In select patients, the more conservative “pit-picking” approach may be offered as a first-line treatment at PTCNJ.

Pit-picking is another first-line approach for pilonidal patients wishing to avoid a larger incision.  It is generally offered to patients with limited disease and an innately shallow cleft.  Hydrogen peroxide is first injected into any dominant sinus tract to define its extent. Via several punctate incisions in and/or to the side of the cleft, using fine hemostats or forceps, hair shafts, skin debris, and inflammatory tissue are extracted and discarded.  Multiple curettes or brushes are used to further clean or “debride” the tracts.  Aggressive antiseptic irrigation is done.  Finally, the tracts are cauterized. These incisions are left open to heal from within.  Serial or repeat procedures of this type may be required to fully eradicate the disease.  At PTCNJ, pit-picking is done in our ambulatory care center under intravenous sedation.  The patient may return to full activities the day after the procedure.


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