A 40-year-old man presents with a tender fluctuant swelling in the natal cleft discharging pus, diagnosed as a pilonidal abscess. Which principle of surgical drainage best reduces the risk of recurrence and delayed wound healing?
- A Drain through a vertical midline incision
- B Wide excision of all pits and sinuses at the same sitting
- C Drain through an incision placed off the midline, lateral to the abscess ✓
- D Incision and marsupialisation of the cavity wall to the skin
Correct answer: C. Drain through an incision placed off the midline, lateral to the abscess
Explanation
An acute pilonidal abscess should be drained through an incision made off the midline, over the point of maximum fluctuation lateral to the midline wounds heal poorly. Midline incisions leave a scar in the natal cleft where dead space and moisture perpetuate disease and delay healing. Wide excision and flap procedures are elective operations for chronic or recurrent disease, never for an acutely infected abscess, which rules out the excision option.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.