After Pilonidal Surgery we always advise the Patient to shave/remove hair from natal cleft repeatedly to prevent recurrence. Usually many patients do not follow these instructions and in some cases recurrence takes place. We started advising permanent hair removal by laser or by other methods. Now we have observed no recurrence (4 yrs. follow up). Are we right ?
You are absolutely right!For 6 months postop we follow our patients and once per week they must shave hair from natal cleft.In case that we found new hairs inside a new small wound we take them out with forceps to prevent recurrence.
A hypothesis is that The Pilonidal Sinuses and its recurrence are not due to the local hairs but the hairs of the back broken down to the cleft area they cause the pilonidal sinuses. Daily cleaning with normal saline is as effective as any thing. I do operate about 30 Pilinidal sinuses per annum and in last 20 years there are only 2 recurrence occurred. Both patients were obese and female with low activity.
Don't think so. I have seen pilonidal sinus disease in absolutely hair free back. Post-operative hair care though has a positive role.
Sure we recommend permanent hair removal so to prevent recurrence we have our preliminary report from our hospital
If you believe that pilonidal disease is caused by in-growing hair, then shaving or removing the hair, before the hair has a chance to curl in itself and penetrate the skin, will prevent re-occurrence.
After a 30-year experience of advising patients to shave/remove this hair, following open excision of pilonidal disease/abscess, I have come to the conclusion that this maneuver is crucially important in preventing re-occurrence.
Easy question. If you look back at the history during World War II this disease is known also as a “Jeep disease” among the US soldiers-drivers, and rules for obligatory shaving the natal cleft reduced dramatically the incidence of this problem in US army.
I strongly recommend it in very hairy patients. It lowers the rate of recurrence. Even if I agree that pilonidal sinuses exists even in hair free patients.
Good point from from Dr Julianov, by going back to the past, important factors that reduced recurrence have been lost in the myths of a multitude of surgical techniques. The advantage of laser versus shaving is the avoidance of damage to the skin surface and a permanent cessation of hair growth. From our experience it does require 4-6 treatments over a number of months.
The definitive surgical treatment for pilonidal sinus is actually to eliminate the natal cleft and re-form it so that it is not a cleft any more. Karydakis procedure is a good choice to achieve such a result. If you eliminate the cleft, then the rate of recurrence is low anyway. Nevertheless, I also recommend my patients to shave or have laser epilation after surgery as well:))
An excellent question. In my experience, hair removal in the area did not prevent recurrence (though it may reduce incidence)
The experience from our clinic reinforce the position adopted in this topic- that beside an correct surgical procedure ( modified Lord, Karydakis,etc), association of pre/ postoperative laser/ different hair removal techniques dramatically lowers the recurrence rate
Preop hair removal of hair by laser definitely decreases the recurrence.of course the surgical procedure also matters a lot,even though we can not say one procedure is better than the other.Inspite of wide exicision and skin grafting recurrences have occurred.
Dr. Dwivedi,
there is an incoherent picture in the literature if laser pepilation reduces recurrence rate in PSD. Razor depilation doubles recurrence rate due to the production of sharp hair fragments or Skin trauma or probably both (see Petersen). Why is laser depilation reducing but not eradicating recurrence? We have new hints that hair in the Sinus nest is partially if not mostly hair from the head - from the occiput. WJS and DCR will publish these results in the near future. Multiple hair fragments with sharp ends stay longer in the intergluteal fold if it is hairy - eradicate the "catching zone", and hair will still fall down from the head, but the contact time is Shorter. So there are some good arguments for laser depilation.
Kind regards,
Dietrich Doll
It seems that Dr. Dwivedi has opened up a can of worms with his question ! I think this is a very relevant and pertinent question, with pilonidal sinus being a common problem, notorious for its recurrence.
I agree with Dr. Naqvi - there is a theory for recurrence in a hairless cleft. It's most likely due to the hairs that fall from the head down the back and eventually into the cleft.