Sacral Cyst or Pilonidal Sinus


Introduction

The sacral cyst, also called sinus or pilonidal cyst, is a benign disease of the subcutaneous tissue of the sacrocoxygeal area characterized by the formation of a chronic infectious process, secondary to hair invagination in the skin fold that separates the glutei. The main factors that favour this pathology, frequent and typical in young people, are: sweating, anatomical shape of glutei and hair.

Such infection can cause symptoms of pain and swelling, cause an abscess, or develop a fistula that shows as a pustule that continuously or occasionally suppurates.


Treatment

The treatment consists of making an incision at the injury site, carrying out curettage and removing the diseased tissue, without stitches; leaving it to heal spontaneously. It is not necessary to cause large wounds. If the injury is extensive, it may be necessary to close the wound with a fat and skin flap.

In most of the cases, an adequate incision is enough to allow a complete cleaning inside the injury and to follow a good postoperative hygiene at home. In addition to a correct procedure, it is recommended a regular monitoring by the surgeon to ensure that the healing process progresses properly, avoiding premature closure of the wound.

In case of large lesions or multiple fistula paths, it is essential to eliminate the disease completely to avoid recurrences. In these cases, it is preferable to close the wound because, if left open, it may take several months to heal, with a severe aesthetic defect. However, the closure of these large wounds in that area of the body should not be carried out directly by joining the edges together because there is a lot of tension and they would open. It is convenient to close the defect with a flap, which consists in moving a part of the healthy tissue from the edge of the wound inwards, so as to cover the gap and be able to suture it without tension. By using these techniques, scarring will be faster and the return to social and work activity easier, as well as a much better aesthetic result will be achieved.


Benefits

Surgery is the only cure for this disease. The continuous or frequent discharge of pus from the wound is a very uncomfortable situation because it causes moisture, staining and unpleasant smell. The opening and curettage of the lesion allow stimulating the regeneration of a new and healthy tissue that can heal in a few weeks without a painful process or restricting the patient’s usual social and working activity.


Postoperative

Closing the wound with a healthy flap tissue adjacent to the injury is a technique that allows a faster scarring and a less uncomfortable healing process.

The opening and curettage of the lesions, with no major wounds, allow healing through a non-painful process of progressive spontaneous scarring that is completed in 3-4 weeks, without restricting the usual social and working activity.



Expert opinion

Dr. Domenico Fraccalvieri
Dr.  Domenico Fraccalvieri

In this surgery, it is not necessary to remove large amounts of skin and underlying fat for the treatment of the sacrocoxygeal cyst or pilonidal sinus, and only involves a major aesthetic defect and a huge delay in healing.

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