Dec 26,2023

Exploring Treatment Options for Pilonidal Cysts

Pilonidal cysts are a painful and often persistent condition characterized by the formation of cysts near the tailbone. These cysts can become infected and are known for their tendency to recur, making effective treatment a critical concern for those affected. This blog explores the various treatment options for pilonidal cysts, focusing on both medical and surgical approaches, and highlights complete resection and flap reconstruction resulting in midline scar as a specialized treatment for chronic pilonidal disease.

Understanding Pilonidal Cyst Symptoms

Before diving into treatment options, it’s essential to recognize the symptoms of a pilonidal cyst, which may include pain and swelling near the tailbone, redness, drainage of pus or blood, and a foul odor. These symptoms can vary in intensity and may become more pronounced if an infection occurs.

Medical Approaches to Pilonidal Cyst Treatment

Initial treatment for a pilonidal cyst often begins conservatively. Some of the non-surgical methods include:

  • Antibiotics: To treat or prevent infection, especially if the cyst is inflamed but not infected.
  • Pain Management: Over-the-counter pain relievers can help manage discomfort.
  • Hygiene: Regular cleaning and hair removal around the affected area may help prevent further irritation.

Surgical Treatment Options

When medical management isn’t enough, or if the cyst recurs, surgical options may be considered:

  • Incision and Drainage: This is often the first line of surgical treatment, where the cyst is cut open and drained. While this can provide relief, recurrence rates are relatively high.
  • Excision: The entire cyst is removed. This method has a lower recurrence rate but requires a longer healing time and might leave a significant scar.
  • Pit Picking Procedure: Less invasive surgeries that involve removing the pits and sinus tracts. These methods aim for quicker recovery times but might not be suitable for all cases.

Complete Resection and Flap Reconstruction: An Advanced Approach

Complete resection and Flap Reconstruction is a specialized surgical approach designed specifically for patients with chronic pilonidal sinus disease. This technique reshapes the cleft to make it shallower, which helps prevent hair from getting trapped and reduces the risk of recurrence. Key aspects include:

  • Reshaping the Area: The procedure flattens the cleft to prevent debris and hair from accumulating.
  • Minimizes and Optimizes Scarring: By creating a suture line close to or at the midline it will leave the scar centrally placed and the least visible thereby optimizes cosmetic outcome.
  • Improving Blood Supply: Unlike other procedures, flap advancement improves the blood supply to the area and promoting better healing by advancing healthy tissue into the defect created after removing the cyst.
  • Reducing Recurrence: By removing the entire cyst and addressing the underlying and adjacent issues that contribute to pilonidal cysts, this procedure has a lower recurrence rate compared to traditional methods.

Aftercare and Recovery

Regardless of the treatment chosen, proper aftercare is crucial. This includes keeping the area clean, following wound care instructions, and avoiding activities that put pressure on the healing area. Regular follow-ups with a healthcare provider are essential to monitor healing and address any complications.


Pilonidal cysts can be a recurring and painful issue, but various treatment options are available ranging from conservative medical management to more invasive surgical approaches. Complete resection and flap reconstruction stands out as a specialized treatment for chronic pilonidal disease, offering a promising solution for those dealing with recurrent issues. It’s important for individuals to discuss all available options with their surgeon to determine the most appropriate and effective treatment plan based on their specific condition and needs. With the right approach, many people find relief and a return to normal activities. Take the first step towards a pain-free future by scheduling a consultation with Dr. Som today. Your journey to relief begins with informed decisions and expert care.