Pilonidal Disease and Hidradenitis Suppurativa
Pilonidal disease and hidradenitis suppurativa are both chronic inflammatory diseases that affect patients in the prime of their lives. They can significantly impact an individual’s quality of life and may cause significant disability and consumption of h
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Key Concepts • Pilonidal disease presents with a wide range of symptoms and multiple treatment options exist. Treatment should be tailored to the severity of disease, anatomy of disease, and patient expectations. • Because of the wide array of available surgical options, the surgeon treating pilonidal disease should master 3–4 approaches that are applicable to a wide range of disease presentations. • Treatments applied to both pilonidal disease and hidradenitis suppurativa should not be more disabling for the patient than the disease itself. • There are numerous medical options available to treat hidradenitis suppurativa. They should be investigated and attempted prior to aggressive radical surgical management. • Radical excision of hidradenitis suppurativa with surgical reconstruction offers the best hope to avoid disease recurrence.
when Dr. A.W. Anderson described a case of “hair extracted from an ulcer” [2]. The first pilonidal abscess was described in 1854 [3], though there is no question that this condition was encountered earlier. It wasn’t until World War II that surgeons became much more familiar with this disease entity, likely because of the large number of cases seen in members of the military. In fact, the disorder was known as “jeep disease” and was thought to be related to modern mechanized warfare, which required soldiers to ride in vehicles for extended periods of time [4]. It is clear from early publications that little has changed in terms of the issues that confront both the patient and surgeon. A 1955 publication from the Veteran’s Administration health system reveals that the debate over open and closed wound management is not new [5]. In this study, patients managed with primary wound closure developed recurrence 40% of the time and required hospital stays of approximately 17 days, while those managed with open technique stayed for 30 days and had a recurrence rate of 35%! While we have seen significant reductions in both length of hospital stay and recurrence, it is clear that we still do not have the ideal answer for this condition.
Background The term “pilonidal” is derived from the root words “pilus” (a hair) and “nidus” (nest). Since 1880 when Dr. R.M. Hodges coined the term pilonidal sinus [1], the diagnoses of pilonidal cyst, sinus, and abscess have been used interchangeably and somewhat indiscriminately to mean the same thing, though they most certainly do not—in the case of abscess. It is largely for this reason that the more modern nomenclature of “pilonidal disease” (PD) is used to describe the spectrum of disorders that may be encountered. The first published description of this disease occurred in 1847
Electronic supplementary material: The online version of this chapter (doi:10.1007/978-3-319-25970-3_17) contains supplementary material, which is available to authorized users.
Etiology There has been considerable debate over whether PD is congenital or acquired, but most would currently agree that it is an acquired disease. It is generally believed that the initiating event is t
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