Editing Pilonidal disease (section)

=== '''Simple procedures''' ===

** Simple abscess drainage
*** Indication: acute pilonidal abscess
*** Typically, the abscess 'points' to one side of natal cleft - incise abscess cavity just off midline in this direction
*** Unroofing and curettage leads to better resolution rates than just I+D (96% vs 79%) and fewer recurrences
*** Break up all loculations, drain all purulence
*** Don't excise pits - no clinical benefit in acute setting
*** Cease antibiotics unless cellulitis
*** Initial packing, but not necessary after first day
*** Once or twice daily showering with soapy water
*** Typically closes in 1-2 weeks
*** Follow-up:
**** Recurrence rate of 10-55% - multiple pores and lateral sinus tracts associated with recurrence
**** UTD says start regular hair control technique (not razor shaving)
** Pit-picking and the simple Bascom procedure (Bascom 1 procedure)
*** Indication: mild chronic disease in which primary complaint is midline pits, or there is a small wound off-midline.
**** This is a good option for when a full resection would be a major undertaking and is not justified
*** Components (can do both):
**** Excise central pits with a punch knife of appropriate size - insert to full depth, remove hair and debris, and close primarily (3-0 vicryl)
**** For off-midline disease, make a 2-3cm incision just lateral to indurated area. Dissect subcutaneous towards midline pits, and excise the lot. Close the superior and inferior aspects, then leave the middle open to pack (comes out next day).
*** Heals in 1-3 weeks
** Excision with or without primary wound closure
*** Apply above principles - wound off midline, as small as possible
*** Primary closure is associated with faster healing (14 vs 60 days), but higher recurrence (8.7 vs 5.3%). Infections were low in both groups.
*** Don't try it in patients with extensive and destructive disease
*** Healing takes weeks to months - can use negative pressure dressings
*** NPWT is more useful for larger defects. Slightly improved time to complete healing in NPWT compared to standard therapy (84 to 93 days).