Treatments employing minimal excision of tissue
With this approach pits are individually excised and underlying cavities and tracts are cleaned from hairs and debris (pit excision, pit "picking"). This treatment targets and removes only the factors that form and maintain the disease and avoids unnecessary excision of the healthy tissue around. The operation is usually performed under local anesthesia with no hospitalization. Healing of the tiny wounds takes place within 2-4 weeks with minimal postoperative discomfort.
The negligible amount of resected tissue results in a much better cosmetic outcome, no deformity and minimal scars, in comparison to any other surgical solution.
Aka: Lord & Millar operation, Bascom mark I operation, Gips operation.
The picture shows the punching tools (trephines), used to remove each pit and subcutaneous tracts.
The principle of minimal surgery is based on the special structure of the basic pilonidal unit:
the unit consists of a dermal opening (pit) that leads to a narrow skin-lined canal. The canal extends to an hair containing inflamed subcutaneous pocket.
Pilonidal disease may include one or several units along the natal cleft and the pockets of the units sometimes merge into one cavity.
During surgery, each of the openings and canals is individualy excised with a trephine (punch) and a canal of several millimeters wide is created, denuded of skin lining. The wider canal enables effective cleaning of the subcutaneous cavity and allows continued drainage from the cavity for several days until it shrinks and disappears along with the opening in the skin.
Cross section along the bottom of the natal cleft illustrating the excision of pits and tracts and cleaning of the underlying cavity.
Excision of a pilonidal pit using a 4mm trephine and extracting hairs from the sinus.
Minimal procedures using trephines with complete healing within few weeks.