I had to have a pilonidal cyst drained.
The pain is gone, but there is still a little
drainage. Should anything be done about this?
There are some theories about the cause of
these odd infections, but in cases, it is hard
to explain why a given individual gets one. In
some cases, there is an ingrowth of hair across
the deep cleft between the buttocks. The hair
seems to actually grow outward from one side,
and into the skin on the other side. The hairs
can then continue growing, curling up into a
tight ball of hair and debris, until an
infection develops. In other cases there is no
hair ingrowth and the cause is not clear.
I had to have a pilonidal cyst drained.
The pain is gone, but there is still a little
drainage. Should anything be done about this?
Pilonidal cysts frequently recur, though they
may not cause any problems for years after the
initial infection. Surgery can be done to remove
the remaining cyst though this may not be
appropriate to do after the first episode of
infection. Surgery is not always curative,
unfortunately. Recurrence can occur probably up
to about 20% of the time, with most of the
surgical options. A number of different surgical
procedures have been tried through the years,
and different surgeons may have different
preferences.
One surgical procedure involves the removal
of much of the fatty tissue in the area where
the infection developed. The skin and
surrounding tissue is sewn back together to
close the defect. There is a possibility that an
infection will occur shortly after the surgery,
and this can require that the surgical incision
be re-opened. Although the incision will
ultimately heal even in this case, the incision
will require daily care with cleansing and
dressings for several weeks.
Another surgical procedure involves an
excision of the skin and fatty tissue in the
crease, down almost to the underlying bone.
Rather than closing the the incision, it is left
open and dressings are used in the open area for
6 weeks or more until it heals on its own.
Surgeons who use this technique feel that the
success rate is closer to 100%, but it is a very
difficult postoperative period for the patient,
because of the open area and the need for
dressing changes for so many weeks. And in
reality, there is still a recurrence risk.
Another surgical technique takes the
minimalist approach. This technique has come to
be known as the Bascom technique, named after a
surgeon in Oregon who has popularized it. This
technique is based on the theory that small hair
pits directly in the midline of the crease of
the buttocks are the root of the problem. Rather
than cut out a large amount of skin and
underlying tissue here, only the small "pits"
are individually removed. A counter incision may
be added, placed about 1 inch away from the
midline crease to help the underlying infection
drain away from the crease. A very
distinct advantage of this technique is that it
can almost always be done as an outpatient, with
local anesthesia. The time to return to normal
activities is less. Dr. Bascom does
recommend a more "invasive" procedure with
excision of tissue for recurrent and more
advanced cases.
Since there is a rather high infection risk,
a non-surgical approach may be considered after
the first episode, reserving surgery for
recurrent cases. The area must be kept
meticulously clean. The hair in the cleft should
be shaved regularly to prevent growth across the
cleft. Any pain or drainage should be promptly
reported to your surgeon, so that immediate
intervention can be made.
Return
to top of page
