Technical options in treatment of pilonidal sinus and hidradenitis suppurativa

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Treatment of PS is depends on the disease presentation. Abscess, chronic sinus, complexity of sinus, chronic recurrent of pilonidal abscess affects the treatment strategy. Each statement has different management option but wide, meticulous shaving and hygiene always should be main part of the all of the management options. In patients, presenting initially with simple midline pits or sinus tracts without acute abscess shaving can be offered as the initial treatment. During both primary and postoperative healing phase, shaving should be continued on a weekly treatment. Patients with acute pilonidal abscess require incision and drainage, ideally making the incision lateral to the midline. Dressing change, baths and shaving should be continued until the wound has healed. The majority of acute abscess treated in this way do not occur. Many patients will present initially with chronic pilonidal sinus. Location of the sinus will help to choice to management way. In the case where all the disease sinuses and pits are located near and in the midline, the conservative midline excision or unroofing with curettage may be the first step treatment. However if the multiple draining sinuses exist and they are located far away from the midline, the simple excision may cause large wound defects. In these situations cleft lift procedures (Bascom) or excision with a rhomboid flap recon- and scarring. Management of the wound after total excision should be tailored to the individual patient. Although the incidence of squamous cell carcinoma is rare but it is the most serious complication of HS. The diagnosis and treatment of anal fistula and anorectal infection is a cornerstone of any busy and dedicated colon and rectal surgeons? practice. Pilonidal sinus (PS) is not strictly a disease of the anus, because of its proximity to the anus and the occasional difficulty in differentiation from anal fistula, these patients commonly referred to a colon and a rectal surgeon for the treatment1. Hidradenitis suppurativa (HS) which occurs more frequently in other areas of the body can be a diagnostic problem when it has seen and suspected in perineal area1,2. Both PS and HS may present as a prolonged and long-suffering course of treatment for the patient and surgeon. This paper reviewed the treatment options of PS and HS briefly.