Pilonidal disease in adolescence: from the local treatment to flap rotation

Abstract

The treatment of pilonidal disease (PD) is often challenging, due to the frequent recurrences and adverse events. The risk factors are well known: obesity, male sex, hairy sacral region, inactivity, inadequate hygiene. To diagnose the PD the physical examination is enough. The acute form is a local imflammation in the sacral region (cellulitis or abscess) and the chronic one can be “sacral pit(s)” or fistula(s). In case of abscess the local therapy with antibiotics or “off-midline” incision can be the best solution. In chronic PD the most important is to reduce the risk factors: weight control, epilation, to enhance the physical activity and local hygiene. If surgery cannot be avoid, the minimally invasive one must be
chosen at first (trephination, PEPSiT). In case of complications, recurrence more complicated surgeries can be performed (ie. flap rotation). The surgery itself is not sufficient, the postoperative care (ie. hygiene, epilation) must be adequate.