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

Pit-picking is another minimally-invasive 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 minimal incision(s) in one or several lateral sinus tracts, using a fine hemostat, thick subdermal hair shafts and associated inflammatory granulation tissue are bluntly extracted. Communicating midline pits are gently bluntly dilated with same fine hemostat, and a similar extraction process is repeated at these pits. Multiple curettes or brushes are used to further scrub or “debride” the tracts and pits. Aggressive antiseptic irrigation is done. Finally, the tracts and pits are thermally ablated with an electrocautery pencil. These incisions are left open to heal from within. 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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