There are dozens of treatment methods for pilonidal sinus disease. This situation causes confusion in patients about which treatment to apply. What is the best treatment for ingrown hair? In order to understand the subject, it is necessary to first explain what ingrown hair is.
Ingrown hair; In the early stages, it consists of a 0.5-1 cm cystic structure containing few or many hairs and surrounded by reactional tissue. It progresses over time, grows by creating tunnels under the skin, and turns into a sinus structure with 8-10 cm tunnels containing hair and 3-5 fistula holes with pus discharge. As you can see, it can vary in size from half a cm to 10-15 cm. The critical point here is that a 1-2 cm early ingrown hair can be easily removed with a 1-1.5 cm incision. If flap surgery is performed with an incision of 8-10 cm, an unnecessarily large piece of solid tissue will be removed and a large wound will be created, which will take a very long time to heal and will leave a serious scar in the wound area.
A more accurate approach is to choose the treatment method that can be applied with the smallest incision, depending on the size of the ingrown hair, and if this cannot be applied, to choose flaps or other surgical methods. In addition, sinusotomy, one of the non-surgical treatment methods, may be a good alternative solution for patients who do not have the opportunity to rest.
Let's briefly examine the treatment methods applied to ingrown hairs;
Surgical methods:
1-Microsinusectomy; It is performed by removing the pilonidal sinus with a 1.5-2 cm incision and closing it with 1-2 sutures. If it is done by an experienced specialist in appropriate cases, very good results are obtained, especially in terms of cosmetics.
2-Leaving it open; It involves removing the pilonidal sinus with a wide incision (may be 10-15 cm) and leaving the wound to heal with a dressing without closing it. It is not recommended due to dressing times that can last up to 5-6 months.
3-Primer closure; It involves wide excision of the pilonidal sinus (may be 10-15 cm) and closure with direct stitches. magic of the wound Because the stitches and stitches are very tight, the surgery is very painful and long periods of rest are required. The recurrence rate is high.
4-Karidakis operation; It is an asymmetrical incision of the pilonidal sinus so that it is closed on the side of the midline, and one side of the incision is released, pulled to the side and stitched. The results are satisfactory in appropriate cases.
1A-1B:Karidakis 2A2B:Ramboid flap
5- Flap surgeries; Many types are applied, such as ramboid flap, Z-plasty, clover flap, D flap. The pilonidal sinus is removed by cutting different geometric shapes, each side of which can be 8-10 cm, and a piece (skin-subcutaneous) is cut from the side in the same way, turned and stitched to close the gap. It is the most commonly applied surgical method, but it causes very serious scars and deformation of the hip.
Apart from these, minor surgical interventions such as Bascom operation, pitch picking, etc. are also performed.
Interventional treatment methods:
SINUSOTOMY; The pilonidal sinus holes are widened and their contents are scraped from under the skin with a wire brush and curette, and the wound heals with dressing in 2 weeks. It has the advantages of being applied on foot and not requiring rest.
In addition, methods such asfibrin glue, phenol and silver nitrate are also applied in appropriate cases.
< strong > As a result, the application of major surgical methods such as flap and open surgery to all patients leads to unnecessary loss of healthy tissue and large surgical wounds in patients with a sinus size of 1-2 centimeters. The healing period is accordingly longer and leaves more serious scars. For ingrown hairs, which can vary in shape and size, it seems to be a more appropriate approach to perform the smallest possible surgical intervention for each case.
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