Dr. Som has focused his years of training and expertise to the treatment of Pilonidal Disease. By using his background and training in general surgery combined with his training in Plastic Surgery, Dr. Som has brought a new technique for resection and reconstruction that leads to cure with a more aesthetic centrally placed scar. Thereby, giving patients the optimal outcome aesthetically and functionally. He will tailor a plan and treatment specifically for you or your loved ones and with his expert team take you through the entire process.
What is Pilonidal Disease
Pilonidal disease, or pilonidal cyst is a cyst overlying the tailbone formed when skin or other skin appendages – particularly hair form inward rather than outwards (similar to an ingrown hair). These cysts get infected resulting in pain, redness and drainage along with or without fever or chills. These may open and drain on their own or often require oral antibiotics along with a drainage procedure to let the infection resolve. Once the infection is resolved then more definitive treatment can be performed which usually includes removal of the cyst and any of its tracts followed by local wound care for healing versus reconstruction. Dr. Som has done extensive research on the presentation and treatment of Pilonidal disease including education of other surgeons in local and national meetings on Pilnonidal disease and its treatment.
Procedures
Indications for Surgical Treatment
The decision to operate on those with pilonidal disease depends on the state of the affected area. If there is an acute infection, the first step will be to address the infection with antibiotics as well as a first stage drainage. As the infection clears, a more definitive treatment will be pursued. In order to properly treat the pilonidal disease a wide excision may be necessary to remove the disease bearing tissue followed by reconstruction using plastic surgery reconstructive techniques.
Surgical Techniques
- Incision and drainage
- Incision and drainage with removal of overlying skin, allowing to heal in with time (healing by secondary intention)
- Wide excision of diseased tissue and allowing healing with time (healing by secondary intent)
- Wide excision of diseased tissue and Reconstruction
- Reconstruction with flap closure – bilateral buttock flap with midline closure – optimizes cosmetic results with more natural appearance and location of scar
- Rhomboid flap closure
- Other flap reconstruction
Risk Factors
There are a few known predispositions to pilonidal disease, including but not limited to:
- Family History
- Spina Bifida Occulta (Fetal developmental problems)
- Large amount of hair in the tailbone and intergluteal area
- High impact activities to the intergluteal/tailbone, i.e. horseback riding
- Activities that create friction in the intergluteal/tailbone area, i.e. improper or too much sitting, over-weight, tight clothes
- Hair follicle problems i.e. acne, boils, sebaceous cysts, hidradenitis suppurativa
- Trauma to tailbone/intergluteal area
- Dermatologic conditions, i.e. eczema
Contact Us
If you have any questions about Pilonidal disease or other plastic surgery procedures, or wish to schedule an appointment for an initial consultation, please contact us today.