Pilonidal disease is treated by follicle removal and lateral drainage. The method is suited to outpatient management and gives minimal disability and good long-term control. Other treatment methods for management of the unhealed midline pilonidal incision are discussed. Results are satisfactory to as long as nine years on follow-up. Microphotographs demonstrate that pilonidal disease arises from hair follicles in the skin.

Anesthesia, Local↗

PubMed1980

Pilonidal disease: origin from follicles of hairs and results of follicle removal as treatment.

Contrary to current concepts, shafts of hairs apparently are not the source of most pilonidal disease. Instead, follicles of hairs seem to be the source. Pilonidal disease progresses through five stages. Accumulation of hair within a chronic pilonidal abscess is a late and secondary phenomenon. The acute abscess is drained only. Over the chronic abscess the distended hair follicles are removed individually from the gluteal cleft. In addition, the cavity of the chronic abscess is cleaned out through incisions placed parallel to, but to one side of, the cleft. Acute abscesses are similary treated 5 days after drainage. Cavity walls are not excised. They are allowed to fall closed and to heal. An epithelial tube, when found, is dissected out through incisions beside the cleft. Nonhealing wounds are effectively treated with Monsel's Salt. Fifty patients were treated in the author's office under local anesthesia. Disability averaged 1 day. Healing time, without disability, averaged 3 weeks. Recurrences in four patients were healed in an average of 2 weeks.

Abscess↗