The sinus pilonidalis or cysts sacrococcygeal consists in the formation of a cavity pseudo cystic that develops in the subcutaneous tissue of the sacred coccygeal region due to the formation of a granuloma, more or less infected, from hair included. The Pilonidal sinus usually affects young patients with male female ratio of 3:1.
These cysts develop in the sacral region of the fat layer of the skin and the muscle fascia. Formats contain hair, hence the name of Pilonidal sinus (nidus pilorum). Why this occurs is a crucial action of rubbing the buttocks resulting incarnamento hair. These cysts, subject to microtrauma continue as in the sitting position (Jeep jeep disease or disease of American soldiers) end up going to a meeting inflammation which can lead to the formation of an abscess. The abscess tends to empty the pus, following a route that the newly formed fistula said dall'ascesso and comes out in one or more orifices placed in the skin intergluteal sulcus.
Pilonidal disease can manifest itself in three ways:
1) In the initial phase is constituted by a small little painful swelling of the furrow intergluteal that may be accompanied by one or more orifices adjacent skin from which may surface tufts of hair.
2) In the phase of abscess that occurs for the infection of the cysts by the bacteria of the skin occurs a swelling that increases in volume, becomes intensely painful and with reddened skin. The abscess may open spontaneously or require surgical incision.
3) In the phase of pilonidal fistula is present the cystic cavity which communicates with the outside through one or more orifices skin, in furrow intergluteal, from which emerges continuously or intermittently a liquid serum purulent yellowish
The diagnosis is simple and is performed with a simple surgical visit.
Therapy: In the phase of abscess is required surgical incision to allow the escape of purulent material. The simple abscess drainage temporarily solves the festering but it is always followed by recurrence or the formation of the fistula. To avoid this, you can in some cases make an intervention called marsupialization.
The radical treatment of pilonidal cyst removal is the large bulk of the granuloma, including his sinus tracts and the skin above. This surgery involves the creation of a large surgical wound that arrives, in depth, to the plane presacral. The technique involves the so-called open healing of the residual cavity by second intention, that is, is characterized by a spontaneous closure of the wound in a variable period of up to 3 months. The technique involves so-called closed suturing of the wound directly or by means of sliding flaps, ensuring a more rapid healing (about 15 days). However, the postoperative course is characterized by the presence of a greater pain and especially for a high proportion of abscess that requires the reopening of the suture with healing by second intention.
Despite the obvious inconvenience caused by these works and a number of other more complicated gradually developed over time, the recurrence of the disease are more frequent
For this reason, considering unjustified penalize patients with hospital stay, postoperative pain, disability long, numerous medications and other discomforts, compared with a benign disease that does not require a radical like a cancer, we use a conservative technique that is practiced under local anesthesia and outpatients.
The project entails the removal of only the orifices in the thorough cleaning of the cavity with hair removal and tissue inflammation. Its duration is 15 - 20 minutes and the immediate resignation. In the postoperative period, the patient can immediately play all kinds of activities, including sports, without any restrictions. Are not necessary dressings. The recurrence may occur in approximately 10% of cases, like all the other techniques.
After surgery should be retained shaved the area around the intergluteal sulcus to avoid falling and tipping hair to prevent disease recurrence in portions not affected by the intervention.