A Review and Case Studies of Seven Female Cases of Sacral Pilonidal Sinus Requiring Surgery

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The sacral pilonidal sinus is known to be more common in men, and reports of pilonidal sinuses in women are scarce. We treated seven cases of sacral pilonidal sinuses in women in our department. This case series focuses on the sacral pilonidal sinus in women. Most of the cases did not have clinically obvious obesity or hypertrichosis around the pilonidal sinus, but all had defective granulation tissue in the sacral region. In the previous case, computed tomography fistulography was performed to confirm that the fistula remained subcutaneous. For surgery, a simple suture was chosen if the tissue defect after fistula excision was < 3 cm in length and almost flat, Z-plasty was chosen if the defect was between 3 and 5 cm, and local skin flap reconstruction was chosen if the defect was larger or in cases of recurrence. Histopathology showed hair infiltration in 86% of cases, a typical finding of a pilonidal sinus. After surgery, recurrence was observed in 29% of patients; who were under 20 years old and required two revision surgeries of Z-plasty and local flap reconstruction. It is important to recognize that sacral pilonidal sinus can develop in women without risk factors. Moreover, we should also be mindful of the need to accurately diagnose the presence of congenital disease involvement in women, which will lead to prompt appropriate treatment.