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Pilonidal Sinus

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What is Pilonidal Sinüs?

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The name of the disease comes from the Latin words Pilu (hair) and Nidus (nest).

It is a disease that occurs as a result of dead skin residues spilled from the back area, feathers and hairs nesting in the coccyx area.

It is generally known as the disease of young adult men.

How Pilonidal Sinus Occurs

There are two theories of the formation of the disease. The first is that the skin in the area where the disease started is sensitive and the existing hairs are pushed into the skin by friction, and the second is that the dead skin residues block the exit points of the hairs and the hair grows inwards, not outwards.

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For this reason, pilonidal sinus can be seen not only in the coccyx, but also in the beard, bikini area, armpit and legs. Among these, the most problematic for the patient are those located in the coccyx.

Inwardly growing hairs are responded by an inflammatory reaction by the body and become a cocoon-shaped cyst (pilonidal cyst). The diameter of the formed cyst is variable. It can even be thought of as an iceberg. The greater the number of holes (sinus mouth) in the midline, the greater the spread of the disease at the base.

In general, in very chronic patients, the depth of the base may continue up to the membrane of the coccyx, while the width will be different in each patient and depending on the stage of the disease.

Pilonidal Sinus Symptoms?

Kuyruk sokumunda oluşan kıl dönmesi.

Patients often present with complaints of itching in the coccyx, yellow and foul-smelling discharge, sometimes soiling of the underwear due to bleeding, and palpable stiffness. Color change in this region is also typical.

When the hips are spread in the prone position, it is seen that there are one or more holes (sinus mouths) on the coccyx. It may even produce a yellow discharge when pressed. As time passes, the number of sinus openings increases and the disease spreads from the midline to the skin above the hips.

If there is excessive pressure or exposure to trauma in the area of the pilonidal sinus, an abscess will be seen. Sometimes the disease manifests itself as this abscess. It is noticed that there is a very painful, red and swollen stiffness in the coccyx. This abscess either drains spontaneously or needs to be drained surgically.

Causes of Pilonidal Sinus


  • kıl dönmesi Genetic predisposition (most patients have a family history)
  • Obese and overweight patients (due to excess subcutaneous adipose tissue)
  • Occupational groups that require sitting for a long time (drivers, desk workers)
  • Those with hard bristle structure and high bristle density
  • Poor hygiene
  • Excessive sweating
  • Tight clothing preference

Pilonidal Sinus Surgery

As a general treatment approach, the patient should be informed about the methods and the most appropriate treatment should be decided together according to the stage of the disease.

Pit picking + Laser closure can be applied in early-stage patients who present only with complaints such as discharge and itching. Here, under local anesthesia, the sinus openings are removed, the contents of the cysts are cleaned, and the remaining area is closed with the help of a fiber with a laser at the end. It is possible for the patient to return to his normal life on the same day after resting for a while.

Microsinusectomy may be preferred in early-stage suitable patients. Under local anesthesia, the sinuses are removed with 1-2 cm incisions and the skin is closed with sutures. The patient can return to his daily life on the same day.

Surgical techniques are planned for patients with a large number of sinuses, a history of abscess, and long-standing complaints, considering that the disease is common and complicated. For this purpose, after the cyst is removed, the open wound can be covered with a skin layer taken from the hip (Flap Shift Technique) or the wound is left open after the cyst is removed.

In surgeries performed using flaps, the patient’s return to work takes 10-15 days. Due to the limitation of movement, the post-operative period can be difficult.

In wounds that are left to heal openly (secondary healing), the dressing is long-term and may impair patient comfort, but it is the method with the lowest recurrence risk.

If there is abscess formation, medical treatment is given for about 2-3 weeks after it is drained and the patient is re-evaluated at the end of the treatment. Generally, the time between evacuation of the abscess and surgery is an average of 1 month.

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