Minor “Conservative” Pilonidal Surgical Treatments
What is a “conservative” treatment?
Treatment plans that do not rely on extensive removal of tissue and can be done under local anesthesia at a doctor’s office are considered “conservative” because they have very minimal damage or risk to the patient.
An abscess is a local accumulation of pus anywhere in the body, formed by tissue disintegration, and surrounded by an inflamed area. Normally, the proper treatment of abscesses is to drain it – not excise with large amounts of tissue removal. Pilonidals are just about the only time doctors think excision is the correct treatment for an abscess. One of our primary missions is to change that thinking and focus on finding the Pits that are causing the abscess.
Pits provide the opening for bacteria to breach the skin barrier and need to be removed, otherwise the infections will continue to reoccur. The problem is not that the tissue is “diseased”, it’s that there is still an opening somewhere in the midline that is allowing anaerobic bacteria access under the skin. Those openings can hide extremely well and sometimes only be seen when the skin is pulled downward and stretched.
Based on Dr. Bascom’s experience, we advocate that the first treatments lean towards the conservative side. It is easy to move forward from a Pit Picking, but you cannot “go back” from an excision surgery once you’ve started removing tissue. The point of conservative treatments is to avoid removing tissue when the underlying problem can likely be resolved without tissue removal.
These techniques are not new, they have been around since the 60’s but were not widely known until the web made the sharing of information open to all.
The basic premise of Pit Picking is to remove the source of the infection without removing any deep tissues. This procedure is best for early stage Pilonidals and the FIRST PLACE we suggest patients start to see if this simple office procedure can resolve the problem without further surgical treatment.
- open up the abscess (lancing)
- clean it out (and is some cases, brush the tracts)
- remove the Pit(s) – this may need to happen 10 days after the lancing when the swelling has subsided
- leave the deep tissues intact
- let it heal
Traditional lancing (i.e. simple drainage of abscess) has a recurrence rate of 85% – meaning most people need further Pilonidal treatment than just draining the abscess. Bascom proposed that this was because simply lancing the abscess wasn’t enough; the Pits that were creating the abscess need to be removed as well. When the Pits are removed shortly after the lancing (an average of 10 days later when the swelling goes down and the Pits are more visible), the need for further treatment drops to 15-20%. With major recurrence factors being other pits left behind, deep clefts (prone to new pits forming and poor wound healing), poor hygiene, and epilation with razors.
It should be noted that Pit Picking technique has evolved since it was originally described by Dr. Bascom. Many surgeons have adopted it over the years. One variant performed by surgeons like Dr. Bascom II for simple (one sinus) pilonidal involves make incisions around the pits and drainage point and then removing the entire 1-2 inch (typical) pilonidal tract intact – with pits on one end and drainage point on the other. The surgeon can immediately verify whether the tract has multiple tunnels by looking at the fat around the sinus. This quick and simple procedure effectively removes the whole diseased tissue with no chance of any lodged hair being left in the area. For simple pilonidal cases, this should effectively cure the disease, unless of course, good hygiene wasn’t maintained, new pits formed due to deep cleft or there was poor wound healing.
Where it’s done – at the doctor’s office, local anesthesia
Recovery time – two to three weeks, depending on necessity of lancing at the same time.
For more detail on various published studies by Bascom and others, please visit our Library.
What it is – Phenol is an aromatic alcohol, it exhibits weak acidic properties and is corrosive and poisonous; it is sometimes called carbolic acid. Phenol causes wide spread tissue destruction in the injected area, including coagulation of nerves and muscle death. It is currently used very selectively for facial peels. For Pilonidal treatment it is injected into the cyst and sinuses in hopes that it will burn the tissues to the point that they no longer become infected.
Where it’s done – At the doctor’s office.
Recovery time – A few days.
What else you should know – Phenol Injection was at one time a promising potential cure for Pilonidal Disease. The idea was to damage the tissue to induce scarring, which would prevent further infections. Scar tissue has no pores or follicles to get infected… After further experimentation, the treatment was dropped as disease recurrences began cropping up, indicating that the underlying problem had not been solved. Most doctors won’t bother with this treatment anymore and it is usually only found being used in Europe.
One other note: Phenol Injection was one of the techniques used to murder prisoners at Auschwitz, the drug was injected directly into the heart and caused death in approximately two minutes.
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This page last updated: January 3, 2019