Pilonidal sinus is an inflammatory disease caused by hairballs nestled under the skin in the coccyx
What is the treatment for ingrown hair?
The only valid treatment is surgery. Methods mentioned in some sources as non-surgical treatment; (phenol etc.) success rate is not high. It needs to be applied repeatedly. In approximately half of the patients, the disease continues despite these procedures.
What happens if it is not treated?
Ingrown hair actually only concerns the skin and subcutaneous tissue and has nothing to do with the internal organs. It is an unrelated, limited disease. However, it is a disease that affects social life due to its location, the fact that it involves sitting and standing, being in an area prone to contamination close to the anus, and wound healing being difficult in that area.
The disease becomes increasingly difficult in terms of personal hygiene. The disease may spread to surrounding tissues and require removal of a larger area during surgery. If an abscess develops in the course of a chronic disease that continues for a long time, the patient may have to undergo two surgeries instead of one.
Abscess
If a patient has ingrown hairs, pain, If it starts with an abscess in the form of swelling and redness, urgent surgery is required. The abscess is drained through an incision made over the inflamed area. The wound is left open and is not stitched. Even if it is done, the wound will collect pus and open back to its previous state. In one out of every three patients whose abscess is drained, the disease is completely resolved. However, in two out of every three patients, the disease becomes chronic and a second surgery is required.
Which Surgery Method
Your doctor will decide which technique the surgery will be used according to the extent of the disease. will decide. Depending on the situation, a drain may be placed in the subcutaneous area to remove the accumulated fluid.
Alternative Treatments and Risks of Pilonidal Sinus Surgery:
• Scraping and freezing of the area may be applied.
• Burning can be done with laser beams or electric knives.
• Different chemical substances such as polyphenol can be applied.
The probability of recurrence of these methods is higher than surgical intervention. is higher.
Excision- Patch Slide Closure (Rhomboid Excision-Fleb shift)
The most appropriate surgery for most cases of chronic pilonidal sinus with long-term discharge. It is a type of surgery that involves removing a large wound and repairing it with a patch. First, the diseased tissue is completely removed. A tongue-shaped patch tissue (flap) is prepared from the hip tissues adjacent to the midline, containing the skin and subcutaneous tissue. The surgery (excision + flap) is completed by turning the patch to the side and stitching it into the space left after the wound removal. In terms of long-term results, it is still the most successful surgical technique.
Excision-Secondary Healing< br /> Cutting out the diseased area and leaving the wound open as is; It is a short and easy process. However, wound healing may take up to 6-8 weeks. The recurrence rate of the disease is 5-10%. Since it is a troublesome treatment method for the patient, it is not preferred unless it is necessary.
Removing and Suturing
The method in which the wound is removed and the wound lips are stitched together (excision + primary repair) is a less preferred type of surgery. Rarely, it is suitable only for minor inflammations. Surgery time is 20 minutes. The wound healing period is 10-15 days, but the recurrence rate of the disease is 20-30%.
Microsinusectomy
The disease is very severe. It is a simple and limited type of surgery performed on patients in a small area. It may be suitable for a very small portion of patients, such as 5-10%. It can only be considered as a simple option in the early stages of the disease, when the gap between the hips is small and the hair density is low. A false impression has been created on the internet that "all ingrown hair patients can be treated with microsinusectomy."
The majority of patients present with a chronic inflamed tissue area of 3-4 cm or larger. It is clear that a permanent treatment cannot be achieved in most patients by removing only a piece of tissue with a diameter of 1-2 cm.
Anesthesia
The most preferred method is The aesthesia method is a waist needle (spinal anesthesia) method. This method is very comfortable as it provides numbness and painlessness from the waist down for 2-3 hours after the surgery. Unless there is a special necessity, there is no need for complete anesthesia (general anesthesia).
What Happens If Pilonidal Sinus Surgery is Not Performed?
If you do not undergo surgery, the gap may grow and as a result of this growth, abscess formation and the abscess opening to the skin at different points. may be the case. In this case, urgent surgical intervention may be required. In addition, such a delay may lead to larger tissue removal in future surgery and an increase in the frequency of surgical complications.
Risks of the Procedures to be Performed:
Risks of Local Anesthesia:Allergic reactions may occur due to the applied substances and this may be life-threatening. However, the probability of development is very low.
Risks and Complications of Pilonidal Sinus Surgery:
The following are possible risks and complications that may be seen in this operation.
• Surgery Bleeding may occur during or after surgery.
• Infection (inflammation) may occur in superficial or deep structures at the surgery site.
• Problems may occur with technological materials such as cautery to be used during surgery. These may lead to complications such as cautery burns.
• After the surgery, your sitting and other activities may be restricted depending on the surgery method.
• In order to fully fulfill the requirements of Pilonidal Sinus Surgery, a more extensive surgical intervention may have to be performed based on the immediate findings during the surgery. More scars may remain. • During the surgery, a drain may be placed at the surgery site, after the surgery, inflammation or yellow fluid may accumulate at the surgery site, which can be drained with a syringe or by opening it, the wound may be opened, healing may not always occur in the expected time, repeat surgery may be required.
• In some patients, the incision healing tissue may be thick and reddish-purple.
• Skin damage and skin death may occur in the area where the surgery is performed. These may require dressing treatment, additional surgeries and skin transplantation. He or she may call other doctors from his/her own branch to ensure that the necessary intervention is carried out. If he sees that there are co-morbidities during the surgery, he can intervene in them. Your doctor makes the decision during the operation.
How is flap surgery performed?
The most successful surgery method for ingrown hair; It is a method of closure (excision + flap) by completely removing the diseased area and sliding a patch from the hip to replace the missing tissue. Surgery time is approximately 45 minutes. The hospital stay is one day. Spinal anesthesia is generally preferred. The diseased tissue under the skin is marked with a dye (blue dye) administered through the leaking holes in the skin. By passing a few millimeters away from the painted borders, the diseased tissue is completely removed.
The removed tissue is generally in the form of a diamond slice (rhombus). A patch (flap) tissue is prepared by removing a few centimeters of tongue-shaped tissue from the hip area adjacent to the wound. The wound is closed using flap tissue. Wound healing time is 10-15 days, and the probability of recurrence of the disease is 2-3%. It is the method with the lowest probability of recurrence.
Ingrown hair after surgery
less. After the surgery, he cannot move his legs for another 2-3 hours. During this period, the patient does not feel pain because numbness continues in the lower half of the body. He can take food orally within an hour or two, and after 5-6 hours there is no need for IV fluids. He can walk and go to the toilet on his own. Painkillers are started before the effects of numbing from the waist wear off and are repeated every 4-6 hours. Most patients do not experience any significant pain problems. Just staying in the hospital on the night of the surgery is sufficient.
Ingrown hairs Post-operative follow-up and recommendations
The patient is discharged the morning after the surgery. The patient is free to walk, sit on the wound, or lie on his back. However, during the first week, it is not appropriate to put weight on the wound for a long time or to act in a way that will stretch the wound excessively. You can sit on the toilet and clean the dressing in a way that does not contaminate it.
It is recommended to use antibiotics and painkillers for the first 5 days. Bathing can be done after 3-4 days. After 10 days, the stitches are removed and the patient can continue working. Rarely lower end There may be difficulty or delay in wound healing.
Hair in the entire hip and anus area should be cleaned using depilatory creams every 15 days for 3 months, the first being 15 days after the surgery. There is no harm in walking and doing light exercises. Football etc. Heavy sports can be done after 3 months. Long-term follow-up is not required unless there is a wound problem.
What are the Points to Consider After Pilonidal Sinus Surgery?
• Meet your toilet needs without sitting down as much as possible. If your wound dressing gets dirty while defecating, change the dressing. Follow the recommendations, consult your doctor when redness, swelling, discharge develops in the wound area or in unexpected situations.
Read: 0
