DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Pilonidal cyst.
POSTOPERATIVE DIAGNOSIS: Pilonidal cyst.
OPERATION PERFORMED: Excision of pilonidal cyst.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General endotracheal.
COMPLICATIONS: None.
DESCRIPTION OF OPERATION: After proper consent was obtained, the patient was brought to the operating room and placed on the table in the supine position. General endotracheal anesthesia was administered. The patient was then transferred to the prone position. Care was taken to properly pad and position this patient. The hair was shaved from around the operative site. Forceps were used to remove some hair, which was within several of the pilonidal cyst tracts.
The area was then prepped and draped in the usual sterile manner. Lines were marked with a marking pen to incorporate all areas of the pilonidal cyst and its draining sinus superiorly. The lines of incision were marked such as to incorporate 1 cm margins of grossly negative tissue all the way around the involved areas. Marcaine 0.5% with epinephrine was then injected throughout the operative areas, and then incision was made with a #10 blade around the lines, which were marked for this large elliptical incision. Cautery was used for meticulous hemostasis. It is important to note that all of the pilonidal sinus tracts were injected with methylene blue prior to the incision to help aid in identifying any subcutaneous tracts that are outside the area of excision. The dissection was continued with traction-countertraction, and cautery dissection to remove the area of the pilonidal cyst. As we went down through deeper tissues on the left lateral sides, several areas of blue tracts were noted, and thus the #10 blade was used to excise a wider area of skin and the subcutaneous dissection was carried out further lateral. At this point, there was no evidence of any further blue tracts of pilonidal tissue.
The incisions were carried down with this manner of dissection all the way down to the fascia, and then dissected off of the sacrum and muscular fascia. The specimen was submitted for permanent pathologic analysis. The subcutaneous layer was mobilized using traction-countertraction and cautery dissection towards the mid portion of the incision to help decrease tension on wound closure.
Wound closure was done after a size #10 round Blake drain was placed in the bed of the wound and brought out through a small incision on the left buttock region. The drain was secured to the skin with 2-0 nylon suture. The incision was closed with full-thickness #1 Prolene sutures, which were placed as vertical mattress sutures. The large sutures were spaced to allow for closure of the wound to take tension off the wound edges, and then between these sutures, staples were placed. At the most inferior aspect of the incision, 2-0 nylon sutures were used to close the incision at that site. Sterile dry dressings were placed. The patient was returned to the supine position and his endotracheal anesthesia was then reversed. The patient was sent to the recovery room postoperatively.
