Management of Interdigital (Pilonidal) Cyst
Surgical excision with complete removal of the cyst and sinus tract is the definitive treatment for interdigital pilonidal cysts, with consideration of flap closure for extensive defects or recurrent cases.
Understanding the Condition
Interdigital pilonidal cyst is a rare occupational disease caused by repeated implantation of foreign hair into the interdigital web space, most commonly affecting barbers and hairdressers 1. Unlike the provided evidence on various other cyst types (pineal, pancreatic, ovarian), this specific entity requires a distinct management approach focused on complete excision.
Primary Treatment Approach
Initial Surgical Management
- Complete excision is the standard of care after administration of methylene blue to visualize the full extent of the cyst and sinus tracts 1
- The goal is complete removal of all cystic tissue and associated sinus tracts to prevent recurrence 1
- Simple excision alone may be sufficient for primary, uncomplicated cases 1
Closure Considerations
For extensive resections or secondary/recurrent cases:
- Skin flap closure becomes necessary when the defect is too large for primary closure 1
- The dorsal metacarpal artery perforator flap is an excellent option with minimal donor site morbidity 1
- This flap provides robust skin coverage that may prevent further hair penetration into the web space 1
Key Clinical Pitfalls
Common presentation patterns to recognize:
- Frequent periods of swelling and purulent discharge in the web space 1
- The second and third web spaces are most commonly affected 1
- Occupational history (barber, hairdresser) is a critical diagnostic clue 1
Surgical planning essentials:
- Methylene blue injection preoperatively helps delineate the complete extent of disease 1
- Incomplete excision leads to recurrence, making thorough visualization crucial 1
- Plan for potential flap coverage in recurrent cases or when extensive debridement is anticipated 1
Recurrence Management
For recurrent interdigital pilonidal sinus, more aggressive surgical management is warranted with flap reconstruction to provide durable coverage and prevent re-implantation of hair 1.