Your NYC Pilonidal Specialist Weighs in on the Term “Cyst”
In pilonidal disease, the term cyst is somewhat misleading. It suggests that an outer lining or “sac” exists, which it does not. In pilonidal pathology, we may see an impressive tuft of hair embedded under the skin, but no sac containing it. This contrasts with other true cysts that develop in the human body, such as those seen within the the ovary, the abdominal cavity, and the joints to name a few.
So what is the impact of the “cyst” misnomer? Does it have anything to do with anything? Unfortunately I think that it does and this impact is negative. Surgeons who have not taken a special interest in treating or understanding pilonidal disease are those whom it affects. These surgeons may approach pilonidal cystectomy with a perceived assignment to remove the entire “cyst” inclusive of its imagined sac. This leads to the unnecessary removal of a large volume of tissue. This alone is highly morbid for the patient.
But it does not stop there. When the wound fails, as it usually does with an operation that does not address the natal cleft, the same nonspecialist surgeon might conclude that “we didn’t get it all”, errantly referring to a cyst and its wall. Additional removal surgery is recommended and performed, leaving an even more morbid wound. The process may repeat, and with each additional flawed surgical attempt, the wound extends closer to the anus. This scenario presents the cleft-lift specialist with the most technically challenging of cases. Please don’t be one of them. Get with a pilonidal specialist from the start.