What Is a Pilonidal Sinus?

Pilonidal sinus and Pilonidal cyst are collectively referred to as Pilonidal disese, which is a chronic sinus or cyst in the soft tissue of the cleft gluteal cleft, with hidden hair as its characteristic. It can also be manifested as an acute abscess of the palatine tail, forming a chronic sinus after perforation, or temporary healing, and eventually perforation. The cyst is accompanied by granulation tissue, fibrous hyperplasia, and often contains a tuft of hair. Although the disease can be seen after birth, it usually occurs in 20 to 30 years of age after puberty, and symptoms occur only due to increased hair fat gland activity.

Hairy sinus

Hidden hair sinus

Pilonidal sinus and Pilonidal cyst are collectively referred to as Pilonidal disese, which is a chronic sinus or cyst in the soft tissue of the cleft gluteal cleft, with hidden hair as its characteristic. It can also be manifested as an acute abscess of the palatine tail, forming a chronic sinus after perforation, or temporary healing, and eventually perforation, which can occur repeatedly. The cyst is accompanied by granulation tissue, fibrous hyperplasia, and often contains a tuft of hair. Although the disease can be seen after birth, it usually occurs in 20 to 30 years of age after puberty, and symptoms occur only due to increased hair fat gland activity.

Tibetan sinus pathology

TCM etiology and pathogenesis

There is a local foreign body in the tail or a combination of evil poisons, which leads to local stagnation of blood and qi, and steam and purulent rupture.

Western medicine etiology and pathology

The etiology of this disease is uncertain, and there are two main views:

Acquired acquired lesions are susceptible to cyst infection due to hair growth into the skin or subcutaneous tissue, and the sinus is not easy to heal ^[1] .

Etiology of Tibetan sinus

The true cause is unknown. There are two theories.

Hidden hair sinus -congenital

Inclusions of the skin due to residual medullary canals or malformations of the zygomatic cleft suture. However, with the baby's midline, the anal recession is rarely found as a precursor to hair-draining disease, and it is more common in adults.

Hidden hair sinus secondary acquired

Sinus and cysts are thought to be granulomatous diseases caused by injuries, surgery, foreign body irritation, and chronic infections. It was confirmed that the hair that entered from outside was the main cause. The gluteal cleft has a negative suction effect, which can make the shed hair penetrate under the skin. The hair in the fissure is too long and too long, and the top of the hair has the function of filtering and soaking the hair. The hair penetrates into the skin to form a short track, and then deepens into sinus. Changes in movement can be seen (Figure 2), but hair can be found in only half of the cases. The disease is more common in patients with hirsutism, excessive sebum activity, deep gluteal clefts, and frequent hip injuries. Car driver's tail skin is often subject to long-term bumps and injuries, which can cause sebaceous gland tissue and debris to accumulate in the sac, causing inflammation. This disease is more common in the US Army and is called jeep disease. Common germs are anaerobic, staphylococcus, streptococcus, and E. coli. Rainsbury and Southan analyzed resting hair disease with less than half a single bacterium and 58% anaerobic bacteria. Strangely, staphylococci are uncommon, and most aerobic bacteria are Gram-negative bacteria.

Differential diagnosis of hairy sinus

Should be distinguished from iliac, anal fistula and granulomatous. The tadpoles grow on the skin, protruding from the skin, and the top is yellow. There are multiple external holes and necrotic tissue inside. The external mouth of the anal fistula is close to the ***, the fistula is running towards the ***, there is a cord on the percussion, the inside of the anal canal has a history of *** rectal abscess. The direction of the Tibetan sinusoids is mostly cranial and rarely downward. Tuberculous granuloma is connected to the bone. X-ray examination shows bone destruction and tuberculous lesions in other parts of the body. Syphilitic granulomatosis has a history of syphilis and is seropositive.

Hairy Sinus Therapy

Hidden hair sinus surgery

Surgery is the main treatment method, but it is contraindicated when there is inflammation, and surgery should be performed after the inflammation subsides. There are several methods of surgery:

1. The first-stage resection suture removes all the diseased tissue, free muscles and skin, completely sutures the wound, and makes the first stage heal. In order to eliminate the deep intergluteal fissure and its negative pressure, and reduce wound dehiscence, hematoma, and abscess, Z formation is feasible (Figure 1). It is suitable for small, non-infective sinus tracts on the cyst and midline, with a recurrence rate of 0% to 37%. The advantages are short healing time, soft movement of scars formed in the gluteal cleft, soft tissue between the scar and sacrum, and can be tolerated. damage.

2. Partial suture was removed to remove the diseased tissue, and the skin on both sides of the wound was sutured with the sacral fascia, so that most of the wounds healed in one stage, and the middle part of the wound was healed by granulation tissue. It is suitable for cases with many sinus ostium and sinus tracts. The effect is the same as that of the primary suture removal, but the healing time is longer. 3. The secondary suture for open wound resection is suitable for cases of severe infection and for cases where incision and drainage of infected wounds occur during primary suture.

4. Excision wound opening is suitable for cases where the wound is too large to be sutured and the operation relapses. The operation is simple, but the healing period is long, and the scars formed are extensive. There is only a thin layer of epithelium, which is adhered to the sacrum. If there is damage, the scar is easy to rupture.

5. Bag-shaped suture is used to remove the surface part of the sinus wall and the skin of the upper cap, and wounds are made with intestinal or absorbable artificial sutures to promote healing. After careful postoperative care, satisfactory results are often seen. Mostly used in cases of unresectable or recurrent hairy sinus.

Non-surgical treatment of hairy sinus

The zygomatic coccyx fossa does not require treatment, because there is only a depression in the zygomatic coccyx joint, the lower part of the sacrum and the tip of the coccyx, without any symptoms, and it is clinically insignificant.

If infection occurs in the sacral tail sinus and sacral tail swelling, anti-inflammatory treatment should be performed to maintain local cleanliness. If abscesses are recurred, incision and drainage should be performed. However, the skin and subcutaneous tissue in the crotch tail are thicker and harder, and there is no obvious manifestation in the early stage. The inflammation often spreads to the surrounding tissues and causes cellulitis. Deep tissue necrosis should be incision and drainage early.

Sclerotherapy is the injection of corrosive drugs into the sinus, destroying the epithelium inside the sinus and the capsule, and closing the capsule cavity and sinus. Some people have used phenol solution injection therapy since 1960, but there are not many users, because the pure phenol solution is used, the pain is severe, and then it is changed to 80% concentration and performed under general anesthesia; a gelatinous substance is injected into the sinus to protect Surrounding skin. Hegge (1987) used 1 ~ 5ml of 80% phenol solution to slowly inject into the sinus, about 15min. Slow injection can prevent complications such as skin burns, fat necrosis or severe pain. This method can be repeated every 4 to 6 weeks, about half of the patients can be cured after only one injection, 12% need 5 or more injections. Of the 43 patients who were followed up for more than one year, only 3 (6%) relapsed. Stansby (1989) Inject 80% phenol solution into the sinus under general anesthesia, keep it for 1 minute, scrape the sinus, and repeat 3 times. Aseptic abscess occurred in 4 of 104 cases, and 1 case of bee disease tissue inflammation, no Other complications. Compared with 65 cases of surgical resection, the treatment rate was 86% of the resection and 75% of the phenol injection. The average follow-up was 8 months (March to 4 years), and 12 of the relapsed patients had recurrence of injection.

Clinical manifestations of hairy sinus

Hidden hair follicles are usually asymptomatic without secondary infections, but the tail of the palate is protruded, and some feel the pain and swelling of the palate. The main and first symptom is usually an acute abscess in the tail of the palate, with local redness, swelling, heat, pain and other acute inflammation characteristics. Many automatically break out of the pus or the inflammation subsides after surgical drainage. A small number of drainage ports can be completely closed, but most of them appear as recurrent attacks or frequent water flow to form sinus or fistula.

Irregular pores can be seen at the midline skin of the zygomatic tail during the stationary phase of the Tibetan sinus, with a diameter of about 1 mm to 1 cm. The surrounding skin is red, swollen and hardened, often with scars, and some hair is visible. Probe detection can penetrate 3 ~ 4mm, some can penetrate 10cm, and it can discharge thin odorous liquid when squeezed. Acute onset of acute inflammation, tenderness and redness, discharge of more purulent secretions, and sometimes abscesses and cellulitis.

Postoperative Nursing of Hairy Sinus Sinus

^[2] If the wound can be closed, this will need to be kept clean and dry until the skin is fully healed. If the wound must be suspended, a dressing or package will need to help clear the secretions and allow the wound to heal, from bottom to top.

After healing, the skin on the hip creases must be kept clean and free of hair. This is done by shaving or using a depilatory every two or three weeks until the age of 30. After 30 years of age, hair shafts become thinner, softer, and hip cracks become deeper.

Hidden hair sinus prognosis

Cancer was rare in the hairy sinus, and only 32 cases were reviewed by Phipshen (1981). The lesions were mostly well-differentiated squamous cell carcinomas. Changes in the wound should cause suspected canceration, such as ulcers that break easily, grow quickly, and get out of the car and mold-like edges. Extensive resection should be preferred. As the wound is widely used to treat skin grafts or flaps. Inguinal lymphadenopathy should be biopsied to exclude metastasis. If there is metastasis, the prognosis is poor. The 5-year survival rate in the literature is 51%. The recurrence rate was 50%. Metastasis of the inguinal lymph nodes was found in 14% at the initial diagnosis.