the result of a congenital remnant of epithelium or an invagination of skin. The presence of hair in the pilonidal cyst was explained by the persistence of hair follicles in the invaginated epithelium. If this hypothesis were true, corrective surgery would require a complete excision of the congenital lesion. Consequently, wide excision of a large elliptical segment of skin down to the post-sacral fascia was advocated. This often left a large skin defect which could not be closed per primam. Consequently, complicated operations, such as sliding flaps of gluteal muscle or broad-based sliding skin flaps, were devised to close the defect. Despite the extensive surgery, primary healing was not uniformly achieved, and recurrences were not uncommon. If the wound was left open after a radical excision, healing by granulation tissue and contraction often required 6–12 months.