Surgical Management of Pilonidal Cysts: A Comprehensive Review

Pilonidal cysts are a common and often painful condition that affects the skin at the base of the spine or between the buttocks. It occurs when hair follicles become blocked and infected, leading to the development of a cyst or abscess. While there are various treatment options available, surgical management is often required for recurrent or severe cases. In this article, we will provide a comprehensive review of the surgical management of pilonidal cysts.

Before delving into the surgical options, it’s important to note that conservative treatment measures such as warm compresses, antibiotics, and proper hygiene should be attempted initially for mild cases. However, if the cyst persists or worsens, surgical intervention becomes necessary.

The primary goal of surgical management for pilonidal cysts is to remove the cyst and its associated sinus tracts or tunnels. There are several surgical techniques commonly employed to achieve this goal, including excision and primary closure, excision with open healing, and excision with reconstructive techniques.

Excision and primary closure involve removing the cyst and underlying sinus tracts followed by suturing the wound edges together. This technique allows for faster healing and reduces the risk of recurrence. However, it is best suited for small cysts and those without significant infection or inflammation.

Excision with open healing, also known as secondary intention healing, involves the complete removal of the cyst and sinus tracts without suturing the wound edges. Instead, the wound is left to heal on its own, with regular dressing changes and wound care. This technique is typically used for larger or more complex cysts, those with extensive inflammation or infection, or cases where primary closure is not feasible.

In cases where primary closure or open healing may not yield satisfactory results, reconstructive techniques may be employed. These techniques involve using local flaps or skin grafts to close the wound after cyst excision. They offer improved wound healing outcomes and can be particularly helpful for recurrent or complex cysts. However, these techniques often require specialized surgical expertise and may result in more extended recovery times.

Post-operative care is essential to ensure successful outcomes following surgical management of pilonidal cysts. This includes proper wound care, regular dressing changes, and maintaining good personal hygiene. Patients may also be advised to avoid activities that put pressure or strain on the area, such as prolonged sitting or cycling, during the healing period.

While surgical management of pilonidal cysts is generally effective, there are potential complications that can arise. Infection, wound breakdown, hematoma, and seroma formation are some of the risks associated with surgery. However, with proper technique, post-operative care, and patient compliance, these risks can be minimized.

In conclusion, the surgical management of pilonidal cysts plays a vital role in resolving this often painful condition. Various surgical techniques are available, ranging from excision and primary closure to more complex reconstructive options. The choice of technique depends on the severity of the cyst, the presence of inflammation or infection, and the likelihood of recurrence. Ultimately, successful outcomes rely on proper pre-operative evaluation, surgical expertise, and diligent post-operative care.