Clifford Deal, III, MD, is a board-certified general surgeon with Richmond Surgical who has specialized expertise in the advanced surgical treatment of pilonidal cysts utilizing the Bascom gluteal cleft lift technique. Although a majority of his practice is surgical oncology, his journey into treating pilonidal cysts began with an Army tour in the Pacific Northwest nearly two decades ago where he trained with the pioneer of the technique, Dr. John Bascom and his son, Dr. Tom Bascom. Their work sparked a revolution in caring for patients with this condition. Dr. Deal is known as the expert in Central Virginia in this technique and treats patients who travel from near and far, including across state lines, who seek him out for his expertise. Below, he explains what a pilonidal cyst is, the symptoms it presents, who is at risk for developing them, and the treatment options available.
What is a pilonidal cyst?
Pilonidal cysts derive their name from the Latin -pilus, which means hair, and -nidus, which means nest. A pilonidal cyst is a pouch of skin that typically develops in the intergluteal crease near the tailbone. It may be filled with fluid, air, skin, hair, or other debris. Much like a splinter, a cyst forms as the body attempts to push the debris out. Pilonidal cysts are a fairly common occurrence, affecting close to 100,000 Americans each year, and are usually caused by an infection resulting from an ingrown hair or friction against the skin. While unpleasant, pilonidal cysts are not contagious.
Pilonidal cysts may occur once or can recur over time. If left untreated, they may become quite painful and result in an infected pocket of skin, which increases the risk of squamous cell carcinoma, a type of skin cancer.
What are the symptoms of a pilonidal cyst?
Some pilonidal cysts do not have symptoms, but once infected, symptoms may include:
- Tenderness or pain
- Redness near the site
- Swelling of the infected skin or a pit near the end of the tailbone
- Secretions from the affected area
- Odor from wound discharge
- Nausea
- Fever
- Fatigue
Who is most at risk for a pilonidal cyst?
Pilonidal cysts can affect anyone, but certain risk factors increase the chance of developing them:
- Being as young as 14, but rarely over the age of 40
- Being male, though females are also at risk
- Sitting for long periods of time, especially those with occupations like office workers or truck drivers
- Thick and/or stiff body hair
- Obesity
- Wearing tight clothing
- Poor hygiene
Pilonidal cysts may be hereditary, especially in families with thick body hair.
Can pilonidal cysts be prevented?
The best way to help prevent pilonidal cysts from occurring is to:
- Bathe regularly and dry the skin thoroughly.
- Shave, wax, or use a depilatory cream to avoid hair growth near the tailbone.
- Maintain a healthy weight.
- Avoid sitting for long periods of time on a regular basis.
- Wear loose clothing.
What treatment options are available for pilonidal cysts?
Treatment options for a pilonidal cyst depend on the severity of symptoms. A warm compress may help soothe the area until further treatment can be performed. Other forms of non-surgical and surgical care include:
- Antibiotics—Antibiotics may be used to help treat inflammation caused by the cyst, but antibiotics alone will not heal the cyst or prevent it from recurring.
- Injection—Phenol is an acidic compound that is injected into the cyst to treat and help prevent less advanced pilonidal cysts.
- Laser therapy—Laser therapy is used to remove hairs where they are prone to become ingrown.
- Surgical removal of the cyst.
What surgical options are available for pilonidal cysts?
If a pilonidal cyst causes pain or infection, or continues to return after trying non-surgical treatments, surgery often is the best option.
Traditional surgical excision
- Incision and drainage
- The surgeon uses a local anesthetic to numb the skin and an incision is made on the cyst to drain it. The remaining cavity is packed with gauze and left open or closed with sutures. It generally takes about a month for the cyst to heal.
- Pilonidal cystectomy
- This is an outpatient procedure requiring either general or regional anesthesia. The surgeon makes an incision to remove skin with pores, underlying tissue, and nearby hair follicles. The area is packed with gauze and a wound drain tube is inserted.
Following either type of traditional excision surgery, pain medication is provided. In addition, secretions from the pilonidal cyst will be sent to the laboratory to determine if squamous cell carcinoma cells are present. These traditional surgical procedures are moderately successful with cyst reoccurrence in up to 50 percent of patients.
State-of-the-art Bascom gluteal cleft lift
The Bascom gluteal cleft lift procedure involves making the cleft area between the buttocks shallower in order to help prevent future accumulation of debris that often leads to bacterial infection and chronic pilonidal cysts. In addition, the incision to drain the cyst is made off of the midline to promote enhanced healing and reduce the risk of the cyst reoccurring. After creating the shallower cleft, the wound is closed and a drain is temporarily put into place to prevent fluid from building up during the healing process. Dr. Deal has treated hundreds of patients with an impressive reoccurrence rate of less than one percent, which compares favorably to other national experts in the field.
Benefits of the Bascom gluteal cleft lift include:
- Significantly lower cyst reoccurrence rate compared to traditional surgical options, around one percent versus 50 percent
- Minimal post-surgical discomfort
- Minimal excision of tissue compared to standard treatments
- Faster recovery time
What are the risks associated with pilonidal cyst surgery?
Pilonidal cyst surgery is generally safe, but like all surgeries it has some risks, including:
- Bleeding
- Infection
- Prolonged healing
- Reoccurrence of the cyst in less than one percent of patients when performed by an experienced surgeon
In general, with lifestyle modifications and advanced surgical treatment, the prognosis for patients with pilonidal cysts is excellent.
To schedule a patient consultation with Dr. Deal,
please call (804) 285-9416 or book an appointment online.