Pilonidal Cyst: Wound Management and Beyond

In this session, Dr. Chaffin discusses the topic of pilonidal cyst and the key takeaways from her session with Hadar Lev-Tov, MD, at SAWC Fall 2023 in Las Vegas, Nevada.

Transcript:
 

Hi. I'm Dr Abigail Chaffin. I'm a plastic surgeon at Tulane University. My practice focuses on complex wound management and wound reconstructive surgery. 

So going over with pilonidal cyst and sinus disease, which as you remember is a cousin of hidradenitis or part of this follicular occlusion tetrad. Most commonly seen in young males with deep gluteal clefts, potentially patients that have more hair in that region. We start with hygiene. We start with hair removal methods. However, much of this disease is a very difficult area to heal. The gluteal cleft surgically has high shear, high contamination, has pressure, and these are young healthy patients in the prime of their life that have this painful wound.

I've commonly seen referrals on patients that have had 2, 3, or 4 prior surgeries as teenagers, and they're either out of school or out of college. So I approached that very similarly. Excision of all the disease and fibrosis. Local flap advancement is usually what's able to be done with progressive tension sutures. Good irrigation of the wound cavity to eradicate biofilm before closure, offloading any tension on the closure, incisional negative pressure to help protect the area, increase perfusion, and protect from contamination.

And then on those patients, a very strict aftercare protocol of minimal activities for a few weeks, which is somewhat difficult on a 17-year-old male to get them healed, hopefully, once and for all. And then long-term hygiene and keeping hair out of the region to decrease recurrence. 

So in the session, I went over a more simple case with excision and local tissue advancement, a more severe case in which the patient had probably a 15 x 15 cm area involved on the buttocks that required a large rotational flap. And then a recurrent case, one of my own patients, who unfortunately failed to keep hair out of the area and came back with a very large recurrence recurring a second flap. But I'm happy to report I saw him last week, and he's fully healed now for 3 years. He had maintained his hair removal, and he, you know, he is so happy that after 5 years of struggling with that disease that he's now finally healed.