PILONIDAL DISEASE

Dr. Burak Yavuz, FTBS

Kozan State Hospital, Department of General Surgery, Adana, Türkiye

ABSTRACT

Pilonidal disease is a chronic condition affecting the sacrococcygeal region, typically seen in young adults, particularly males. The disease is characterized by the formation of pits, sinus tracts, and abscesses, resulting from trapped hairs within the skin. The etiology involves both mechanical and environmental factors such as prolonged sitting, hair penetration, and skin friction, with hairs acting as foreign bodies that trigger inflammation and sinus formation. Although surgical management has evolved from invasive approaches to more minimally invasive techniques, recurrence remains a significant challenge. Recent advancements in pilonidal disease treatment include techniques such as the Limberg and Karydakis flaps, which are off-midline closures aimed at reducing wound tension and recurrence rates. The Limberg flap, a rhomboid-shaped excision followed by flap transposition, provides tension-free healing and is associated with lower recurrence rates and faster recovery. Similarly, the Karydakis flap focuses on creating a lateral incision to flatten the gluteal cleft, promoting better wound healing. Both methods have shown superior outcomes compared to traditional midline closures. Postoperative care is essential in preventing recurrence and ensuring proper wound healing. This includes maintaining hygiene, hair removal through methods like laser epilation, and careful wound management. The role of hair re-entry and anatomical features, such as deep natal clefts, also contributes to the likelihood of recurrence. Patients with higher BMI and smokers face additional risks of complications and delayed healing. Ultimately, despite these surgical advancements, recurrence remains a persistent issue, necessitating ongoing research into better treatment strategies and patient-tailored approaches. Understanding patient preferences and individualized care, especially regarding less invasive procedures like pit-picking or laser treatments, plays a crucial role in optimizing outcomes and reducing recurrence in pilonidal disease management.

Keywords: Pilonidal disease; Surgical treatment; Postoperative care; Minimally invasive procedures; Recur- rence

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