ABSTRACT
Pilonidal disease is a commonly encountered painful condition localized to the gluteal cleft of the sacrococcygeal area. The proposed pathophysiology of the disease is a foreign body reaction to hair follicles present in the skin of the natal cleft with associated formation of midline pits, inflammation, and secondary infection. Standard treatment of an initial presentation of acute pilonidal disease with abscess formation is incision and drainage with healing of the resulting wound by secondary intention. Chronic pilonidal disease may manifest as recurrent abscesses, chronic sinus tracts, and/or persistent non-healing wounds with drainage. Surgical treatment of chronic pilonidal disease follows two general approaches: first, excision of all disease with healing of the resulting open wound by secondary intention, and second, excision of all disease with primary closure. Incision and drainage remains the primary strategy for management of acute pilonidal abscess. Wounds that fail to heal adequately post-drainage or that develop recurrence of pilonidal disease require formal excision.
