What is the treatment for a pilonidal cyst? Is surgery necessary for pilonidal cysts?
Treatment for pilonidal cysts involves draining the infection (abscess), usually by lancing open the wound. A procedure called an "incision and drainage" (I&D) is performed either using local anesthesia or general anesthesia; an I&D drains pus and debris from inside the cyst cavity. Pit picking is a non-excision procedure that involves a lateral (side to side) incision that drains the cyst, and the midline pits leading under the skin are removed.
If extensive scar tissue or chronic sinus tract is found in the pilonidal cyst area, a more extensive excision surgery may be needed for removal of the abscess. A pilonidal cystectomy removes the cysts or tracts that extend from the sinus. The wound may be left open with gauze packing or sutured shut. A cleft lift/modified Karydakis procedure only removes scarred skin, and not deeper tissue, and the incision is more to the side for improved healing. Other types of surgeries for pilonidal cyst include flap procedures such as the Limberg flap, Z-plasty, and rotational flap, which remove larger amounts of tissue. They are usually not a first line of surgical treatment.
If there is a severe infection (cellulitis or sepsis), or if a patient is immune-suppressed (patients with HIV/AIDS, cancer chemotherapy, on steroid treatment, or other immune-modulating medications), antibiotics are usually prescribed and hospitalization may be necessary.
Recovery time for pilonidal cyst surgery varies depending on whether you are left with an open or closed wound. If you have an open wound (tissue is removed, leaving a cavity, and the body heals from the inside out) it can take eight weeks for it to heal into a patch of scar tissue. If you have a closed wound (sutured by the doctor), healing is much faster, however, there is a greater chance for reinfection which can delay healing. Recovery time for the cleft lift/modified Karydakis procedure is about four weeks. In general, inflammation will last up to six days, and growth of new tissue continues for about two months.
The only time nonsurgical treatment for a pilonidal cyst is considered is if the cyst is minor and symptoms are mild and infrequent. Prevent the cyst from getting worse by using good hygiene, exfoliating the area, sitting with good posture, and using a coccyx cushion.