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06-04-2008, 09:08 AM
m Definition: Hair containing sinus or abscess.
m Aetiology:
(I) Congenital theory: Infected dermoid cyst
(II) Acquired theory: Moreaccepted now why?
1- Common in Male > Female (Hirsute individuals) adult > child.
2- Other sites (axilla - umblicus).
3- No hair follicles and tip of hairs directed inwards.
4- The wall of the sinus lined by granulation tissue.
m Clinical Picture:
1) Sinus over the sacrum in the upper part of anal cleft in the middle line discharging purulent fluid containing hair.
2) If the opening is closed, with thick pus, it will give pilonidal abscess with more pain, tenderness & constitutional symptoms.
m Treatment :
(I) Abscess: Drainage then treated as sinus when infection subsides.
(II) Sinus:
1- Excision of the sinus with safety margin:
a- Excision of an ellipse of the tissue containing sinus and all side tracks followed by suturing "High recurrence"
b- Excision, then leaving the wound open to heal by granulation tissue.
Recurrence is low but long period for healing, (2:3 months).
2- Marsupilisation:
Opening the main and side tracks and trimming of edges then leave to heal by granulation tissues. "Low recurrence" in (short period 4:6 weeks)
3- Excision and closure of the cleft using fasciocutaenuous flaps.
SOURCE: DR. AYMAN SALEM'S BOOK
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