Trephine Surgery Steps in Pictures
The minimally invasive surgery is tailored to the special structure of the pilonidal unit: a dermal opening leading to a narrow canal, which extends to a subcutaneous pocket with inflammatory contents and hair. A pilonidal disease can include one unit or several units whose pockets sometimes merge into one space.
During the surgery, each opening and canal are excised with a trephine, creating a wider canal without an internal skin lining — which allows for effective cleaning of the cavity and continued drainage until it shrinks and disappears, along with the opening in the skin.
Several pilonidal skin openings lead to a shared subcutaneous cavity, with a fistula and an additional skin opening on the right.
Structure of a pilonidal unit:
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An opening in the skin of the natal cleft.
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A tract partially lined with skin.
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A pilonidal pocket containing hair.
How is the treatment performed?
Excision of the narrow pilonidal tract, partially lined with skin, using a trephine.
The widened tract allows access to the pilonidal pocket.
Cleaning of the pilonidal cyst using a surgical curette
Cleaning of the pilonidal cyst using surgical forceps
The tract and the pilonidal pocket gradually shrink and disappear after cleaning