SURGICALLY RELEVANT ASPECTS OF PILONIDAL SINUS DISEASE
1) The key aim of PSD treatment is to prevent the entry of new hairs.
2) The primary goal of surgery is to change the configuration of the gluteal cleft and achieve a healed wound.
3) Excision of pilonidal sinus disease is therefore not the main surgical objective.
4) Because hair has a tendency to self exit, not all secondary fistulae need to be excised as these will self-heal.
5) Scar tissue is weaker than intact skin, implying surgical scar must not cross the midline.
6) A wound at the base of the anaerobic environment of the natal cleft will not heal, again avoid a scar in the midline and “keep out of the ditch”.
7) A flat natal cleft prevents the buttocks rolling on each other thereby forcing hair through the skin.
8) Finally, hidradenitis suppurativa may resemble PSD with multiple secondary fistulae but requires different management.
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