Pilonidal Cyst and Sinus Follow-up

Updated: Mar 16, 2017
  • Author: Alex Koyfman, MD; Chief Editor: Gil Z Shlamovitz, MD, FACEP  more...
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Follow-up

Further Outpatient Care

First, packing removal needs to be performed. Generally, a formal wound check should be offered to the patient in the ED or office in 1-2 days, with removal of the packing at that time and redressing of the wound. However, if the patient is reliable and unwilling to return to the ED, he or she can remove the packing at home as long as care is taken to ensure that the ribbon is completely intact when removed. Once packing is removed, site cleansing with warm shower water or sitz baths should begin right away and be taken 2-3 times per day. A clean dressing should be applied after cleansing and continued until the abscess cavity has closed primarily.

Surgical follow-up is recommended in about 1-2 weeks. This allows the surgeon to examine the wound for healing, assess for potential recurrence, ensure that no other diagnosis and therapy should be considered, as well as arrange for definitive care of the sacrococcygeal region if necessary. [8, 4] At least some literature suggests that conservative therapy with good local hygiene and site shaving every 1-3 weeks have been shown to be as effective in preventing recurrence as a secondary surgical procedure. [1]

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Complications

Recurrence of the abscess is by far the most common complication. Most literature reviewed quote a rate between 40% and 50%, although 58% will heal primarily by 5 weeks.

Primary incision and drainage seems to clearly be the primary mode of treatment; for recurrent disease presentations, a multitude of surgical techniques, from incision and curettage and marsupialization to wide excision with flap procedures, have been described throughout the years. A continuum seems to exist, from fairly simple to more complex procedures that should be offered to patients as needed given their particular needs; obviously, the surgeon's own training and experience will factor into the operative decision. [3, 1]

A Cochrane Database of Systematic Reviews article published in 2007 showed no significant difference in outcomes between techniques involving primary closure versus healing by secondary intention, though the review did recommend off-line closure when primary closure is performed. [15] A series of treatments of the local region with phenol have also been described, with a low incidence of recurrence reported. [1]

Wound infection after primary incision and drainage is rare but described. At least one article suggests broad-spectrum antibiotics should be administered given the possibility of both aerobic and anaerobic infection at the incision site. [4]

Squamous cell carcinoma after recurrence of pilonidal disease has been described; it is rare in incidence but, when diagnosed, requires en bloc surgical resection and appropriate oncologic care with local radiation and possibly chemotherapy. [1]

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Prognosis

Long-term prognosis for pilonidal disease is excellent and mortality is practically nil, unless squamous cell carcinoma develops, though abscess recurrence is common as described above.

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Patient Education

Resources the articles Pilonidal Cyst, Boils, and Abscess. Also, see the Skin, Hair, and Nails Center.

Pilonidal Support Alliance is a web-based support group and information for patients with pilonidal disease, particularly of a recurrent nature.

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