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Suggest Treatment For Draining Cyst At Surgery Site

Posted on Wed, 15 Apr 2015

Question: Hi..
I underwent a sebaceous cyst surgery on Feb 28th. It was present in the sacral region. The surgery was performed when the cyst was infected by a plastic surgeon. The surgery went well but the serum in the attached drain did not stop coming even after 2 weeks of the surgery. Doctor removed the drain and stitches after 2 weeks. But the next day after surgery a gap developed at the site and significant amount of serum started coming from it. Doctor advised to continue dressing for a week. After a week the wound healed by about 5-10%. Doctor predicted that there might be some wall of the cyst left in the skin. He advised for a re-surgery. I consulted another surgeon and he told me that a pilonidal sinus is developed below the operated zone and a track is developed between the zone and wound(gapping). He also advised for the surgery and told that the wound will not heal because of the sinus and serum dischargw..
I dont understand why the views of the two doctors vary and what should I do now?..should I go for a re surgery? If yes, then whom should I get operated by...the old plastic surgeon or the new general surgeon.. It has been almost a month and there are no signs of improvement...

Answered by Dr. Deepak Kishore Kaltari (58 minutes later)

Brief Answer:
Likely to be Pilonidal Sinus

Detailed Answer:
Hi
Welcome to Healthcare-Magic
Greetings of the day

Dear Sir

Persistent discharge in the sacral region is likely to be due to Pilonodal sinus. It requires surgical excision in majority of cases. As the 1st diagnosis was sebaceous cyst in sacral region, I would suggest you to go through histopathological report of excised specimen for confirmation of diagnosis.

Also do send me clinical picture for further assessment.

Take care

Best Regards
Dr Deepak Kaltari
Consultant Surgeon

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Deepak Kishore Kaltari (1 hour later)

Hi Sir,

I have attached the Histopathology report and Discharge Summary. The result said Chronic Inflammation.

Should I again go and consult with the surgeon who had performed surgery and is unclear about the situation or should i get this operated by the new surgeon who predicted the sinus or should I continue the dressing and wait for the wound to get healed by itself which seems unlikely since the serum is continuously coming out of the wound.

Answered by Dr. Deepak Kishore Kaltari (9 hours later)

Brief Answer:
Discuss it with first Surgeon

Detailed Answer:
Hi

It is very much likely to be Pilonodal sinus as it's the common site for occurrence . As there is persistent discharge, further surgical intervention in form of excision is required .

I would suggest you to discuss it with your first Surgeon about further management as he will be better equipped to decide based on intraoperative findings.

Take care

Best Regards
Dr Deepak

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Deepak Kishore Kaltari (47 minutes later)

Hi sir,

I underwent a MRI today for this..I have attaches the report. Doctor has advised to go for operation. Please advise. I am thinking of getting it removed tomorrow.

Thanks

Answered by Dr. Deepak Kishore Kaltari (11 hours later)

Brief Answer:
Surgical excision will cure it

Detailed Answer:
Dear Sir

It is definitely Pilonodal sinus tract going by appearance of clinical picture and also substantiated by MRI. Surgical excision of tract will cause resolution of the sinus.
You can go ahead with Surgery as decided by you for tomorrow.

Wishing you a very happy and healthy life.

Take care

Best Regards
Dr Deepak

Note: For further inquiries on surgery procedure and its risks or complications book an appointment now

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar