The hairy sinus is a chronic sinus tract in the soft tissue of the sacrococcygeal fissure, most of which contains hair. In acute attacks, it can also appear as an acute abscess in the sacrococcygeal area, which forms a chronic sinus tract after rupture, often recurrent and persistent.
It was previously thought that the hair hiding sinus was a congenital disease, caused by a congenital defect of the skin in the area due to a residual medullary canal or a developmental malformation of the sacrococcygeal suture, causing the epidermis to fold inward. Currently, it is believed that the hair hiding sinus is an acquired disease, and the sinus and cyst are granulomatous diseases caused by injury, surgery, foreign body irritation and chronic infection, and the sinus tract does not heal easily. The twisting friction of the buttocks when walking makes the hairs between the middle fissure of the buttocks pierce into the nearby skin and form short ducts, while the hairs are still connected to its root, the short ducts then epithelialize, and when the hairs have the original follicles shed, they are gravitationally inhaled by the epithelialized short ducts. Most of the current treatments for sacrococcygeal sinus diseases are also based on the former proposal.
Clinical manifestations and diagnosis Patients with sacrococcygeal sinus can see skin depression in the midline of sacrococcygeal area with irregular small holes, about 1~3 mm in diameter, usually with a history of repeated infection and septic rupture or surgical incision to drain pus. In the early stage, the symptoms are recurrent swelling, pain and foreign body infection in the sacrococcygeal area with limited cyst formation, and in the late stage, the symptoms are cyst infection and formation of superficial abscess that breaks down by itself. Typical symptoms are acute abscess or chronic secretory sinus tract in the sacrococcygeal region, with acute symptoms such as local fever, pain and squeezing pain, and systemic clinical manifestations of acute infection such as fever and chills. The presence of hairs inside the sinus tract is characteristic, but not the only criterion. In many clinical cases, no hair can be found in the sinus tract.
Treatment 1.Non-surgical treatment If infection occurs in sacrococcygeal sinus and sacrococcygeal swelling, anti-inflammatory treatment should be performed to keep local cleanliness, and if abscess is reproduced, incision and drainage should be made. However, the skin and subcutaneous tissue of sacrococcygeal region are thicker and harder, and there is no obvious performance in the early stage, and the inflammation often spreads to surrounding tissues to cause cellulitis. Deep tissue necrosis should be incised and drained at an early stage.
Sclerotherapy is the injection of corrosive drugs into the sinus tract to destroy the sinus and intracapsular epithelium, so that the cystic cavity and sinus tract are closed. Since 1960, someone applied phenol solution injection therapy, but not many applicants, because the application of pure phenol solution, the pain is severe, later changed to 80% concentration, and under general anesthesia; sinus injection gel to protect the surrounding skin. hegge (1987) with 80% phenol solution 1 to 5ml slowly injected into the sinus, about 15min, slow injection can prevent complications, such as skin burns, fat necrosis or severe pain. Stansby (1989) injected 80% phenol solution into the sinus under general anesthesia, kept it for 1 min, scraped the sinus tract, and repeated 3 times, treating 4 cases of aseptic abscess and 1 case of bee sore fossa in 104 cases. Tissue inflammation, no other complications. Compared with 65 cases of surgical excision, the treatment rate; excision is 86%, phenol injection is 75%; follow-up average 8 months (3 months to 4 years), 10 cases of excision recurrence injection 12 cases of recurrence.
2.Surgical treatment Surgery is the main treatment method, but it is contraindicated when there is inflammation, and surgery should be performed once the inflammation has subsided. There are several surgical methods as follows: (1) excision and one-stage suture surgery to remove all diseased tissues, free muscles and skin, and completely suture the wound to make one-stage healing. To eliminate deep intergluteal fissures and their negative pressure and to reduce wound dehiscence, hematoma and abscess, Z formation surgery is feasible. It is suitable for cysts and small uninfected sinus tracts on the midline, with a recurrence rate of 0% to 37%. The advantages are short healing time, soft and mobile scar formed within the intergluteal fissure, and soft tissue between the scar and the sacrum that can tolerate injury.
(2) Excisional partial suturing. The diseased tissue is excised and the skin on both sides of the wound is sutured to the sacral fascia so that the majority of the wound heals in one stage and the middle part of the wound is healed by granulation tissue. It is suitable for cases with many sinus openings and sinus tracts, and the effect is the same as excisional one-stage suture, but the healing time is longer.
(3) Open secondary suture of the excisional wound. For cases with severe infections and cases with infected wound incision and drainage from a one-stage suture.
(4) Open excisional wound. It is suitable for cases where the wound is too large to be sutured and for cases of surgical recurrence. The operation is simple, but the healing period is long and the scar formed is extensive with only a thin layer of epithelium that adheres to the sacrum, and the scar is prone to rupture if there is injury.
(5) Pouch suturing. The surface portion of the sinus wall and the overlying skin are excised, and the wound is sutured with intestinal thread or absorbable artificial sutures to promote healing. Satisfactory results are often seen with careful postoperative care. It is mostly used for unresectable cases or recurrent hidden hair sinuses.