Microsurgical excison of Pilonidal Sinus

A new minimally-invasive approach is microsurgical excision. Enlarged hair follicles (pits) are cut out as in pit picking. The resulting little openings allow the separation of the "fistula tube" consisting of scar tissue from the surrounding, healthy subcutaneous tissue. Microscopic view allows for high precison surgery. Compared with pit-picking, only little more tissue is removed, but the chance of complete cure is improved to over 90 ´%.

The procedure requires more attention to hemostasis, which is achieved by bipolar vessel sealing and resorbable, hemostatic fleeces. Time to complete closure of the wounds is longer than in conventional pit-picking, but fast recovery in terms of return to work and physical training is the rule.

The wounds are usually left open and do not require special attention or treatment. Having a shower once or twice a day, covering the wound with a simple dressing or the use of hygienic pads for protection of the underwear is sufficient. Usually the discharge of fluids ceases after a week or two. Pain is minor and easily controlled by analgetics as ibuprofen.

There is evidence that wound healing is faster with the use of collagen particles (Helisorb). I prefer to control the wounds every two weeks. Disturbances of wound healing result from ingrowing hair from the wound borders and from loose hair falling into the wounds, which can be easily managed by shaving and removing of visible hair with a forceps.