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Controversy surrounds pilonidal disease, from who first described it, to the etiology, and how to manage it surgically. Some believe that pilonidal disease was first described in 1880 by Hodges.1 However, others say it was first described in 1833 by Mayo.2 Hodges used the term “pilonidal sinus” to describe a chronic infection that contained hair and was usually found between the buttocks. The word “pilonidal” comes from “pilus” or hair and “nidus” or nest. It literally means “nest of hair.” The condition did not receive much attention until it became a significant problem in the armed services around the time of World War II. In 1940, in the United States Navy, the number of sick days caused by pilonidal disease and its complications exceeded those of either syphilis or hernias.3 This condition was coined as “jeep disease” by Buie in 1944 because of the high occurrence rate in those that drove or were frequent passengers in military vehicles.4
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Pilonidal sinus disease primarily affects Caucasian males. Blacks are infrequently affected and the condition is rare in Asians and Indians. Males are affected three to four times more frequently than females. The affected females tend to be younger than males.19 The condition is prevalent from the onset of puberty to young adulthood and is rare after the age of 40. The peak age of incidence is 21 years. The increased incidence in adolescents and young adults is attributed to hormonal effects of increased hair on the torso, increased activity of sebaceous and sweat glands, fat deposition on the buttocks, and deepening of the gluteal cleft. Other risk factors may include hirsutism, obesity, and poor personal hygiene. Repeated trauma to the area may also contribute to the formation of pilonidal disease. There is an increased prevalence in drivers and others with occupations requiring long periods of sitting.6,7
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Patients with pilonidal sinus disease may present with three different clinical pictures: asymptomatic disease, an acute abscess, or chronic disease. Asymptomatic disease patients have a painless sinus pit at the top of the natal cleft. Patients with chronic disease may have mild discomfort and a chronically draining sinus in the upper gluteal region. Approximately 50% of patients with symptomatic pilonidal disease will present acutely with severe pain and frequently swelling that is indicative of a pilonidal abscess that necessitates incision and drainage.8,9 Inspection will reveal one or more midline sinus tract openings, often with protruding tufts of hair. The area will be tender, erythematous, and indurated when an abscess is present. Fluctuance and swelling may not be readily appreciated. The sinuses may be quite extensive depending upon the chronicity of the disease process prior to presentation.
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A pilonidal sinus consists of a characteristic midline opening, or series of openings, in the upper aspect of the gluteal cleft and approximately 4 to 5 cm from the anus (Figure 109-1). The skin enters ...