Wide Local Excision
Wide local excision (WLE) of the pilonidal sinus is another standard treatment option to surgically address pilonidal cysts. It surgically removes pilonidal sinuses, inflammatory tissues, tracts, or abscesses en bloc, down to the sacral fascia by excising individual pits to drain the cyst cavities in the skin and subcutaneous tissues in the sacrococcygeal area.
Different types of wide local excision include open or closed incisions at either the midline, off-midline, or with a flap. Despite the variations, the surgical procedures for wide excisions include the removal of the surrounding rim of normal tissue, excisions of lined sinus tracts, and using multiple-sized trephines. Because of the nature of the excisions, postoperative care requires the assistance of caregivers for dressing changes. Unfortunately, it leaves a sizeable cosmetic defect, pain, and discomfort, and it takes approximately eight weeks to heal following the surgery.
On the other hand, the good news is that wide local excisions have a low recurrence rate and better wound outcomes since the procedure enabled the removal of all inflammatory tissues, and the sinus tract and debris, thus allowing the granulatation of the wound from the base. It also offers fewer complications though the recovery takes a little longer than other procedures.
