If you are experiencing what you believe to be symptoms of pilonidal disease or have been diagnosed with pilonidal disease, you may understandably have questions. Dr. Michael Reinhorn, MD FACS, performs the most up-to-date procedures to treat pilonidal disease. Below, find his answers to questions patients commonly ask about pilonidal disease, the cleft lift procedure, and what to expect from surgery.
Pilonidal disease occurs in the natal cleft as a result of midline openings or pits. Hair and bacteria can get inside the pits, and lead to infections, cysts and fistula tracts. This can become a chronic problem.
Usually patients present with bloody drainage on their underwear. This can be painful at times, but is often just a nuisance. Some patients, however, present with quite a bit of pain and sometimes with a fever. This is a sign of an abscess, which needs to be taken care of by a physician.
Historically, treatment of pilonidal disease involved removing the infected area, and either leaving the hole open or closing the incision. More recently, Dr. John Bascom from Eugene, OR developed a procedure called the cleft lift which involves removing the infected tissue and moving one area of the cleft over to the other side, creating an incision that is away from the midline. Dr. Bascom's procedure has become the "gold standard" in pilonidal surgery because the outcomes are better than the traditional approach. I (Dr. Reinhorn) have been performing the cleft lift procedure for 6 years.
In recent years, several researchers have described using a laser to remove the hair in the area. This procedure allows the body to heal surgical incisions, without hair as a foreign body that can get into the wound. Lasers are believed to stimulate healing as well. Laser treatment is still considered experimental, and I am currently conducting my own research on this. For now, we generally recommend laser for patients who have already had surgery and are back with recurrent disease or a difficult-to-heal wound.
Generally I recommend people shave the area around the cleft with a clipper once per week if they are not undergoing laser therapy. I highly recommend all pilonidal patients wash with Hibiclens® antimicrobial soap daily during the time they have a pilonidal cyst or sinus and for a year after they have been medically "cured."
If you have an active infection with drainage, typically I will treat you with an antibiotic before and after surgery. This will allow for your body to be in the best shape possible before the upcoming surgery.
You will need to come to the hospital about 90 minutes before surgery. This allows plenty of time for parking and registration. Once you register, you will be taken to the surgical center where you will change into appropriate gown for the operating room and an IV will be started. You will then meet with the nurses, anesthesiologist. I will stop by to meet with you and anyone accompanying you and provide some time to ask a few questions. Surgery time is about 2-2.5 hours, after which you will spend about 2 hours in recovery.
Once you are discharged from the hospital, I recommend that you refrain from sitting down for about 1 week. There are anywhere from 60-100 stitches used to move the skin and tissues from one side to the other, but prolonged sitting can increase the pressure on the area. Most people buckle in to the back seat of the car and ride home on their sides. I typically place a small rubber drain that I remove 3-5 days after surgery.
Typically, I see patients 3-5 days after surgery to remove the drain and two weeks after surgery to remove the ends of a dissolvable stitch. After that I see most patients at 1 month, 3 months, 6 months and 12 months after surgery. Patients that have a wound issue may need to be seen more frequently.
Pilonidal.org offers general information, a forum to ask your questions, and an updated list of surgeons who perform the cleft lift procedure in every state.
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