What is Pilonidal sinus?

Pilonidal sinus is midline opening formed by a cyst or an abscess near the tailbone that often contains hair, dirt and skin debris.

How does it occur?

It is thought that the combination of buttock friction and shearing forces in that area causes broken hairs which collect there and drill through the midline skin and enter the skin by the suction created by movement of the buttocks. The body considers this hair foreign and launches an immune response against it and this immune response forms the cyst around your hair.

What are the risk factors of Pilonidal sinus?

obesity – having a body mass index (BMI) of 30 or above

age – pilonidal sinuses can occur at any age, but are more common in young adults between the ages of 15 and 40

having an above-average amount of body hair, which may be why more men are affected than women

having coarse and curly body hair

a previous injury to the affected area of skin – for example, from a fall

having a deep cleft between your buttocks

having a family history of the condition – more than one-third of people have a family member with the condition

having a job involving a lot of driving or sitting down for long periods

What are the symptoms of Pilonidal sinus?

At first you may notice a small, dimple-like depression on the surface of your skin. However, once the depression becomes infected, it will quickly develop into a cyst or an abscess.

Signs and symptoms of infection are-

pain when sitting or standing

swelling of the cyst

reddened, sore skin around the area

pus or blood draining from the abscess, causing a foul odour

hair protruding from the lesion

formation of more than one sinus tract, or holes in the skin

How do you treat Pilonidal sinus?

Conservative treatment- In those whose symptoms are relatively minor, simple cleaning out of the tracks and removal of all hair, with regular shaving of the area and strict hygiene, may be recommended.

Incision and drainage- This is done in acute exacerbation of the disease.

Before this procedure, your doctor will give you a local anaesthetic. They will then use a scalpel to open the abscess. They will clean away any hair, blood, and pus from inside the abscess. Your doctor will pack the wound with sterile dressing and allow it to heal from the inside out. The wound usually heals within four weeks, and many patients don’t require any further treatment.

Surgery- Surgery is the treatment of choice in chronic or recurring abscesses or sinuses.

What are the surgical treatments available?

Limberg Flap- The rhomboid (Limberg) flap. The flap design places the longitudinal axis of the rhomboid excision parallel to the line of minimal skin tension

Irrespective of procedure, postoperative wound care is important and centres around elimination of hair (ingrown, local or other) from the wound.

How can you prevent the recurrence of Pilonidal sinuses?

You can prevent recurrence by washing the area on a daily basis with a mild soap, making sure all soap is removed, keeping the area completely dry, and avoiding sitting for long periods.

Shaving of hair on the back and the buttock area.

Permanent laser treatment also can be helpful.

What is abdominoplasty?

Abdominoplasty or “tummy tuck” is a cosmetic surgery procedure used to make the abdomen thinner and more firm. The surgery involves the removal of excess skin and fat from the middle and lower abdomen in order to tighten the muscle and fascia of the abdominal wall. This type of surgery is usually sought by patients with loose or sagging tissues after pregnancy or major weight loss.On whom can abdominoplasty be done?
A tummy tuck is suitable for men and women who are in good health.
Women who have had several pregnancies may find the procedure useful for tightening their abdominal muscles and reducing skin. It is done in something called as Divarication of recti. For some women, pregnancy can cause abdominal separation called divarication of recti. It is a condition where the right and left sides of the rectus abdominis, the so called ‘six-pack’ muscles, spread apart at the stomach midline.

A tummy tuck is also an option for men or women who were once obese and still have excess fat deposits or loose skin around the belly.

On whom it shouldn’t be done?
If you’re a woman who plans to get pregnant, then you may want to postpone a tummy tuck until you’re done having children. During surgery, your vertical muscles are tightened, and future pregnancies can separate those muscles.
Are you planning to lose a lot of weight? Then a tummy tuck also is not for you. A tummy tuck should be a last resort after you’ve tried everything else. It should not be used as an alternative to weight loss.
You should also consider the appearance of scars after a tummy tuck. You can talk about scar placement and length with the doctor before the surgery.

How is it done?
Abdominoplasty operations vary in scope and are frequently subdivided into categories. Depending on the extent of the surgery, a complete abdominoplasty can take from 1 to 5 hours. A partial abdominoplasty (mini-tuck abdominoplasty) can be completed between 1 and 2 hours.
Complete abdominoplasty
In general, a complete (or full) abdominoplasty follows these steps:

An incision is made from hip to hip just above the pubic area.

Another incision is made to free the navel from the surrounding skin.

The skin is detached from the abdominal wall to reveal the muscles and fascia to be tightened. The muscle fascia wall is tightened with sutures.

Liposuction is often used to refine the transition zones of the abdominal sculpture.

A dressing and sometimes a compression garment are applied and any excess fluid from the site is drained.

Partial abdominoplasty
A partial (or mini) abdominoplasty proceeds as follows:

A smaller incision is made.

The skin and fat of the lower abdomen are detached in a more limited fashion from the muscle fascia. The skin is stretched down and excess skin removed.

Sometimes the belly button stalk is divided from the muscle below and the belly button slid down lower on the abdominal wall.

Sometimes a portion of the abdominal muscle fascia wall is tightened.

Liposuction is often used to contour the transition zone.

The flap is stitched back into place.

Before After

Possible Complications
You will have pain and swelling in the days following surgery. Your doctor will prescribe pain medicine and tell you how to best handle the pain. You may be sore for a few weeks.
You may also experience numbness, bruising, and tiredness during that time.
As with any surgery, there are risks. Though they’re rare, complications can include infection, bleeding under the skin flap, or blood clots. You may be more likely to have complications if you have poor circulation, diabetes, or heart, lung, or liver disease.
A tummy tuck leaves scars. Though they may fade slightly, they will never completely disappear. Your surgeon may recommend certain creams or ointments to use after you’ve completely healed to help with scars.

What is fissure-in-ano or Anal fissure?
An anal fissure or rectal fissure is a break or tear in the skin of the anal canal. It may occur when passing large or hard stools, straining during childbirth, or experiencing bouts of diarrhea. The crack in the skin exposes the muscle tissue underneath, causing severe pain and bleeding during and after bowel movements.

What are the causes of Anal fissure?
Most anal fissures are caused by stretching of the anal mucosa beyond its capability. An anal fissure most often occurs when passing large or hard stools. Chronic constipation or frequent diarrhea can also tear the skin around the anus.

Other common causes of anal fissures include:

Childbirth trauma in women

Sexual Activities

Crohn’s disease

Ulcerative colitis

Poor toileting in young children.

Decreased blood flow to the anorectal area

Overly tight or spastic anal sphincter muscle

What are the symptoms of Anal fissure?
An anal fissure may cause one or more of the following symptoms:

a visible tear in the skin around the anus

a skin tag, or small lump of skin, next to the tear

sharp pain in the anal area during bowel movements

burning or itching in the anal area

streaks of blood on stools or on tissue paper after wiping

How is anal fissure diagnosed?
Anal fissure is usually diagnosed simply by examining the area around the anus. However, digital rectal examination can also be performed to confirm the diagnosis. During this exam, the doctor will insert an endoscope or anoscope into your rectum to make it easier to see the tear. These medical instruments are thin tubes with attached cameras and lights that allow doctors to inspect the anal canal. Using an anoscope may also help your doctor find other causes of anal or rectal pain such as hemorrhoids.
What are the treatment options for Anal fissure?
Non-surgical treatments are recommended initially for acute and chronic anal fissures. These include topical nitroglycerin or calcium channel blockers (e.g. diltiazem), or injection of botulinum toxin into the anal sphincter. Other measures include warm sitz baths, topical anesthetics, high-fiber diet and stool softeners.

Sitz Bath

Surgery-
Surgical procedures are generally reserved for people with anal fissure who have tried medical therapy for at least one to three months and have not healed. It is not the first option in treatment.
Lateral internal sphincterotomy
Lateral internal sphincterotomy (LIS) is the surgical procedure of choice for anal fissures due to its simplicity and its high success rate (~95%). In this procedure the internal anal sphincter is partially divided in order to reduce spasming and thus improve the blood supply to the perianal area. This improvement in the blood supply helps to heal the fissure, and the weakening of the sphincter is also believed to reduce the potential for recurrence.[citation needed] The procedure is generally performed as a day surgery after the patient is given general anesthesia. The pain from the sphincterotomy is usually mild and is often less than the pain of the fissure itself. Patients often return to normal activity within one week.
Fissurectomy
A fissurectomy is another surgery that can be used to treat anal fissures. This procedure produces the same result as a sphincterotomy, except that during this surgery, the edges of the fissure are also surgically removed, as are any skin tags that may have occurred in conjunction with chronic tears. A cauterizing tool is then used to seal the entire area of the wound. The muscle is not cut.

How can you prevent these fissures?

keeping the anal area dry

cleansing the anal area gently with mild soap and warm water

avoiding constipation by drinking plenty of fluids, eating fibrous foods, and exercising regularly

treating diarrhea immediately