From the Guidelines
Surgical intervention, specifically deroofing or excision, is the recommended treatment for a tunneling pilonidal cyst. The goal of treatment is to alleviate symptoms, prevent further complications, and improve quality of life. According to the North American clinical management guidelines for hidradenitis suppurativa, recurrent nodules and tunnels, such as those found in tunneling pilonidal cysts, may be best treated with deroofing or excision 1.
Treatment Options
- Deroofing: a surgical procedure that involves removing the roof of the cyst to promote healing and prevent further infection
- Excision: a surgical procedure that involves removing the entire cyst, which may be necessary for extensive chronic lesions
- Incision and drainage: may be recommended only for acute abscesses to relieve pain, but is not a definitive treatment for tunneling pilonidal cysts 1
Postoperative Care
- Wound healing may occur through secondary intention, primary closure, delayed primary closure, flaps, grafts, and/or skin substitutes 1
- Continuing medical therapy in the perioperative period is likely to be beneficial and poses minimal risk of increased postoperative complications 1
- Proper wound care, including keeping the area clean and dry, changing dressings as instructed by the healthcare provider, and completing the full course of any prescribed antibiotics, is essential for promoting healing and preventing infection.
Conservative Management
- Regular cleaning of the area with mild soap and water
- Hair removal around the site through shaving or laser treatment
- Sitz baths for 15-20 minutes several times daily to reduce inflammation
- Pain management with over-the-counter medications, such as ibuprofen or acetaminophen, as needed.
It is essential to note that tunneling pilonidal cysts can lead to chronic infection, abscess formation, and significant discomfort if left untreated, which is why surgical intervention is often necessary for definitive treatment.
From the Research
Treatment Options for Tunneling Pilonidal Cyst
- Surgical treatment is the principal method of treatment for pilonidal cysts, including tunneling pilonidal cysts 2
- Several surgical techniques have been proposed, including excision of the cyst with open or closed wound for healing, incision and curettage, and flap reconstruction 2, 3
- Excision with primary closure and excision with flap reconstruction are two common surgical techniques used to treat pilonidal disease, with flap reconstruction showing superior results in terms of reducing morbidity, healing time, and recurrence rates 3
- The use of antibiotics, such as metronidazole, may be beneficial in preventing infection-related wound complications after pilonidal sinus excision 4
- Closed incision negative pressure therapy may also be used to promote healing and reduce pain after pilonidal cyst excision 5
Surgical Techniques
- Excision with primary closure: This technique involves removing the pilonidal cyst and closing the wound with sutures 3
- Excision with flap reconstruction: This technique involves removing the pilonidal cyst and reconstructing the area with a flap of skin and tissue 3
- Incision and curettage: This technique involves making an incision in the pilonidal cyst and scraping out the infected tissue with a curette 2
Recommendations
- Minimal surgical procedures, such as the Gips procedure or sinusectomy, may be more appropriate as first-line treatment for pilonidal disease due to faster recovery and patient preference 6
- Excision with midline closure should be avoided due to high recurrence rates and patient discomfort 6
- Flap repair is acceptable and preferred by patients over healing by secondary intention for recurrent or persistent disease 6