A pilonidal cyst, also called a pilonidal abscess or pilonidal sinus, develops from an opening in the skin at the bottom of the natal cleft (buttock crease). There are different theories as to why this opening forms. Hair, lint from clothing, shed skin cells, dirt and debris can pass through this opening and collect under the skin, creating an inflammatory pocket. This pocket can fill with fluid (becoming an abscess) and cause symptoms such as discomfort, redness or skin discoloration. It can spontaneously drain through the skin or require incision and drainage by a medical provider.
A pilonidal cyst usually develops after puberty and before age 40, but cases can occur in older patients. Men are 3-4 times more likely to be affected but women can also experience this condition.
The exact cause of pilonidal cysts is not fully understood. However, certain risk factors are associated with their development, including elevated body mass index, history of acne, hidradenitis suppurativa, a deep buttock cleft, sedentary lifestyle or prolonged sitting, increased hair in the area, family history and polycystic ovary syndrome. Many patients with pilonidal cysts have no known risk factors.
Treatment options for pilonidal cysts vary depending on symptom severity. Patients often first seek care from their pediatrician, primary care provider, dermatologist or urgent care before being referred to a surgeon. Dr. Wilkiemeyer and Dr. Michael Genz offers specialized pilonidal cyst treatment in the Atlanta Region.
Treatment options include:
The main goals of pilonidal cyst surgery are to remove the problematic tissue, flatten the buttock cleft as much as possible and achieve a closure that is off the midline to reduce recurrence risk.
Different surgical options exist for treating pilonidal disease. In the opinions of Dr. Wilkiemeyer and Dr. Genz, the cleft lift procedure described by Bascom is far superior to other approaches. This outpatient surgery involves removing the area of skin containing the chronic inflammatory pocket and advancing skin from one side of the buttock to the other to cover the excised area.
This results in a linear incision off the midline, generally not visible when wearing underwear or a bikini bottom. The procedure also flattens the upper buttock ridge but this change is subtle when wearing clothing.
Although recurrences can occur, they are rare after cleft lift surgery compared to other procedures. The Bascom cleft lift appears to have a lower risk of recurrence and offers the quickest surgical recovery among available options.
Not all patients with a pilonidal cyst require surgery. The decision depends on symptom severity. Some patients experience flare-ups every few years, others every few months and some suffer from daily chronic drainage. If the cyst interferes with a patient’s lifestyle, such as causing them to miss school or work, or if there is significant discomfort or drainage, surgery may be warranted.
At Surgical Specialists of Atlanta, Drs. Wilkiemeyer, Genz, Wood and Ali-Mucheru all perform pilonidal cyst surgery. Patients benefit from a collaborative approach, thorough pre-surgical evaluation and surgical techniques designed to minimize pain, reduce recurrence and promote faster recovery.
With more than 25 years of focused experience in pilonidal cyst treatment, Dr. Wilkiemeyer has extensive experience with the cleft lift rotation advancement flap procedure. His expertise offers patients a unique perspective and depth of knowledge in managing this condition.