Umbilical pilonidal sinus: a new treatment technique of sinus excision with umbilical preservation.

Under general anesthesia, careful inspection revealed a 3-mm ulcerated site in the depth of the umbilicus from which bits of hair protruded. A vertical skin incision through the umbilicus skirting one side of the sinuses was made. Diathermy cutting was used to minimize bleeding and ensure visibility of the lesion. There were several strands of hair projecting through three sinus openings (Figure 1). These communicated with a single subcutaneous tract that reached the sheath in the midline but did not branch laterally. All three openings and the tract were completely excised using a probe as a guide (Figure 2), approaching the tract superiorly, inferiorly, and laterally deep to the umbilicus, excluding the umbilical cicatrix and thus preserving it. The skin was closed primarily with subcuticular polypropylene, and the patient was given a course of antibiotics. He recovered uneventfully, had the sutures removed 10 days postoperatively, and has had no recurrence at 2 years.