Pilonidal Surgery and Flap Closure
Jun 1, 2016 @ 08:14 PM — by Shareef Jandali M.D.
Pilonidal Surgery in Connecticut, New York, and Massachusetts
Dr. Shareef Jandali is a Board Certified Plastic Surgeon who performs pilonidal surgery with flap closure. His modified flap technique for pilonidal reconstruction has a limited scar, minimal discomfort, and low recurrence rate.
What is pilonidal disease?
Pilonidal disease affects the gluteal crease area in men and women. There are openings or pits in this area that occur for an unknown reason. It could be from ingrown hairs that build up fluid and form a pilonidal cyst. The fluid eventually forms a tract and drains into the crease or on either side of the buttock.
What happens when pilonidal disease becomes infected?
If the cystic fluid cannot drain freely, it builds up underneath the skin and can become infected. If this occurs, the area gets red, warm, and tender to touch. Once infected, it usually needs to be surgically drained in the Emergency Room or by a surgeon. The drainage does not cure the pilonidal disease, but allows the infected fluid to drain out and the patient is treated with antibiotics.
What are the symptoms of chronic pilonidal disease?
Often the area does not become acutely infected, but becomes chronic. It often drains a small amount of bloody fluid on a daily basis. It usually doesn't cause pain when it is chronic and not infected. However, it is quite a nuisance and can be embarrassing to have drainage onto one’s underwear or clothes.
How is pilonidal disease treated?
Surgery for pilonidal disease involves removal of the diseased area, including the pits, cysts, and sinus tracts. This is usually performed by a general surgeon or a colorectal surgeon. There are options after removal of the diseased tissue:
- Closing the wound with sutures. This avoids having an open wound but also has a high complication rate and risk of the wound opening, becoming infected, and having the pilonidal disease come back.
- Leaving the wound open to heal on its own. Patients have to do sitz baths to keep the area clean and have to do dressing changes until it heals. This conservative approach is often performed to avoid the high complication rate with closing it. However, the wound can take months to close and may never close. It can lead to chronic granulation tissue in the area which can easily bleed and become even more of a nuisance than the original pilonidal disease.
- Flap closure. This method allows the incision and scar to be moved out of the deep moist gluteal crease area and heal more easily and under less tension. However, this technique is a larger surgery and can lead to larger scars, depending on which flap technique is used.
What is the best flap technique for pilonidal disease?
Dr. Jandali performs his own modified version of a combination of the Karydakis flap and the Cleft Lift procedure. These flaps for pilonidal reconstruction are performed at the same surgery as the removal of all diseased tissue. Both of these procedures have been proven to be successful in studies on hundreds of patients and have low recurrence rates. Dr. Jandali modified some aspects of both of these flap procedures for a quicker recovery and lower chance of complications.
During this procedure, the diseased tissue is removed, as well as the remainder of the diseased cleft with its pits and any potential ingrown hairs. All of the deep tissue is spared to avoid a large space which can accumulate fluid and cause more pain after surgery. A flap of skin from one side is then advanced to the other side to make the crease more superficial and move the scar outside of the deep indented crease. This has been shown to aid in healing and lower the chance of recurrence.
Are there nonsurgical treatments for pilonidal disease?
There are no proven medications to treat pilonidal disease. An infection or abscess can be treated with antibiotics but it does not cure the pilonidal disease. The only known cure for pilonidal disease is surgery. After surgery, there are some small studies which show that laser hair removal may have a beneficial effect on preventing recurrence of the pilonidal disease.
What should I expect on the day of pilonidal surgery?
The surgery is performed under general anesthesia, so you are completely asleep and don't feel anything during the surgery. Long acting local anesthesia is injected for pain control immediately after surgery. The wound is completely closed and no packing or dressing changes are required. The entire procedure takes about 1 hour.
There are two temporary drains placed during surgery that come out of the skin just above the scar. These prevent fluid from building up which can cause the incision to open up and delay healing. A large soft gauze dressing is applied on top of everything. This is an outpatient procedure and patients go home after surgery.
How is the recovery after pilonidal surgery?
Patients have minimal discomfort after surgery. Pain medication and antibiotics are given. There antibiotics cover bacteria that are on the skin and in the stool.
After pilonidal surgery and flap reconstruction, patients are to avoid sitting for two weeks after surgery. Standing, lying on one's back, and lying on one's chest/abdomen are fine. Sitting can put excessive tension on the scar.
Patients are instructed to remove the dressings when they have a bowel movement. They should then shower after each bowel movement for the next two weeks and vigorously wash the area and incision with soap and water. The drains are usually both removed in the office 1 week after surgery.
What is the scarring after flap closure for pilonidal surgery?
Patients are often nervous about scarring after pilonidal surgery. Doing a Google search for "pilonidal flaps" shows some large and disfiguring scars that other surgeons have tried. However, the scarring after Dr. Jandali's flap procedure is limited, does not extend onto the buttock, and heals very well. The patient's scar seen to the right is two months after pilonidal removal and flap reconstruction.
Is plastic surgery flap closure of pilonidal disease covered by insurance?
Insurance companies always cover flap closure after pilonidal removal. It is considered reconstructive surgery. For specifics of your insurance benefits, including your deductible and co-insurance, please contact your insurance company.
If I live out of state, can I still set up surgery with Dr. Jandali for pilonidal surgery?
Yes, we will coordinate your surgery from consult to surgery to recovery, and make the process easy and straightforward. We will provide all instructions for after surgery at the time of your consultation.
If you think you may have an active pilonidal abscess or infection, please do not wait for a visit with us. Visit your local Emergency Room or general surgeon for appropriate care and possible drainage and antibiotics.
Contact Us for Pilonidal Surgery and Reconstruction
If you are afflicted with pilonidal disease, schedule a consultation with Dr. Shareef Jandali today. Call 203-374-0310 to set up an appointment. We look forward to seeing you.