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Sinus pilonidalis
(hairy cyst)
Sinus pilonidalis is a tubelike ulcer which is caused by ingrowing hair. Generally it occurs in the buttock slit. Characteristic is returning inflammation, pain, swelling and from time to time pus production. Treatment is possible by excision of the complete area (click here) or injection with an etching fluid in the fistula as a result of which it shrivels (for the smaller lesions, like in the example shown below).
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This patient was operated on before and a small sinus recurs. It is decided to treat this under local anesthesia. In 1 the opening of the sinus can clearly be seen in the scar. In 2 the local anesthesia is administered and then vaseline (3) is put around the opening. This is to protect the skin from the fluid that is used to scar the sinus. Nevertheles, some leakage mostly occurs around the sinus.
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With a special instrument the sinus is cleaned (4-7).
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Fenol, an etching fluid, is then introduced in the sinus and left there for a minute (8,9). Then it is removed and the procedure is repeated one more time. In this way an inflammatory response is evoked that results in healing of the sinus. In 10 the white discoloring is seen as a result of the chemical burn. The aftertreatment consists of showering two times daily. Sometimes the whole procedure has to be repeated with an interval of several weeks.