الفهرس 
Surgical AnatomyOnly 14 pages are availabe for public view
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Abstract
The term pilonidal disease is usually referred to as jeep disease, a well-documented phenomenon of hirsute jeep drivers during World War II. It is a common and well-recognized entity that is prevalent in young adults occurring more commonly in males. Risk factors for pilonidal sinus disease are white race, male sex, family predisposition, increased sweating, activity associated with sitting and buttock friction, sedentary lifestyle, poor personal hygiene, obesity, and local trauma. However, the majority of opinion favors the acquired theory, which may be summed up as hormones, hair, friction and infection are corner stones in the development of the disease.
Pilonidal disease is a chronic soft tissue infection, promoted by hair propelled into the soft tissue. Some pilonidal cases may be asymptomatic with or without pits in the natal cleft. Sometimes, symptomatic disease presents as a pilonidal abscess. Another frequently encountered clinical picture is the chronic draining openings. It is most common in the gluteal cleft but can occur in bizarre places like web spaces of fingers (barbers) and toes (Hair mattress factory), umbilicus, perineum, axilla, amputation stumps and the clitoris.
Common complications of pilonidal disease are infection, abscess formation, and recurrent sinus disease after surgery. Less common complications include sacral osteomyelitis and meningitis. Malignant transformation is a rare but well-known complication.
A number of operative and nonoperative techniques are currently used for the management of pilonidal disease.
Conventional trends in management of pilonidal sinus disease can be classified as follow; Conventional non surgical methods including shaving and phenol injection.
Conventional surgical modalities including; Wide excision and open granulation, lay-open procedure, modified lay-open with marsupialization, excision and primary closure, simple Bascom’s technique, Bascom’s cleft closure and Z-Plasty.
Postoperative wound complications have always been the main cause of concern followed by the risk of recurrence. Complete excision of the sinus is widely practiced, but controversy remains about what to do with the wound after excision. Despite the controversy about the best surgical technique for the treatment of pilonidal sinus, an ideal operation should minimize financial cost, allow patients to return earlier to work, be simple to perform, not require a prolonged hospital stay, inflict minimal pain, and have a low disease recurrence rate.
Many recent surgical modalities have been tried to fulfill criteria of the best treatment of pilonidal sinus disease including; Karydakis flap, excision and classic Limberg flap reconstruction, excision and modified Limberg flap reconstruction, adipo-fasciocutaneous flap, limited excision (sinusectomy), cutting seton, superior gluteal artery perforator flap, lumber adipo-fascial turnover Flap, crossed triangular flaps, V-Y flap technique, human dermal tissue allograft, and radiofrequency surgery.
Despite all these recent trends, the “gold standard” surgical treatments have not yet been described. Unfortunately, recurrences after destructive surgical interventions are relatively common especially after the hair of the buttocks starts to re-grow again and begins to migrate toward and is entrapped within the indentation at the apex of the proximal gluteal cleft.
Recent non surgical trend for hair control using Laser in adjunction to surgical modalities considered to be very useful.