Pilonidal Cyst Excision

Procedure Snapshot

• Indication: Chronic pilonidal sinus or abscess.
• Expected duration: ___
• Special instruments: Electrocautery, flap set.

Step Workflow

1. Prone; elliptical excision encompassing all sinus openings.
2. Remove tracts to sacrococcygeal fascia.
3. Open: pack for secondary healing.
4. Closed: Bascom cleft-lift flap with off-midline closure reduces recurrence.

Key Pimp Questions

• Q: Recurrence rate open vs flap? A: Lower with off-midline (2–7 %) (PMID 31637579).

Critical Anatomy

• Landmarks: Gluteal cleft, sacrum.
• Danger zones: Deep fascia, midline tension.

Informed Consent Highlights

• Bleeding, infection, recurrence, delayed healing.

Post-op Considerations

• Hair removal, off-midline dressing.

References

• Chassin’s, Skin/Soft Tissue. Clinical Scenarios, Anorectal.
• Bascom 2020 (PMID 31637579).