This is a wide excision of the coccygeal cyst with a 5 mm margin up to the sacrococcygeal fascia. In particular, three methods of wide excision of the coccygeal cyst are described: The closed, the semi-closed and the open method.
In the closed method, after wide excision of the bladder, the wound is first closed with stiches. This technique has the advantage of faster healing and better aesthetic result, but is accompanied by a higher rate of complications, such as recurrence of the cyst, inflammation, wound perforation and rupture, etc.
In the semi-closed method, the wound is first of all closed with stiches, only half of it, in order to facilitate healing, but at the same time to ensure adequate drainage of the wound, so that the risk of perforation, local collection and rupture is significantly reduced. By constantly changing the gauzes on the wound, it is healed in a second way. It has advantages over the closed method in terms of reduced chances of recurrence or perforation and disadvantages in terms of increased healing time.
In the open method, the wound after excision of the coccygeal cyst is left open and healed, after successive changes and use of topical antiseptics. It shows a significantly lower chance of perforation or recurrence, but requires a significantly longer healing time and is often accompanied by a poor aesthetic result.
Entering a probe through the main duct, opening and communicating all cavities and cleaning by creating a shallow wound that heals more easily. Stitches of marsupialization are applied on the periphery. It has similar healing rates to wide resection.
They consist of careful removal of hair and fibre from the pores without excision. It requires long-term monitoring.
It has high recurrence of rate and is associated with a lot of pain.
Consists of resection of the pilonidal cyst alone without other tissue, either through a median incision left open or through a median incision which is then closed. The lateral incision has the advantage of being easier to heal, but it is not always easy, especially in complicated cases.
The main problem is necrosis and infection of the flap.
Eccentric ellipsoidal incision (A), removal of the cyst and all pores up to the sacrococcygeal fascia, mobilization of a flap on one side (B) and closure of the wound, thus making the intergluteal fold shallower (C) with placement of a closed drain (recurrence 1%). Main complication is the hematoma.
This is the closed method with an eccentric incision. We close it by creating a skin flap. There is a subcutaneous drainage.
They are divided into full thickness z-flap, rhomboid flap, V-Y flap.
