What is it?

The term “Pilonidal Sinus” is a combination of two words – “Pilus” which means hair, and “Nidus” meaning a nest, or a “nest of hairs”. Also known as Jeep Bottom, Sacrococcygeal Pilonidal Sinus Disease, is an inflammatory disorder, found in 0.7% of the population, chiefly among the post pubertal male demographic between the ages of 15-38. It is more likely to occur in males with darker skin tones and more hair.

The hair follicle cannot be found in the sinus wall, but is present as a part of the content. Shedding of hair due to vibration and friction in the gluteal cleft results in its accumulation and then, the hair ends up entering the sweat gland openings. The dead hair has pointed ends, and is located in the blind end of the sinus.

How can it present in someone?

A person with this condition usually presents with an external sinus opening, located just above the anal verge in the middle of the coccyx, along with a history of pus discharge and/or recurrent abscesses, which if present, might rupture. Thus, PSD can have either an asymptomatic presentation or an acute painful episode and most commonly runs a chronic course.

Obese individuals, smokers, poor personal hygiene, sedentary workers, a positive family history, deep natal cleft and excess hair in body are all the factors which makes one run the risk of developing PSD.[24]

The major problem with PSD is the adverse effect to the quality of life of the most productive ages of an individual’s life as well as in a community. 

Treatment

A number of techniques have been implemented as conservative management for PSD namely local curettage, phenol injection, silver nitrate application and electro cauterization of cavity. Surgical techniques include Excision-primary repair, Excision-Marsupialisation, De-epithelialisation, Bascom operation, Karydakis operation, VZY plasty, Limberg Flap and elliptical Rotation Flaps.

There was a time when surgeon use to lay open and then let it heal by dressings. This use to take about 2 to 3 months time to heal.Nowadays with plastic surgeon doing the cases they use flap to cover the defect. This has drastically reduced the healing time to 2 to 5  days. The chances of recurrence is also reduced. As a plastic surgeon Dr. S S Gambhir is treating the pilonidal sinus as a whole. Doing surgery with flap cover and then giving laser to the buttock area so the no. of hairs is reduced and recurrence rate is also drastically reduced.