PMC4060288_01
Demonstration of the complex pilonidal sinus disease with multiple pits on and beside the natal cleft.
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His physical examination revealed a chronic PSD, including hair follicles with multiple pits in the natal cleft as well as on both sides of the gluteal cutaneous tissue (Figure 1).
Landmarks of the incision.
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The buttocks were spread and taped to make the sinus holes and the intergluteal sulcus more visible. The area to be incised was marked (Figure 2).
Demonstration of the patient's operation: (a) resection of the pilonidal cyst and the sinus tracts with the underlying subcutaneous tissue and fat; (b) a relaxation incision was made in the fascial layers of the wound edges, by incising the gluteus muscle fascia vertically on either side, which allowed rotation of the skin and the underlying tissue for tension-free primary closure; (c) both wound edges were approximated subcutaneously with deep interrupted sutures using 0 polyglactin; (d) a closed suction drain was inserted in the cavity.
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After resection of the pilonidal cyst and the sinus tracts (Figure 3(a)), a relaxation incision was made by incising the gluteus muscle fascia vertically on either side, which allowed rotation of the skin and the underlying tissue for tension-free primary closure. Both wound edges were approximated subcutaneously with deep interrupted sutures using 0 polyglactin (Vicryl, Ethicon, Johnson & Johnson Medical, Somerville, NJ, USA) (Figures 3(b) and 3(c)), and the skin was closed by mattress sutures with 3/0 polypropylene (Prolene, Ethicon, Johnson & Johnson Medical, Somerville, NJ, USA) (Figure 3(d)).
Postoperative appearance of the operative field at the end of one-year followup.
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At the end of one-year followup, the patient is now disease-free and comes for routine checkups (Figure 4).