Pilonidal sinus disease, popularly known as pilonidal sinus disease, is a disease that occurs in the area between the two buttocks, on the coccyx bone, called the intergluteal sulcus. Although it is not known exactly why it occurs, it is thought that this cleft creates a vacuum while sitting and pulls the hair towards the midline dimples. The hairs growing inward then become infected, causing abscess development and disease.
Acute disease is due to abscess formation. Patients present with very severe pain, swelling and redness in the coccyx. Emergency treatment of abscess is drainage, that is, surgically draining the pus inside the abscess. This procedure is performed in an outpatient clinic environment, without the need for general anesthesia, by anesthetizing only the diseased area, that is, with local anesthesia. After the abscess is drained, antibiotic treatment is given and 2 weeks are waited for the diseased area to heal. Abscess drainage does not eliminate the ingrown hair disease, it only eliminates the complication caused by the disease, namely the abscess. After the wound has healed, the main procedure required to completely get rid of ingrown hairs will need to be performed. These procedures can be simply divided into two: surgical and non-surgical procedures. Surgical procedures, that is, surgeries, can be performed by several different methods. Depending on the prevalence of pilonidal sinus, the physician selects the most appropriate method for the patient and the disease and performs surgery. The purpose of surgery is to completely remove the diseased area and close the wound in a healthy way. In minor diseases, the diseased area is removed and the wound can be closed by stitching the two lips of the wound together. However, in cases of extensive disease, the location of the removed piece is sometimes so large that the two lips of the wound cannot be brought together. In this case, a piece called FLEP is taken from the hip and the wound is closed. This is a flap closure technique.
Laser treatment is applied in the operating room with spinal or local anesthesia. After the hair in the sinus is cleaned, the inside of the sinus is burned with a laser probe. However, it cannot be applied to every patient; appropriate patient selection is very important. Complicated patients with a very large pilonidal sinus and those who have had a pilonidal sinus for many years and have abscessed many times are not suitable for laser treatment. . The crystallized phenol method also has similar properties to laser. It can be performed under local anesthesia in patients with small pilonidal sinuses that are known to have newly formed. It does not require hospitalization, and post-procedure pain is minimal or usually absent. After the hair in the sinus is cleaned, a chemical substance called crystallized phenol, which visually resembles rock salt, is filled into the tissue. This substance creates a burn-like chemical reaction within the tissue, allowing the tissue to heal on its own.
Pilonidal sinus treatment should be planned according to the patient and the disease. Just as the same surgical method cannot be applied to every patient, not every patient will be suitable for laser and crystallized phenol treatment. The most important element of treatment is to be treated with the appropriate method recommended by an experienced physician, without delay as soon as the diagnosis is made. It should not be forgotten that as the disease progresses, its treatment may become more complicated and some patients may even require several surgeries.
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