45 year old man had pilonidal disease since his early 20s. His first operation was 23 years ago and he has had multiple procedures since. His natal cleft was often painful and discharged pus frequently. He had multiple pits and hard indurated tissue in the natal cleft.
To cure the recurrent disease, radical excision of the affected area and coverage of the defect with a rhomboid flap was performed.
First the flap is marked out on the skin
The rhomboid flap is mobilized and sutured in place.
The patient was kept in for 2 days nursed on his side or prone.
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so i see that skin area is remove totally?
ReplyDeleteI dont really understand whats the meaning of pilonidal disease and why this procedure is undertaken?
pilonidal literally means nest of hair. pits form in the skin of the natal cleft which become filled with hair and other debris especially in people with dark thick hair. This debris often gets infected causing pain, abscesses, discharge and further tracks to develop. This procedure was performed because there was ongiong and frequent dischage and pain, generally making the patients life a misery.
ReplyDeletejon,
ReplyDeleteKeep writing everyday. I'll help out to promote your blog as it is very informative.
By the way, looking at the last picture, it looks very asymmetrical. What does the patient feels?
Thanks for your support fatehsaleh.
ReplyDeleteThe patient feels a bit uncomfortable for the first couple of days but there is as little tension as possible on the flap.
Jon
out of interest what technique was employed in his previous operations?
ReplyDeletei.e was he a bascom?
He'd had the works: wide excision with and without primary closure, what was described as a bascoms although the notes unclear and a couple of I+d for abscesses.
ReplyDeleteWould you have done a flap or something else?
Hi Megan - did you have a question or comment?
ReplyDeleteThis operation is very painful truth would rather not see the pictures, but I hope that after the surgical intervention, is healthy.,maybe you can Buy Cialis for pain
ReplyDeletehello, im 16 and may have to have this operation. i am so scared, what can you tell me in more detail about this?
ReplyDeleteHI Emily
DeleteSorry to hear you've got such bad pilonidal sinus disease.
I tend to reserve this operation for the worst cases (recurrence after other treatments or where the skin and fat are severely affected by recurrent infection so that they feel very woody over a large area).
The procedure is as in the pictures above. The affected tissue is removed in the big diamond shaped skin and fat, and the hole left is filled with fresh tissue from the buttock (as in the pictures above)
It works pretty well, but can be painful, bleed, get infected and can even recur sometimes. You'll be away form normal activities for a while after the operation until things heal.
If you're only 16 you might want to think about what the shape of your buttocks and the valley between them will be afterwards. The operation flattens the valley, which we think helps cure, but it will look different.
You should read around the subject (plently on line, including a few fora and blogs), adn discuss the alternatives with your surgeon. He or she should talk about all the options (doing nothing, fibrin glue (new treatment so they may not be familiar with this), and lateral closure techniques such as Bascom II and Karydakis procedures).
After you have all the info, its up to you. You should weigh up the benefits (how much getting rid of the pilonidal sinus disease is worth to you) vs the success rates and complications and time off school/work etc for each of the alternatives. You should then be able to come to a decision which is best for you at this moment and in the long run.
I hope this helps, and good luck with any operation you decide to have.
Jon
How close was the disease to his anus? Mines very close so I wonder if that will be an issue.
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