SACROCOCCYGEAL CONDITION
Pilonidal Sinus
A small pit or tunnel near the tailbone containing hair and skin debris, causing recurrent painful infections. Dr. Samhitha Reddy offers the full range of pilonidal sinus treatments, including minimally invasive options.
ABOUT THIS CONDITION
What is Pilonidal Sinus?
A pilonidal sinus is a small hole or channel in the skin near the tailbone (coccyx), at the top of the buttocks cleft. It is most common in young men who sit for prolonged periods. The sinus becomes infected by ingrown hair and skin debris, forming a painful abscess with pus discharge. Recurrence after conventional surgery is high, technique selection is critical. Pilonidal sinus treatment includes the complete range of surgical options, from acute abscess drainage to definitive flap reconstruction. Dr. Samhitha selects the approach best suited to disease extent, number of pits, and risk of recurrence for each individual patient.
SIGNS TO WATCH
Common Symptoms
Symptoms that need attention
WHY IT HAPPENS
Causes & Risk Factors
- Ingrown hair penetrating the skin near the tailbone
- Prolonged sitting, office workers, students, drivers
- Friction and pressure in the natal cleft
- Excess body hair in the natal cleft region
- Deep natal cleft anatomy that traps hair
- Poor local hygiene in the sacrococcygeal area
CLINICAL DETAILS
KeyFacts
Minimally invasive removal of midline pits under local anaesthesia, selected primary cases
Endoscopic Pilonidal Sinus Treatment, available at selected specialised centres
Asymmetric flap moves the scar off the natal cleft midline, low recurrence
Rhomboid flap reconstructs the cleft, effective for complex or recurrent disease
Flattens the natal cleft, addresses the anatomical root cause of recurrence
Minimally invasive: 2-3 weeks. Open excision: 6-8 weeks. Flap repair: 3-4 weeks.
HOW WE TREAT IT
Treatment Approach
Complete Pilonidal Sinus Care, Acute Drainage to Definitive Reconstruction
Pilonidal sinus surgery is personalised based on disease stage. Acute abscesses are drained as an emergency. For definitive treatment, minimally invasive options (pit picking, EPSiT at selected centres) are considered for simple primary cases. Complex or recurrent disease requires flap reconstruction, Karydakis, Bascom Cleft Lift, or Limberg Flap, to minimise recurrence.
- 1
Acute Abscess: Emergency Drainage
When active infection is present, incision and drainage under local anaesthesia is performed as an emergency. Definitive surgery is deferred until inflammation resolves.
- 2
Minimally Invasive Options (Selected Cases)
Pit Picking (Bascom's procedure) removes only the midline pits with minimal tissue disruption. EPSiT (endoscopic) destroys the sinus tract under direct vision at selected centres.
- 3
Excision with Open or Primary Closure
Wide excision of the sinus with open healing (secondary intention) or primary closure, options for uncomplicated primary disease. Open healing has higher recurrence; primary closure is faster to heal.
- 4
Flap Reconstruction (Recurrent or Complex Disease)
Karydakis Flap, Bascom Cleft Lift, or Limberg Flap (rhomboid flap) moves tissue to flatten the natal cleft and relocate the wound off the midline, the most effective approach for reducing recurrence in complex or recurrent disease.
AVAILABLE TREATMENTS
Treatment Options
Incision and Drainage (acute abscess)
A surgical procedure involving incision of an abscess cavity to evacuate pus, relieve pressure, and control infection.
Bascom Cleft Lift
A reconstructive procedure that flattens the natal cleft and lateralizes the incision to reduce hair accumulation and recurrence.
Karydakis Flap
An off-midline flap technique that excises the sinus and shifts the closure away from the midline to minimise recurrence.
Limberg Flap (Rhomboid flap)
Excision of the sinus followed by reconstruction using a rhomboid-shaped transposition flap.
Excision with Open Healing
Complete removal of sinus tracts, leaving the wound open to heal by secondary intention.
Excision with Primary Closure
Excision followed by immediate suturing of the wound for faster healing, though with a higher recurrence risk in some cases.
Pit Picking
Minimally invasive removal of sinus pits and tracts through small incisions.
EPSiT
Endoscopic visualisation and ablation of the sinus tract using specialised instruments.
COMMON QUESTIONS
Frequently Asked
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