Recurrent Sinuses Research Articles

MRI findings of preauricular sinus: a case report

BackgroundThe preauricular sinus (PS) is a benign congenital abnormality affecting the soft tissues in the preauricular region. Diagnosis is typically clinical and routine imaging is usually unnecessary in symptomatic cases, but individuals with recurrent sinuses or previous unsuccessful surgeries may benefit from pre-operative imaging. Furthermore, PS may be detected incidentally during head and neck magnetic resonance imaging (MRI), emphasizing the need for radiologists and ear, nose, and throat specialists to be familiar with its characteristics. Notably, there is a gap in the existing literature regarding the MRI description of PS.Case presentationWe present the case of a 19 year-old man complaining of pain in the right external auditory canal. During the physical examination, a small depression was observed at the front edge of the ascending limb of the helix with the discharge of particulate material. Suspecting a PS, further investigation through an MRI examination was requested. The contrast-enhanced MRI documented a PS characterized by a small superficial subcutaneous cyst located in front of the right external auditory canal at the front edge of the ascending limb of the helix, behind the superficial temporal artery, and behind and above the parotid gland. The cyst showed restricted diffusivity (due to purulent content) and was surrounded by inhomogeneous adipose tissue with contrast-enhancement (due to inflammatory phenomena).ConclusionsTo the best of our knowledge, there is a lack of clear description of MRI semeiotics of PS in the literature and this case helps to fill that gap. MRI could play a role in the pre-surgical planning of complex PS cases. Additionally, a comprehensive understanding of the MRI appearance is essential for distinguishing PS from other diseases, such as branchial fistulas, epidermal inclusion cysts, and trichilemmal cysts.

In Their Own Voices; Living with Hidradenitis Suppurativa: A Qualitative Study.

To provide a deeper assessment of the lived experience of patients with hidradenitis suppurativa, a chronic inflammatory disorder characterized by recurrent abscess, sinuses, and scars. This study used a phenomenologic approach. Researchers recruited 10 participants via purposive sampling. Data were collected via semistructured, in-depth, face-to-face interviews, and interpretative phenomenologic analysis was performed. Data analysis uncovered two primary themes among participants' interview responses: "unending symptoms" and "life becoming hard." The symptoms of hidradenitis suppurativa negatively affect individuals' family, professional, and daily lives, and patients may benefit from psychiatric intervention.

Hair in the Wrong Place

Introduction: The preauricular sinus is a congenital abnormality which was initially identified by Van Heusinger in 1864. Preauricular sinus development is strongly related to the development of auricle in the sixth week of pregnancy. Preauricular sinus can be inherited or are sporadic. Most cases are sporadic and over half of all cases are unilateral. Bilateral cases are more frequent in inherited cases. Case Report: A 10 year old boy was brought with complaints of discharge from left pre auricular region on and off since birth. History of frequent episodes of discharge from left pre auricular region about 2-3 episodes per year. Local examination showed preauricular sinus tract at the root of helix on both sides. There was no discharge, no warmth, no tenderness. The child underwent necessary investigations and pre aneasthetic fitness was obtained. Pre auricular sinus tract excision on left side under general anasthesia was done. Multiple sinus tracts were excised and sent for histopathological examination which showed evidence of pilonidal sinus. There was presence of sinus tract line by epidermis, lumen filled with keratin and hair shafts. The child was brought for follow up on postoperative day 10, the sutured site was found to be healthy. Suture removal was done and the wound was healing well. The child is on regular follow up and has shown no signs of any recurrence. Discussion: The only definite treatment of recurrent infective sinuses is complete excision of the sinus tract. In our case, supra aural elliptical incision was placed and all visible sinus tracts were cleared and sent for histopathological analysis. When these sinuses get infected, most frequent cause being with gram-positive bacteria, the exudates should be sent for culture, and the appropriate antibiotics should be administered. The temporalis fascia, the cartilage of the helix, and the auditory canal are identified using the supra-auricular approach. An en bloc excision of the sinus is then carried out. Pilonidal sinus is a difficult condition that causes suffering and embarrassment to its victims. Despite it being rare and atypical, pilonidal sinus could also occur in the auricular region. Although pilonidal sinus has been reported in a number of uncommon areas of the body besides the sacrococcygeal region, this is the second case of pilonidal sinus that we are aware of in the preauricular region that is reported in literature. Conclusion: Thus we present a very rare case of pilonidal sinus in pre auricular region. Only two cases have been reported till date in literature and our case is the second one to be reported in the pre auricular region.

DIAGNOSTIC DILEMMA AND TREATMENT CHALLENGES IN IDIOPATHIC GRANULOMATOUS MASTITIS

Objective: To outline diagnostic difficulties and problems in the treatment of Idiopathic Granulomatous Mastitis
 Study Design: Prospective observational study.
 Place and Duration of Study: Breast clinic, Combined Military Hospital Rawalpindi, from Aug 2019 to Jul 2020.
 Methodology: Patients with tender mass with or without signs of inflammation, mass with abscess, sinus formation, and with recurrent abscesses were included. Those cases were labelled as IGM whose histopathology showed granulomatous mastitis with no evidence of malignancy and tissue cultures were negative. Patients with mild to moderate symptoms were treated with reassurance, analgesia and multivitamins. Abscesses were treated with incision & drainage and empirical antibiotics for 1-2 weeks. All these patients were followed at 1, 3, 6 and 12 months.
 Results: A total of 35 patients fulfilled the criteria for Idiopathic Granulomatous Mastitis and were included in the study. Two patients had lactational abscess, 3 had bilateral disease and 1 patient was with diabetes 0% patients were having mass with abscess; spontaneous resolution was observed in majority of them with a few requiring incision and drainage. Of 31.4% presented with tender mass only; majority of them resolved with observation, except mass excision in two patients, 19.7% presented with discharging sinuses with underlying mass; among them 71% responded to conservative treatment while 29% were treated with anti-tuberculous therapy for recurrent sinuses. 8.5% presented with spontaneously ruptured abscesses with sinuses; they were managed conservatively.
 Conclusion: We concluded that Idiopathic Granulomatous Mastitisis a benign self-limiting disease which can be effectively managed with conservative treatment.

Outcome of Excision with Primary Midline Closure for Sacrococcygeal Pilonidal Sinus Disease

Sacrococcygeal Pilonidal sinus disease is common chronic inflammatory disease affecting chiefly young adult male . It cause much discomfort and morbidity and affect negatively the quality of life of patients. There are various techniques of surgical treatment for the chronic sinuses but still there is no gold standard one. The aim of this study to report our experience with excision and midline closure technique of chronic Sacrococcygeal Pilonidal sinus disease and to identify the outcome of the procedure for postoperative wound complications and recurrence rate. This is a retrospective study with telephone contact and review of 36 patients operated for Sacrococcygeal pilonidal sinus disease from January 2011 through January 2016 under care of one consultant surgeon (the Author) in Public and Private Hospitals in Rania, Sulaimani, Iraq. Inclusion criteria was all patients with chronic midline located sinuses without evidence of acute inflammation. Exclusion criteria was all infected ,off midline located sinuses and recurrent sinuses. Elliptical Excision of the sinuses with primary midline closure over a vacuum drainage performed. End point of this study was rate of wound complications and recurrence of sinus. Thirty six patients with median age 22 years (range 14-40) with 24/12 male /female ratio. Median follow up was 24 months (12 - 66 months), the recurrence occurred in 3/36 ( 8.3%) patients at a median of 12 months (range 5 - 48), failure of treatment in 5/36 (13.9%) patients, and postoperative wound complications was seen in 5/36 ( 13.9%) patients. In the conclusion, excision and primary midline closure is simple, effective and preferable procedure for management of uncomplicated Sacrococcygeal pilonidal sinus disease associated with early wound healing and low rate of postoperative wound complications and recurrence rate.

Hidradenitis Suppurativa, Can Be Fatal: Case Report

Hidradenitis Suppurativa (HS) is a relatively common chronic debilitating skin condition characterized by recurrent abscesses and sinuses formation on apocrine sweat glands bearing areas. Although immune modulating therapies have been popular lately but definitive surgery with wide excision and reconstruction can provide permanent cure for the involved areas. Here we are reporting an unfortunate case of a 47 years old male who has been suffering from HS in the buttocks and perineum since adolescence. Patient was first seen 8 years back and he was advised to consider wide surgical excision and skin grafting. Patient did not accept this solution and kept undergoing alternative treatments with prolonged courses of antibiotics as well as steroids. Eventually he presented with fungating areas in the gluteal region which proved to be moderately differentiated squamous cell carcinoma (SCC). Sacrum was already invaded with the disease and has metastasized to regional lymph nodes, liver and lungs. Patient was treated as palliative including conservative surgical debulking and skin grafts. He received further oncologic treatment in a different center overseas. Unfortunately developed brain metastasis and expired two years following diagnosis of Marjolin’s ulcer (MU). Patients with chronic HS, recurrant infections and sinuses must be encouraged to seriously consider definitive surgical treatment to eliminate the risk of such long term fatal complication of their disease.

An Update on Health-Related Quality of Life and Patient-Reported Outcomes in Hidradenitis Suppurativa.

Hidradenitis suppurativa is a common inflammatory skin condition which causes recurrent abscesses, sinuses and scarring in the axillae, groin and inframammary areas. As well as causing significant physical distress due to pain and discharge, the condition impacts psychological well-being with markedly impaired quality of life. Patients suffer pain, embarrassment and psychological distress with impairment of their work and intimate relationships marking it as one of the most distressing dermatological conditions. Numerous studies have documented markers of psychological distress encompassing the physical effects such as pain and itch, affects on mood and impaired function.

Recurrent sternal sinuses caused by retained temporary epicardial pacing wires and different wire fixation techniques

Temporary epicardial pacing wires are routinely used after open-heart surgery without any major complications, but varied complications have been described with their use though rare. They are often pulled out after recovery of the patient, usually on the 4th postoperative day, but sometimes, they are cut flush with the skin, especially if they are not coming out after the usual amount of pulling force. We describe a patient who had recurrent sternal sinuses with retained pacing wires which were missed on imaging. We emphasize on the importance of proper fixing of epicardial pacing wires during cardiac surgery, the need for their complete removal after recovery and the need of documenting the same in discharge summaries if they are cut flush and retained in situ.

Retrospective analysis of 30 cases of pilonidal sinus by various techniques of conservative and surgical management and review of literature

Background:The pilonidal sinus disease may present as chronic cutaneous infection, pilonidal abscess, pilonidal sinus or recurrent pilonidal sinuses. There are several conservative non-surgical and surgical methods of treatment of pilonidal sinus. The wound healing of pilonidal sinus depends upon multiple factors such as the stage at which patient presented to the surgeon, co-existing medical conditions, method of medical/surgical treatment chosen and the expertise of the surgeon. Here we are presenting the retrospective analysis of 30 cases of pilonidal disease, in view of different modalities of treatment, challenges faced, post-operative results and hospital stay.Methods: Over a period of 7 years, 30 patients suffering from various stages of pilonidal sinus disease were treated by conservative and surgical methods. The choice of treatment modality offered to each patient was individualized based on the stage and severity at the time of presentation. The patients were followed up to assess recurrence for 1 year after complete healing of the pilonidal sinus.Results:All patients with pilonidal sinus/ ulcer < 5 mm showed complete healing without recurrence with conservative line of management. There was recurrence of sinus in 80 % patients treated with only Incision and Drainage for pilonidal sinus abscess. The patients with large sinus (> 5 mm ulcer or skin involvement), were treated by excision with healing by secondary intension. This group of patients was associated with recurrence in 80% cases. The remaining patients with large pilonidal sinus disease were treated by the newer technique of semi-closed method with drain. In this group, only 20% patients developed recurrent sinus. All patients with recurrences healed after either conservative method or surgical method involving local skin flap.Conclusions:The conservative method of treatment is suitable for early and superficial pilonidal sinuses. For chronic and extensive pilonidal sinus disease, surgical treatment with the newer technique of semi-closed method with drain was found to reduce the rate of recurrence. The cases with superficial recurrent pilonidal sinuses may heal with conservative approach and extensive recurrent lesions require reconstruction with local skin flap. The results of the newer technique of semi-closed method with drain were found to be comparable with that of surgery by excision with primary closer. These results may be further evaluated at high volume centre for practical statistical significance regarding choice of treatment.

Wide anterior neck dissection for management of recurrent thyroglossal duct cysts in adults.

Thyroglossal duct cyst recurrence following resection is attributed to anatomical variability and residual thyroglossal ducts. In adults, thyroglossal duct cyst recurrence is extremely rare and a surgical solution is yet to be well explored. This paper describes our approach to the management of recurrent thyroglossal duct cysts and sinuses in adults using a wide anterior neck dissection. A retrospective review was performed to identify adults who underwent a wide anterior neck dissection for recurrent thyroglossal duct cyst management between 1 January 2009 and 1 January 2015. Six males and one female were included in the series (mean age, 26.4 ± 10.9 years). Recurrence occurred at a mean of 18 ± 9.8 months following primary surgical management (3 patients underwent cystectomy and 4 had a Sistrunk procedure). All patients subsequently underwent wide anterior neck dissection; there was no further recurrence over the 12-month average follow-up period. This paper describes a wide anterior neck dissection technique for the management of recurrent thyroglossal duct cysts or sinuses in adults; this approach addresses the variable anatomy of the thyroglossal duct and is associated with minimal morbidity.

Outpatient Treatment of Pilonidal Disease with a 1470nm Diode Laser; Initial Experience

Background: Pilonidal sinus disease affects young people and most commonly men. Although a significant number of treatment methods to cure this disease are still in use in every-day clinical practice, there is still no consensus as to which of these methods is closer to ideal in offering definite treatment. During the last decades, a number of less invasive or non-surgical methods for pilonidal sinus treatment that were first described half a century ago have regained popularity, whilst new techniques have evolved with promising results. Methods: This small case series study including 5 patients suffering from both primary and recurrent pilonidal disease was undertaken in order to present the initial experience with the use of a diode laser technique (1470 nm wavelength through a radial fiber) for treating primary and recurrent sinuses. Results: All 5 patients were treated successfully on an outpatient basis under local anaesthesia, receiving no antibiotics or painkillers after discharge. At 6 months complete follow-up, no recurrence was documented. Conclusions: Pilonidal cyst obliteration with laser application seems to be a simple, safe and successful treatment option for primary or recurrent pilonidal sinus disease. It should be considered as an alternative method against more extensive surgical procedures.

The bacteriology of hidradenitis suppurativa: a systematic review.

Hidradenitis suppurativa (HS) is a chronic inflammatory disabling skin disease consisting of recurrent nodules, sinuses, fistulas and scarring involving the intertriginous regions. HS is often a therapeutic challenge and most treatments are off-label. A better understanding of aetiology and pathogenesis of HS may facilitate the development of effective treatment. Although the clinical presentation is strongly reminiscent of bacterial infection, the role of bacteria remains controversial. Studies have isolated an array of different bacteria specimens. Consistent findings of Gram-positive cocci and Gram-positive rods including Staphylococus aureus, coagulase-negative staphylococci (CoNS) and Corynebacterium species in deep tissue samples have been demonstrated in HS and may constitute a central target for the immune system. Efficacy of antibiotics, that is rifampicin, clindamycin or tetracycline, supports a microbial role in disease pathogenesis. However, these antibiotics also work as immunomodulators of especially T cells, and the underlying mechanisms may therefore be more complex. We performed a systematic review of previous studies investigating the bacterial flora in hidradenitis suppurativa. We searched PubMed, EMBASE, Royal Danish Library and Cochrane library (search date 11 December 2014). A total of 66 papers were identified and nine papers published between 1988 and 2014 matched our inclusion criteria, yielding bacteriological data of a total of 324 patients with HS (mean age 36.8years and female/male ratio 215/109). This overview of the bacteriology may aid researchers and physicians exploring the potential role of bacteria in HS. Furthermore, to stimulate a broader debate, we also present different viewpoints on the possible role of bacteria in HS.

Cleft lift technique with tension-free primary closure for repair of pilonidal sinuses: Three years experiences

Objective: Cleft lift technique was performed in patients with chronic or recurrent pilonidal sinus (PS). It has been reported to provide better results than simple excision and closure in the midline. The aim of this retrospective study was to evaluate the results after introducing the tension-free flap as asymmetric cleft lift procedure in our hospital on a day care basis. Patients and methods: Between June 2008 and July 2011, 236 patients (199 males, 37 females: median age 30 years; range, 18-46 years) underwent excision ofthe pilonidal sinus with tension-free primary closure in cleft lift technique. Patients were observed and followed up (126 cases (53.3%) of these patients accepted a consultation in the outpatient clinic w hile 75 cases (31.7%) were interviewed by phone) for the healing rate and reporting the postoperative criteria over 2 years. Results: At follow up mean 24 (range 10--27) months after the operation, 169 (72.6%) of the wounds were healed while recurrences were present in 32 (13.5%) of the patients. Further results related to pre-, per- and postoperative conditions are discussed in this paper. Conclusion: Cleft lift procedure results in a similar looking wound of the midline and a shallow cleft. It is very successful in the treatment of difficult recurrent sinuses, where the early results are promising.

Crystallized Phenol in Nonoperative Treatment of Previously Operated, Recurrent Pilonidal Disease

Recurrence after surgery for pilonidal disease remains a challenge. We investigated the application of crystallized phenol as a nonoperative treatment for patients with recurrent, previously operated pilonidal disease. Participants were patients treated for recurrent pilonidal disease at our clinics from January 1995 through August 2007. Crystallized phenol was administered on an outpatient basis. Patient and disease characteristics including age, gender, body mass index, occupation, family history, time from previous operation to recurrence and to phenol treatment, number and type of previous operations, and characteristics of recurrent sinuses at entry were prospectively recorded. Outcome variables included number of phenol applications, recovery time, recurrence, and treatment success or failure. A total of 36 patients with recurrent pilonidal disease were treated with crystallized phenol (mean recurrence time after previous surgery, 16.2 +/- 4.6 months; number of previous operations, 1.47 +/- 0.9). The mean number of phenol applications per patient was 3.7 +/- 1.3 (range, 1-7). No serious side effects were observed. Exfoliation of a 2-cm area around the sinus openings in 3 patients (8.3%) was easily treated with ointments locally; patients reported minimal pain. Healing was obtained in all patients in a median of 48 (range, 10-153) days. During follow-up (mean duration, 54.4 +/- 5.2 months; range, 29-169 months), 31 patients (86.1%) had no recurrence and 5 patients (13.9%) had recurrence. Recurrent sinuses were successfully treated by a second course of crystallized phenol in 2 patients, 1 patient refused retreatment, and healing was not obtained with a second treatment course in 2 patients, yielding an overall success rate of 91.7% and failure rate of 8.3%. Crystallized phenol application is a simple, inexpensive nonoperative procedure that can be performed in an outpatient setting and is suitable for the treatment of previously operated recurrent pilonidal disease.

Neck dissection for tuberculous suppurative cervical lymphadenitis

Introduction: Tuberculous cervical lymphadenitis is a common manifestation of tuberculosis, however persistent and recurrent cutaneous sinuses are rare sequaelae. Established treatment includes chemotherapeutic and surgical excision of ulcers and sinuses. We report a case of recurrent suppurative cervical lymphadenitis which required a selective neck dissection despite previous anti-tuberculous medications, multiple surgical excision of sinuses and cutaneous ulcers.

Vacuum-assisted closure for wound management in the pediatric population

Background/Purpose Wound management in children has traditionally consisted of daily dressings. Although vacuum-assisted closure (VAC) is well described in the adult literature, there are few reports about children. We reviewed our experience with VAC. Methods A retrospective review from 2003 to 2005 revealed that 16 children underwent VAC. Variables analyzed included demographics, diagnosis, duration and characteristics of VAC, wound closure, recurrence, complications, and cost analysis. Results Sixteen children received VAC therapy at an average age of 12.1 years (range, 1 month–18 years). Indications included tissue loss after pilonidal sinus excision (n = 8, primary = 5, recurrent = 3) after wound dehiscence of the abdomen (3), the sternum (2), the back (1), the leg (1), and after chronic postoperative perineal fistula. Average length of VAC use was 23 days, with an average pressure of 104 mm Hg. Wound closure occurred in 15 of 16 patients. Patients with primary pilonidal disease obtained wound closure by 45 days, whereas those with recurrent disease required 72 days. Children with wound dehiscence healed by 28 days. Recurrent sinuses developed in all 3 patients with known recurrent pilonidal disease. Pain in 1 patient required cessation of VAC therapy after 7 days. Follow-up after wound closure averaged 8 months. Conclusions Vacuum-assisted closure is well tolerated in our pediatric population and offers many advantages including fewer dressing changes and an earlier return to daily activities.

Wound management with vacuum-assisted closure: experience in 51 pediatric patients

Background/Purpose Soft tissue loss from infectious, vascular, and traumatic disorders often results in poor healing, painful wound care, and the need for repeated operations. This retrospective study evaluates a single-institutional experience with negative pressure therapy (NPT), using the vacuum-assisted closure (VAC) device in a group of children with diverse soft tissue problems. Methods The medical records of 51 patients treated with NPT from January 2000 to July 2003 were reviewed for demographics, diagnosis, duration of VAC therapy, wound closure, recurrent disease, and complications. Results Patients were classified by diagnosis: group 1: pilonidal disease (n = 21, primary = 6 and recurrent = 15); group 2: sacral and extremity ulcers (n = 9); group 3: traumatic soft tissue wounds (n = 9); and group 4: extensive tissue loss (n = 12) from the abdominal wall (n = 7), perineum (n = 2), thigh (n = 2), and axilla (n = 1). Group 1 had an average age of 16 years (range, 10-20 years), 67% were obese, and had an average length of follow-up of 13 months (range, 8-36 months). VAC was placed in the operating room in 95% with subsequent outpatient care that included dressing change 3 times weekly. Healing occurred in all patients with primary disease at an average of 37 days. For patients with recurrent disease, 12 healed at an average of 48 days and 3 developed recurrent sinuses. Group 2 was treated with VAC as a bridge to skin grafting or flap closure. All children in group 3 achieved healing without skin grafting at an average of 10 days and with acceptable cosmesis. Negative pressure therapy in group 4 was the only wound treatment in 10 patients and adjunctive to operative closure in 2. Complications from VAC occurred in 5 patients: retained sponge in 2 and device malfunction in 3. Conclusions Negative pressure therapy offers a safe, cost-effective alternative to traditional complex wound care in children. Its advantages are less frequent dressing changes, outpatient management, resumption of daily activities including return to school, and a high degree of patient tolerance.

Role of simple V-Y advancement flap in the treatment of complicated pilonidal sinus.

To evaluate our short term results of simple V-Y advancement flap for complicated pilonidal sinus. Prospective study. Yüzüncü Yýl University hospital, Van, Turkey. 23 patients aged 19-47 (mean 31) years with complicated pilonidal sinus treated between October 1994 and December 1996, of whom 9 had had previous operations for pilonidal sinus. Bilateral V-Y-plasty to close the defect after wide excision (n = 7), and unilateral V-Y-plasty (n = 16) were performed under spinal anaesthesia. There were no complications during the operation. There were 4 minor complications (17%) consisted of seroma (n = 2) and severe wound pain, and wound infection (n = 1 each). All patients were discharged within 10 days of operation and returned to work within 3 weeks. The mean follow up was 18 months (range 10-25) and no recurrences have occurred so far. Simple V-Y advancement flap may prove to be useful in patients with recurrent and complicated pilonidal sinuses.

Excision and simple primary closure of chronic pilonidal sinus.

To evaluate the outcome of asymmetrical complete excision of pilonidal sinus with simple primary closure without using drains or tension sutures. Prospective study. Teaching hospital, Jordan. 46 patients with chronic pilonidal sinus treated between November 1994 and October 1998 by excision of the sinus down to the sacrococcygeal fascia and simple primary closure of the wound without tension sutures or drains. Patients stayed in hospital for 48 hours and postoperative pain was minimal. Complete healing was achieved in 41 patients (89%) after a mean follow up period of 36 months (range 12-60). Two patients (4%) developed recurrent sinuses and in three (7%) the wound broke down. All the patients who healed completely were back to work within three weeks of the operation. Excision and simple primary closure is a cost-effective way of treating chronic pilonidal sinus.

Recurrent Pilonidal Sinus: Etiology and Treatment

A clinical and histologic study of recurrent pilonidal sinus is presented. During a 5-year period 44 patients were treated for recurrent pilonidal sinus. Of these, recurrence had occurred within 1 year in 26 patients (76%). After 26 reoperations with excision and primary suture further recurrence was seen in 23% (6/26), and in 24% (6/25) after reoperations with open treatment. The histologic findings in recurrent sinuses (18 patients) were almost identical to that of primary disease. Recurrent sinuses were situated in the scar in 80% of the cases and caudal in 50% of the cases. A known wound infection had been present in 27% of the patients. Although keratin plugs were observed in 15/18 (83%) of those with a recurrence, the importance of this finding is uncertain. We conclude that recurrent pilonidal sinuses are chronic inflammatory processes usually located at the site of the surgical wound. The cause is uncertain, although there is an indication that wound infection plays a role. Keratin plugs have also been observed in scar tissue. Surgical treatment of recurrent disease has a higher recurrence rate than after that of primary disease.