Pilonidal disease: Origin from follicles of hairs and results of follicle removal as treatment

Contrary to current concepts, shafts of hairs apparently are not the source of most pilonidal disease. Instead, follicles of hairs seem to be the source. Pilonidal disease progresses through fiue stages. Accumulation of hair within a chronic pilonidal abscess is a late and secondary phenomenon. The acute abscess is drained only. Over the chronic abscess the distended hair follicles are removed individually f rom the gluteal cleft. In addition, the cavity of the chronic abscess is cleaned out through incisions placed parallel to, but to one side of the cleft. Acute abscesses are similarly! treated 5 days after drainage. Cavity walls are not excised. The)l are allowed to fall closed and to heal. An epithelial tube, when found, is dissected out through incisions beside the cleft. Nonhealing wounds are e$ectively treated with Monsel’s Salt. Fifty patients were treated in the author’s o&e under local anesthesia. Disability averaged I day. Healing time, without disability, averaged 3 weeks. Recurrences in four patients were healed in an average of 2 weeks.