[size=5]A 15-year-old presents with a 1-year history of intermittent pain and drainage from the superior gluteal cleft treated with oral antibiotics. On exam, there are three midline pits with a small amount of seropurulent drainage, but no signs of infection. After instituting a shaving regimen and starting LASER hair removal, what is the best next step in management?

 

a Wide excision with off-midline flap closure

 

b Incision and drainage with curettage of the sinus tract

 

c Minimally invasive excision of the pits and sinuses

 

d Long-term suppressive oral antibiotics

 

e Wide excision with healing by secondary intention[/size]

[size=5]A 15-year-old presents with a 1-year history of intermittent pain and drainage from the superior gluteal cleft treated with oral antibiotics. On exam, there are three midline pits with a small amount of seropurulent drainage, but no signs of infection. After instituting a shaving regimen and starting LASER hair removal, what is the best next step in management?

 

a Wide excision with off-midline flap closure

 

b Incision and drainage with curettage of the sinus tract

 

c Minimally invasive excision of the pits and sinuses

 

d Long-term suppressive oral antibiotics

 

e Wide excision with healing by secondary intention[/size]

C

C

correct answer

c Minimally invasive excision of the pits and sinuses

 

Minimally invasive approaches that achieve excision of the pits and underlying hair and inflammatory tissue have low rates of recurrence and wound complications. These include the Gips procedure, in which pits are cored out, the fistula tracts and hair are excised. The addition of endoscopic approaches may result in less recurrence and wound morbidity. Wide excision with off-midline flap closure should be reserved for recurrent drainage after a less invasive procedure as it is associated with more wound complications. Wide excision with healing by secondary intention has a high rate of recurrence. Incision and drainage is appropriate for acute care of an abscess. Long-term suppressive antibiotics are not beneficial. Aggressive hair removal, especially LASER epilation, improves outcome with all procedures.