This page is not intended to offer a major scientific discussion about a troublesome and sometime embarrassing condition but more to provide a bit of background information on the condition and give some insights into why I do what I do to treat it. It is fair to say that I have made this condition into something of a special interest over the years and have written several papers and presentations about it which can be easily found on-line if anyone wishes to. I will try to make this into the sort of information that you might want to know if you were coming to a consultation with the condition. I have been managing this disease for more than 20 years now and "seen it all" and I might say that I know how to manage it when things go wrong which is always an advantage! I have successfully treated a professional Snowboarder, an Olympic yachtsman and a Modern Pentathlete and I imagine that most people's needs are less demanding than those: if they can have successful outcomes, then so can most others! This disease mostly affects people younger than 40-years-old but it can present at any age.Causative factors
Pilonidal disease of the natal cleft is largely a result of three physical attributes:
- The nature of the hair (which often comes from the head hair rather than natal cleft hair)
- The robustness of the skin to resist the sharp hairs sticking in to it
- The anatomy or depth of the natal cleft where the infection that results from hair and bacteria that accumulate under the skin after it has been broken
It is seldom possible to affect surgically (or otherwise) the first two elements of these but changing the anatomy of the natal cleft by making it shallow and stopping the tendency for hair to penetrate it is what I aim to do. At this point, most people look somewhat horrified that their natal cleft will be eliminated but be reassured - the results of surgery are very cosmetically acceptable!The operation (Bascom's Cleft Closure)
Many, many operations and treatments have been invented for pilonidal sinus disease which, if nothing else, tells us that not one of them is a universal success!
The most common operation that I do is called the Bascom Cleft Closure (he calls it a cleft lift) which is the one that flattens off the natal cleft. John Bascom is an American surgeon whose disciple I have become in this regard.
In essence, I remove a portion of the natal cleft skin under a general anaesthetic; this piece of skin is shaped like a boat sail and allows the cleft to be stitched together and the skin too with the bottom flatter and the wound to one side. After this, a drain is needed for three days to suck away excess liquid that accumulates and I usually aim to see patients after 2 weeks to remove stitches - usually expecting to see the wound neatly healed!
The general principle of this is that the natal cleft is "built up" rather than excised which is, I am sure, the reason for the success of the surgery. As I said, the scientific results from these procedures can been seen in the medical literature but suffice it to say, I can get rapid and near complete healing at 2 weeks with a very low rate of return of the infection of less than 2% in my latest series.