Pilonidal Cyst Excision
The surgeon performs a complete surgical resection of a cyst, sinus tract, or abscess located in the sacrococcygeal intergluteal cleft. The goal is to remove all epithelialized tissue and debris to prevent recurrence of chronic infection.
Surgical instruments
12 on this table — tap a photo to zoom, the name for its full card.
The case
Spark notes
The 30-second rundown — scan this outside the room.
- Apply silk tape to separate buttocks. Prep and drape patient. Set up suction tubing and bovie.
- Make wedge incision with 10 blade. Use toothed forceps and bovie for dissection. Use skin hooks and Army-Navys for retraction.
- Use yankauer on suction tubing while bovie is in use to prevent inhalation of surgical smoke.
- Dissect carefully around cyst to avoid spillage. Expect hair and fluid within cyst.
- Utilize bovie for hemostasis in surrounding tissue post-cyst removal.
- Close with 2-0 and 4-0 Vicryl, 4-0 Monocryl, and 3-0 Nylon. Use Mayo Hegar needle driver, adsons or rat tooth pickups, and straight mayo scissors for closure.
Walkthrough
What the surgeon does — and what to have in your hand before they ask.
Preparation and Positioning
Begin by placing several pieces of silk tape or similar material to gently separate the buttocks, ensuring optimal visualization of the pilonidal cyst location. Once the patient is prepped and draped, suction tubing and a bovie should be passed off the sterile field and plugged in for immediate use during the procedure.
Incision and Dissection
Using a 10 blade loaded on a #3 knife handle, make a wedge incision. Use toothed forceps and the bovie to carefully dissect around the pilonidal cyst. Skin hooks provide superficial retraction, transitioning to Army-Navys for deeper retraction as needed. An Allis clamp is beneficial for grasping tissue edges for maneuvering purposes.
Smoke Evacuation
Prioritize safety by utilizing a yankauer attached to suction tubing while employing the bovie to prevent inhalation of surgical smoke.
Cyst Dissection
Exercise caution to avoid dissecting into the cyst itself. Instead, meticulously dissect around it to ensure complete removal without spilling contents into the incision. Expect to encounter hair and fluid within the cyst.
Achieving Hemostasis
Following cyst removal, utilize the bovie further to achieve hemostasis in the surrounding tissue, ensuring minimal bleeding.
Closure Technique
The closure technique plays a pivotal role in successful healing. Utilize 2-0 and 4-0 Vicryl, 4-0 Monocryl, and 3-0 Nylon for closure. Instruments such as the Mayo Hegar needle driver, adsons or rat tooth pickups, and straight mayo scissors are used during the closure process. Pay careful attention to achieving precise closure to promote optimal healing outcomes.
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