Pilonidal Cyst Case Presentation: Update Course 2015

After 2-3 recurrences of pilonidal cyst, definitive surgery is indicated rather than repeat I&D.

The Bascom technique involves excising 1-millimeter pits at skin level under local anesthesia, allowing secondary healing, with 70% not recurring by their data (though no control group exists).

For large draining sinuses or recurrence after pit excision, formal OR excision of the entire affected area with off-midline layered closure and drain placement is performed.

Physical exam findings including deep gluteal fold and heavy hair burden are high-risk factors for pilonidal disease recurrence.

For severely infected pilonidal disease, open excision with wet-to-dry dressing changes or wound VAC is an option.

Post-operative management with prone positioning until wound healing is critical for preventing recurrence; pilonidal disease is fundamentally a wound healing problem.

Plastic surgery consultation for flap reconstruction with strict prone post-operative positioning is used for multiply recurrent pilonidal disease.

One patient reported laser hair removal as the most painful procedure they had experienced, completing only half a session and refusing further treatment.

Laser hair removal for pilonidal disease is expensive and insurance reimbursement has not been successful.