Excision of pilonidal sinus with secondary healing - general and visceral surgery

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date of publication: 30.12.2013

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  • Exposing the fistulizing sinuses

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    Several fistula orifices are visible in the anal cleft. Probing demonstrates fistulization nearly to the posterior anal verge. The fistulizing sinuses are marked with a dye (toluidine blue) (this ensures complete excision of all secondary sinuses).

  • En-bloc excision

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    Complete oval excision of the entire chronically infected tissue. All tissue marked blue must be safely removed in toto while sparing the sacral fascia and leaving on the sacral fascia as thin a layer of fat as possible.

  • Inspecting the specimen

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    The transected specimen reveals a wide fistulizing sinus with tufts of broken hair.

    Note: 

    • The benefit of excision with healing by granulation is that it requires little technical effort, the biggest downside being the rather long time required for healing.
  • Dressing

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    Petrolatum gauze wound dressing Cover this with crumpled gauze pads. The wound is left to secondary healing.

    Note:

    The hairless scar and the flattening of the anal cleft should eliminate the causes of pilonidal sinus.