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Allen KamravaMD · MBA · FACS · FASCRS

What should you do if a pilonidal cyst bursts on its own?

In patients whose pilonidal cyst or abscess has spontaneously ruptured and drained, what wound care, follow-up, or surgical management reduces infection, speeds healing, and prevents recurrence compared with formal incision and drainage or excision?

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Evidence review in plain language · compiled 2026-10-13 · checked 2026-10-13 · next 2026-11-13 · automated review, how it works

What the evidence says

Bottom line

No study has tested what to do when a pilonidal cyst bursts open on its own at home.

The 48 studies found here look at related but different situations — cysts drained by a doctor in a clinic, or removed in surgery — not cysts that rupture by themselves without any procedure. Because none of this research followed people after a spontaneous burst, there is no evidence about whether home wound care, antibiotics, or a doctor's visit changes healing time, infection, or recurrence in that specific situation.

How certain

Very low

The 35 human studies found measure a related question rather than this one, so they can only be read indirectly.

What it shows

Not studied

No study has measured this outcome in people with this condition.

studies found
48studies found
randomised trials
4randomised trials
people studied
17,423people studied
reviews of trials
4reviews of trials
years covered
2017–2026years covered

What the research shows

  • Time to complete wound healing

    Studies measuring healing time looked at wounds after a clinician drained or surgically removed the cyst — healing took roughly 8 to 11 weeks depending on the dressing or technique used. None of these studies involved a wound that opened on its own without any procedure, so these figures may not apply to that situation.[1,2,3,4]

    Insufficient evidence

  • Rate of recurrent abscess or sinus formation

    After a clinician performed incision and drainage, somewhere between about 30% and 54% of people needed more treatment within one to five years in large cohort studies. No study tracked recurrence specifically after a cyst burst on its own without any medical procedure.[1,2,3]

    Insufficient evidence

  • Rate of surgical site infection

    Complication rates of about 4% to 22% have been reported after a doctor drains a pilonidal abscess surgically. No study measured infection rates for a cyst that ruptured and drained by itself at home.[1,2]

    Insufficient evidence

  • Need for subsequent surgical intervention

    Large registry studies found that about 30% to 45% of people needed another operation within five years after a doctor-performed drainage procedure. Whether this applies to a cyst that bursts on its own, with no initial procedure at all, has not been studied.[1,2]

    Insufficient evidence

  • Pain and symptom resolution within days to weeks

    No study in this review tracked how pain or symptoms change in the days or weeks after a cyst ruptures on its own without treatment.

    Not studied

  • Hospitalization or emergency department visits

    No study measured how often people need a hospital or emergency department visit after a pilonidal cyst bursts by itself at home.

    Not studied

Important limitations

  • Every study found describes a cyst or abscess that was drained, lanced, or removed by a clinician — none followed a cyst that ruptured by itself without any procedure, which is the exact situation this question asks about.[1,2,3,4]
  • Most of the available evidence is retrospective cohorts, case series, or narrative reviews rated low or very low quality. Among the 48 studies, only 4 are randomised trials, and those trials test wound dressings or topical treatments (honey, propolis, alginate) applied after surgical excision of a cyst, not what to do after a cyst bursts on its own.[1,2,3,4]
  • A case series shows that when hair is left behind inside a drained pocket, the area can keep draining or form a lump needing further treatment — but this was studied after a clinician's incision, not after a cyst burst on its own.[1]
  • Studies mix children, teenagers, and adults, and mix first-time cysts with repeat or chronic disease, making it hard to know which findings would apply to any one person, let alone to someone whose cyst just burst at home.[1,2,3,4]

Why people try it

  • The cyst already opened and drained on its own, so it can feel like the problem is resolving itself without needing a doctor.
  • Fear or dislike of the idea of surgery or an in-office drainage procedure.
  • Embarrassment about the location of the cyst, near the buttocks crease.
  • Hoping to avoid the cost, time off work, or scheduling hassle of a medical visit.
  • Past experience with skin boils or pimples that healed on their own without treatment, leading to the assumption this will too.

What the studies found

  • Found a benefit21 · 44%
  • Found no clear effect3 · 6%
  • Mixed or unclear23 · 48%
  • Found possible harm1 · 2%

What kind of studies

  • Retrospective12 · 25%
  • Narrative review11 · 23%
  • Case series10 · 21%
  • Prospective cohort5 · 10%
  • Randomised trial4 · 8%
  • Meta-analysis3 · 6%
  • Guideline2 · 4%
  • Systematic review1 · 2%

The studies that decided it

  • Faurschou et al. 2026

    Risk of re-operation after Bascom I for pilonidal sinus disease. A Danish population-based cohort study

    High re-operation rates after surgery.RetrospectiveModerate qualityRelated question

    3,555 people5-year

    5-year re-operation risk was 30% overall, with 65% of re-operations happening within the first year; after a second Bascom I the 5-year risk rose to 45%

    Who was studied
    Danish patients with chronic pilonidal sinus disease who had elective Bascom I surgery, some with no prior treatment and some with prior drainage or other procedures
    What they received
    Bascom I surgical procedure for pilonidal sinus disease
    Compared with
    Patients grouped by prior treatment history (no previous treatment, one incision & drainage, two incision & drainage, or other prior procedures)
    Main outcome
    Risk of needing another operation (re-operation) after surgery
    Quality
    This is a large nationwide registry study, which gives reliable real-world numbers, but it has no comparison group testing whether surgery is better than other options, so it can't say what works best.
    Limitations
    The abstract does not address spontaneous bursting of a cyst at all; it only studies elective surgical treatment (Bascom I) and its re-operation rates, with no comparison to non-surgical management or watchful waiting after rupture.

    Taken word for word from the abstract

    • n Of 3555 (79% male) PSD patients undergoing Bascom I procedure
    • population we identified patients diagnosed with PSD undergoing incident Bascom I
    • intervention The preferred minimally invasive treatment in Denmark is the Bascom I procedure.
    • comparator Based on previous surgery, patients were divided into four groups: (i) Bascom I with no previous PSD treatment; Bascom I with history of (ii) one or (iii) two incision & drainage (I&D) procedures; and (iv) Bascom I with history of other PSD procedures.
    • primaryOutcome AIM: To evaluate re-operation rates following elective Bascom I and to identify potential risk factors.
    • result The overall 5-year re-operation risk was 30%, highest in younger age groups. As much as 65% of re-operations occurred within the first 12 months. After a second Bascom I, the 5-year risk was 45%.

    Colorectal Dis · PMID 42227065 · Read it on PubMed ↗

  • Donnelly et al. 2026

    Minimally Invasive, Maximally Effective: Outpatient Strategies for Paediatric Pilonidal Disease

    Non-surgical care tied to fewer recurrences, but groups differed.RetrospectiveLow qualityRelated question

    69 people2026

    the cyst came back in 26.1% of patients who had surgery compared with 2.2% of patients managed without surgery

    Who was studied
    children and teenagers with pilonidal sinus disease
    What they received
    a stepped outpatient care plan (simple wound care, in-clinic cleaning, or surgery for severe cases)
    Compared with
    patients who needed surgery versus those managed without surgery
    Main outcome
    the cyst coming back after it had healed
    Quality
    it is a single-centre look-back study where the patients who had surgery were likely sicker to begin with, so the comparison may be unfair.
    Limitations
    retrospective single-centre design and patients choosing or needing surgery likely had more severe disease, which could explain the difference seen

    Taken word for word from the abstract

    • n 69 patients were included
    • population patients aged ≤ 18 years treated for PNS between February 2023 and August 2024
    • intervention Management followed a stepwise protocol: structured conservative care, in-clinic debridement and operative intervention (trephination or limited excision) for refractory or severe disease.
    • comparator Recurrence occurred in 6/23 (26.1%) in the operative group and 1/46 (2.2%) in the non-operative group
    • primaryOutcome Primary outcome was recurrence after documented healing.
    • result Recurrence occurred in 6/23 (26.1%) in the operative group and 1/46 (2.2%) in the non-operative group (Fisher's exact p = 0.0045).

    Int Wound J · PMID 42020338 · Read it on PubMed ↗

  • Faurschou et al. 2025

    Risk of re-operation after incision and drainage for acute, abscess-forming pilonidal sinus disease: A Danish population-based cohort study

    About a third needed repeat surgery.RetrospectiveModerate qualityRelated question

    8,251 peoplefive-year

    about one-third of patients needed another operation within five years, with risk higher in younger patients, those with a family history, and after repeated drainage procedures

    Who was studied
    patients with acute abscess-forming pilonidal sinus disease treated surgically
    What they received
    lateral incision and drainage (I&D) as initial surgical treatment
    Main outcome
    risk of needing a repeat operation after initial incision and drainage
    Quality
    it is a large national registry study giving reliable rates, but it is observational with no comparison group and does not address what happens if a cyst bursts on its own rather than being surgically drained.
    Limitations
    observational cohort using registry data; no untreated or spontaneous-rupture comparison group; re-operation risk factors examined only in subgroups.

    Taken word for word from the abstract

    • n Of 8251 (62% male) patients included, 2455 underwent re-operation for PSD.
    • population we identified patients diagnosed with abscess-forming PSD undergoing lateral I&D as the initial treatment for PSD
    • intervention identified patients diagnosed with abscess-forming PSD undergoing lateral I&D as the initial treatment for PSD
    • primaryOutcome To evaluate re-operation rates following abscess-forming PSD treatment with lateral I&D
    • result The overall five-year CIF was 32% for males and 33% for females.
    • result A family history of PSD was found to increase re-operation risk, especially among female patients (aHR: 1.64 (95% confidence interval [95% CI]: 1.39-1.93)).
    • result The risk increases following the second and third consecutive I&D procedures to 52% and 69% in males, and to 57% and 64% in females, respectively.

    Colorectal Dis · PMID 41239746 · Read it on PubMed ↗

  • Darnis et al. 2025

    Management of pilonidal sinus and recurrences in 2025

    Medical care or drainage, no comparison givenNarrative reviewVery low quality

    size not given2025

    the abstract states only that treatment is based on medical treatment or emergency incision and drainage, without comparing their outcomes

    Who was studied
    people with pilonidal sinus who develop abscess or suppuration
    What they received
    medical treatment (analgesics, antiseptics, sometimes antibiotics) or emergency incision and drainage
    Compared with
    medical treatment versus emergency incision and drainage in the operating room
    Quality
    this is a narrative review describing general practice rather than a study comparing outcomes, so it cannot show which approach works better.
    Limitations
    no study design, no outcome data, no comparison of effectiveness between the two approaches is given

    Taken word for word from the abstract

    • population If suppuration and abscess develop
    • intervention treatment is based either on medical treatment combining analgesics, local antiseptics and sometimes antibiotics, or on emergency incision and drainage in the operating room
    • comparator treatment is based either on medical treatment combining analgesics, local antiseptics and sometimes antibiotics, or on emergency incision and drainage in the operating room
    • result treatment is based either on medical treatment combining analgesics, local antiseptics and sometimes antibiotics, or on emergency incision and drainage in the operating room

    J Visc Surg · PMID 39875233 · Read it on PubMed ↗

  • Huurman et al. 2024

    Acute pilonidal abscess: Prospective nationwide audit in the Netherlands

    Less than half healed after drainage.Prospective cohortLow qualityRelated question

    208 people1 year

    42.2% of wounds had healed by the time of outpatient follow-up, with a median of 43 days to closure, and 4.4% had complications

    Who was studied
    people with a sudden pilonidal abscess (an infected pocket near the tailbone)
    What they received
    surgical incision and drainage of the abscess
    Compared with
    no comparison group; all patients received incision and drainage
    Main outcome
    wound healing, time to resume daily activities, and complications
    Quality
    This was an observational study of surgical drainage with no comparison group, so it cannot tell you whether draining is better or worse than letting an abscess burst and heal on its own.
    Limitations
    No comparator group (e.g. no surgery or spontaneous rupture), all patients had surgical drainage so results don't show what happens without intervention.

    Taken word for word from the abstract

    • n Of 681 included patients, 208 presented with an acute pilonidal abscess.
    • population only patients with an acute abscess were included for analysis
    • intervention Incision and drainage (I&D) was performed in 205 of these patients (99%).
    • comparator Incision and drainage (I&D) was performed in 205 of these patients (99%).
    • primaryOutcome Outcomes included symptoms, wound healing, time to resume daily activities and complications.
    • result The wound healing rate after I&D was 42.2% at the outpatient clinic, with a median time to closure of 43 days. The complication rate was 4.4%.
    • followUp Follow-up was 1 year

    Colorectal Dis · PMID 39635960 · Read it on PubMed ↗

  • Nepomuceno et al. 2024

    Pilonidal granuloma formation after an incision and drainage procedure is associated with retained hair within the sinus - A case series

    Leftover hair caused recurring drainage.Case seriesVery low qualityRelated question

    2 people2024

    after incision and drainage, both patients developed a granuloma with ongoing drainage because hair was left inside the sinus; removing the hair and granuloma resolved it

    Who was studied
    teenage boys with pilonidal cysts that had been cut open and drained
    What they received
    pit-picking procedure with removal of granuloma and hair from the sinus
    Compared with
    no comparator, same patients followed after initial incision and drainage
    Main outcome
    whether the wound healed or kept draining/forming a granuloma
    Quality
    only two patients with no comparison group, so it cannot show what works, only what can go wrong
    Limitations
    extremely small case series of only two patients, no control group, and it describes drainage after a surgical incision rather than a cyst bursting on its own

    Taken word for word from the abstract

    • n Two adolescent males presented with pilonidal disease.
    • population Two adolescent males presented with pilonidal disease.
    • intervention He underwent a pit-picking procedure along with excision of the granuloma.
    • comparator an incision and drainage procedure was performed
    • primaryOutcome the incision site formed a granuloma with intermittent draining wound with granulation tissue
    • result Even though the pilonidal abscess was drained with an incision, a granuloma was able to form with recurrent drainage when hair was retained within the pilonidal sinus.

    Int J Surg Case Rep · PMID 39461136 · Read it on PubMed ↗

  • Mahjoubi et al. 2022

    RADICAL VERSUS CONSERVATIVE METHODS IN ONE-STAGE PILONIDAL ABSCESS SURGERY: THE EXPERIENCE OF A TUNISIAN CENTER

    Excision: fewer recurrences, slower healing.RetrospectiveLow qualityRelated question

    57 people2022

    excision had less recurrence (19% vs 54%) but took longer to heal and longer to return to activity than incision

    Who was studied
    patients who had surgery for a pilonidal abscess
    What they received
    radical surgery (excision)
    Compared with
    conservative surgery (incision, with curettage or drainage)
    Main outcome
    recurrence of the cyst after surgery, plus healing time and return to activity
    Quality
    it is a small, non-randomized comparison of surgical techniques, not a study of spontaneous rupture or its management.
    Limitations
    not randomized, small sample, compares two surgical approaches rather than addressing spontaneous rupture or non-surgical management

    Taken word for word from the abstract

    • n We analyzed 57 patients
    • population patients operated on for pilonidal abscess
    • intervention Excision of pilonidal abscess
    • comparator incision in 11 (19%) cases associated with curettage in three cases and drainage in 1 case
    • primaryOutcome We looked for the occurrence of postoperative recurrence
    • result The recurrence rate was 19% in radical surgery and 54% in conservative surgery.
    • result Conservative surgery was significantly associated with faster healing of the surgical wound (p<0.001).
    • result Excision of pilonidal abscess was significantly associated with a longer time to return to activity (p=0.04).

    Arq Bras Cir Dig · PMID 36542008 · Read it on PubMed ↗

  • Menegas et al. 2021

    Abscess Management: An Evidence-Based Review for Emergency Medicine Clinicians

    Needle aspiration with antibiotics may be alternative.Narrative reviewLow qualityRelated question

    size not given2021

    Pilonidal abscesses have traditionally been managed with I&D, but needle aspiration with antibiotics may be a suitable alternative.

    Who was studied
    people with abscesses treated in the emergency department, including those with pilonidal abscesses
    What they received
    needle aspiration with antibiotics for pilonidal abscess
    Compared with
    incision and drainage (I&D) for pilonidal abscess
    Main outcome
    best approach to managing pilonidal abscesses in the emergency department
    Quality
    This is a narrative review summarizing other studies without describing its own evidence quality or comparative data for pilonidal abscesses specifically.
    Limitations
    The abstract does not describe study design, sample sizes, or quality of the underlying evidence for the pilonidal abscess claims; it also addresses formed abscesses needing drainage in an ED setting, not a cyst that has burst on its own at home.

    Taken word for word from the abstract

    • result Pilonidal abscesses have traditionally been managed with I&D, but needle aspiration with antibiotics may be a suitable alternative.
    • intervention needle aspiration with antibiotics
    • comparator Pilonidal abscesses have traditionally been managed with I&D
    • population pilonidal abscesses
    • primaryOutcome evidence-based nuances to the management of specific types of abscesses, such as Bartholin, breast, dental, hidradenitis suppurativa, peritonsillar, and pilonidal abscesses

    J Emerg Med · PMID 33298356 · Read it on PubMed ↗

What actually helps, on this site

More about the condition:

All 48 studiesEvery study that answered the question, with its design, size and result.
The other 40 studiesEverything else the search returned, including anything retracted.

  • Garcia et al. 2026

    Patient characteristics and microbiology in pilonidal abscesses in children

    No recurrence risk factors found.RetrospectiveLow qualityRelated question

    154 people2026

    No risk factors for recurrence were identified.

    Who was studied
    children with pilonidal abscesses treated at a children's hospital
    What they received
    none - observational study of abscess microbiology and patient characteristics
    Compared with
    none reported
    Main outcome
    which bacteria were found and whether any factors predicted the abscess coming back
    Quality
    This is a retrospective review without a control group or any tested treatment, so it can't show what works.
    Limitations
    Abstract does not describe study limitations in detail; no comparison group or intervention tested.

    Taken word for word from the abstract

    • n 216 pilonidal abscess episodes among 154 children
    • population 216 pilonidal abscess episodes among 154 children over a 10-year period at a tertiary pediatric center
    • primaryOutcome We described the microbiology of 216 pilonidal abscess episodes among 154 children over a 10-year period at a tertiary pediatric center and assessed patient characteristics associated with recurrence.
    • result No risk factors for recurrence were identified.
    • intervention surgical cultures
    • comparator Anaerobes and Streptococcus anginosus group were the most common organisms isolated from surgical cultures.

    J Pediatric Infect Dis Soc · PMID 41454773 · Read it on PubMed ↗

  • O'Guinn et al. 2026

    Pilonidal Disease

    Draining and removing pits helps.Narrative reviewVery low qualityRelated question

    size not given2026

    adding deroofing of pits at time of drainage lowered recurrence compared to drainage alone

    Who was studied
    adolescents and young adults with pilonidal disease
    What they received
    incision and drainage with deroofing of identified pits
    Compared with
    incision and drainage alone
    Main outcome
    recurrence of pilonidal disease
    Quality
    this is a narrative review summarizing general management approaches without data, numbers, or study details to assess reliability
    Limitations
    abstract does not describe study methods, sample sizes, or specific data behind these claims

    Taken word for word from the abstract

    • population Pilonidal disease, common in adolescents and young adults
    • intervention the addition of deroofing identified pits at the time of drainage can reduce recurrence
    • comparator Acute disease is primarily managed by incision and drainage
    • primaryOutcome can reduce recurrence
    • result the addition of deroofing identified pits at the time of drainage can reduce recurrence

    Surg Clin North Am · PMID 41241452 · Read it on PubMed ↗

  • Ukleja et al. 2025

    A Case Report of Wound-Vacuum-Assisted Closure (VAC) Treatment Following Pilonidal Cyst Excision

    Healed well after surgery and vacuum dressing.Case seriesVery low qualityRelated question

    1 peoplethree weeks

    wound healed over several weeks with minimal pain and no complications after wound-VAC treatment and dressing changes

    Who was studied
    28-year-old man with a recurring pilonidal cyst and chronic sinus tract
    What they received
    surgical removal of the cyst followed by vacuum-assisted wound closure (wound-VAC)
    Compared with
    no comparison group
    Main outcome
    wound healing after surgery
    Quality
    this is a single patient case report, so it cannot show whether this approach works better than others.
    Limitations
    only one patient; no comparison group; describes a surgically excised cyst, not a cyst that burst on its own

    Taken word for word from the abstract

    • population an otherwise healthy 28-year-old man who presented with a recurrent pilonidal cyst with a chronic sinus tract despite previous repeat incision and drainage procedures
    • intervention underwent pilonidal cyst excision with vacuum-assisted wound closure (wound-VAC) placement to facilitate the healing process
    • comparator Different therapeutic options have been described, including excision with primary closure, healing by secondary intention, or flap creation
    • primaryOutcome The wound size and the wound depth decreased, requiring no further need for wound-VAC dressing.
    • result Over the next three weeks, the wound healed via secondary intention with a simple dry-to-dry gauze dressing with minimal intermittent pain and without any complications.
    • n a recurrent pilonidal cyst

    Cureus · PMID 40821131 · Read it on PubMed ↗

  • Liang et al. 2024

    Management and outcomes of pilonidal patients with secondary sinuses-a cohort study

    Drainage often resolved without more surgeryProspective cohortLow qualityRelated question

    105 people367.0 days

    most patients healed, but some had the drainage site reopen temporarily, and this usually went away without needing another surgery

    Who was studied
    teenagers and young adults with pilonidal disease who also had a draining secondary opening near the tailbone
    What they received
    surgical removal of the pilonidal cyst along with the secondary sinus opening (Gips procedure)
    Compared with
    regular hair removal (epilation) versus no regular hair removal after surgery
    Main outcome
    whether drainage or the cyst came back after surgery
    Quality
    this is a single-group observational study of surgical patients, not a controlled comparison, so it cannot show what works best
    Limitations
    no comparison group, single center, and it studies surgically excised cysts rather than cysts that burst on their own

    Taken word for word from the abstract

    • n One hundred and five patients (seventy-one males) with a median age of 17.2 years
    • population Patients with PD and concurrent secondary sinus who underwent Gips procedure with secondary sinus excision from 2019 to 2023 were prospectively followed.
    • intervention underwent Gips procedure with secondary sinus excision
    • comparator Without regular epilation, six patients (5.7%, five males, one female) had recurrent PD. With regular epilation, three patients (2.8%, three males) had recurrent PD.
    • primaryOutcome Patient demographics, drainage recurrence, symptom resolution, treatment, and follow-up period were recorded.
    • result Excision can be complicated by recurrent drainage from the secondary sinus site that can resolve without repeat surgical excision.

    Pediatr Surg Int · PMID 39145895 · Read it on PubMed ↗

  • Ram et al. 2024

    Efficacy and safety of RD2 Ver.02, a whole blood clot therapy, coupled with a minimally invasive procedure in pilonidal sinus: a phase II study

    High healing rate with this specific injected procedure.Prospective cohortLow qualityRelated question

    51 people12 months

    82.4% healed at 3 months, 90.2% at 6 months, 82.4% at 12 months, with recurrence in 11.8% of patients

    Who was studied
    people with pilonidal sinus (infected hair-filled skin tunnel near the tailbone)
    What they received
    a minimally invasive procedure plus injection of a blood-clot product (RD2 Ver.02) into the cavity
    Compared with
    none (single-arm study, no comparison group)
    Main outcome
    whether the wound fully healed at 3, 6, and 12 months
    Quality
    This was a small, single-arm study with no comparison group, so it can't show whether this treatment is better than other options.
    Limitations
    Open-label, single-arm pilot study with no control group; abstract does not address spontaneous rupture of a cyst, only a specific procedure-based treatment for diagnosed pilonidal sinus.

    Taken word for word from the abstract

    • n Overall, 51 patients participated in the study.
    • population Patients with PNS underwent a minimally invasive trephine procedure under local anesthesia
    • intervention a minimally invasive trephine procedure under local anesthesia followed by RD2 Ver.02 instillation into the cavity
    • comparator A Phase II open-label, pilot, single-arm prospective study
    • primaryOutcome Primary healing was assessed at 3, 6, and 12 months.
    • result At 3 months, 42/51 healed (82.4%), 7/51 (13.7%) were granulating but not completely healed, and 2/51 (3.9%) failed to heal. At 6 and 12 months, 46/51 (90.2%) and 42/51 (82.4%) achieved complete healing, respectively.
    • result a total of recurrence in six patients (11.8%)

    Tech Coloproctol · PMID 39136828 · Read it on PubMed ↗

  • Hagen 2024

    Utility of synthetic electrospun fiber matrix in general surgery: From head to toe

    No specific pilonidal cyst outcome reported.RetrospectiveVery low qualityRelated question

    19 people2024

    89.5% of patients (17 of 19) met their individual clinical goals after treatment with the matrix, but only one patient in the series had a pilonidal cyst and no separate result was given for that case

    Who was studied
    patients with complex, hard-to-heal wounds of many different causes, including one with a pilonidal cyst
    What they received
    a synthetic electrospun fiber matrix wound dressing applied to the wound
    Compared with
    none (no comparison group; before-and-after case series)
    Main outcome
    whether the wound met the patient's individual clinical healing goal
    Quality
    This is a tiny, uncontrolled retrospective case series mixing many different wound types, with only a single pilonidal cyst case and no isolated outcome for it.
    Limitations
    Retrospective, no control group, very small and mixed-etiology sample, and only one case was a pilonidal cyst with no individual outcome reported for it.

    Taken word for word from the abstract

    • n Nineteen patients (22 wounds) met the inclusion criteria for analysis.
    • population pilonidal cyst (n = 1)
    • intervention complex wound care treatment with at least 1 application of the electrospun fiber matrix
    • comparator This was a retrospective study of patients at a single institution
    • primaryOutcome A total of 17 of 19 (89.5%) patients were observed to meet their individual clinical goals after application of the wound matrix.
    • result A total of 17 of 19 (89.5%) patients were observed to meet their individual clinical goals after application of the wound matrix.

    Surgery · PMID 39095220 · Read it on PubMed ↗

  • King et al. 2024

    Commentary on packing vs non-packing of pilonidal sinus cavities after incision and drainage

    No result reported; only a methods critiqueNarrative reviewVery low qualityRelated question

    size not given2024

    This abstract only critiques the methods of an earlier review; it does not state which approach worked better for pilonidal sinus patients

    Who was studied
    People with pilonidal sinus disease treated with incision and drainage
    What they received
    Packing the wound cavity after incision and drainage
    Compared with
    Not packing the wound cavity after incision and drainage
    Main outcome
    Comparative outcomes after packing versus not packing the abscess cavity
    Quality
    This is a commentary critically appraising another review's methods rather than presenting new patient data or outcomes.
    Limitations
    The underlying review it critiques covered cutaneous abscesses anywhere on the body, not specifically pilonidal sinus disease, and this abstract gives no new outcome data.

    Taken word for word from the abstract

    • population Pilonidal sinus disease (PSD) manifests as an inflammatory skin condition typically emerging within the anal cleft.
    • intervention packing versus non-packing of an abscess cavity following incision and drainage of cutaneous abscess on any part of the body
    • comparator packing versus non-packing of an abscess cavity following incision and drainage of cutaneous abscess on any part of the body
    • primaryOutcome to evaluate the comparative outcomes of packing versus non-packing of an abscess cavity following incision and drainage of cutaneous abscess on any part of the body
    • result This commentary aims to critically appraise the methods used within the review by Mohamedahmed et al (2021) and expand upon the findings in the context of treatment and management of PSD.

    Br J Community Nurs · PMID 38478417 · Read it on PubMed ↗

  • Anorectal Branch of Chinese Medical Doctor Association et al. 2023

    [Chinese expert consensus on the diagnosis and treatment of sacrococcygeal pilonidal disease (2023 edition)]

    No specific guidance given here.GuidelineLow qualityRelated question

    size not given2023

    The abstract does not report specific guidance on what to do if a cyst bursts on its own; it describes a consensus process forming opinions on diagnosis, risk factors, non-surgical and surgical treatment, minimally invasive treatment, and wound management.

    Who was studied
    people with sacrococcygeal pilonidal disease
    What they received
    various treatments for pilonidal disease (hair removal, sinusectomy, surgery, minimally invasive treatment, wound management)
    Main outcome
    standardized diagnosis and treatment recommendations
    Quality
    This is an expert consensus statement based on opinion and literature summary, not original research testing a specific intervention or outcome.
    Limitations
    The abstract gives no original data, no patient numbers, and no specific statement about spontaneously ruptured cysts; it is a general consensus document.

    Taken word for word from the abstract

    • population Sacrococcygeal pilonidal disease(SPD) is an acquired disease intimately related to the presence of hair in the gluteal groove.
    • intervention numerous treatment options are available for SPD including gluteal groove and surrounding skin hair removal, sinusectomy, open healing by secondary intention, primary closure, and local excision with flap reconstruction
    • primaryOutcome formed opinion in 12 terms of SPD diagnosis, risk factors, non-surgical treatment, surgical treatment, minimally invasive treatment, and wound management
    • result developed the "Chinese expert consensus on the diagnosis and treatment of sacrococcygeal pilonidal disease (2023 edition)" after rounds of discussion and revision, to improve the diagnosis and treatment of SPD.

    Zhonghua Wei Chang Wai Ke Za Zhi · PMID 37974345 · Read it on PubMed ↗

  • Gan et al. 2024

    A meta-analysis comparing phenol treatment with surgical excision for pilonidal sinus

    Phenol as good as surgery, fewer complications.Meta-analysisLow qualityRelated question

    size not given2024

    Phenol had similar recurrence to surgery, fewer wound complications, and faster recovery

    Who was studied
    people with pilonidal sinus disease
    What they received
    phenol treatment
    Compared with
    surgical excision
    Main outcome
    disease recurrence and wound complications
    Quality
    Pools mostly non-randomized studies (9 of 14 non-RCTs) comparing two active treatments, not addressing what to do about a sinus that has already burst on its own.
    Limitations
    Mix of RCTs and non-RCTs; not about spontaneous rupture of a cyst but about chosen treatments for pilonidal sinus disease.

    Taken word for word from the abstract

    • population comparing phenol treatment and surgical treatment of pilonidal sinus
    • intervention phenol treatment
    • comparator surgical excision
    • primaryOutcome recurrence rate is not significantly different from surgical treatment
    • result wound complications were considerably less common (RR = 0.40, 95% CI [0.27,0.59])
    • result The phenol group had a slightly higher rate of disease recurrence than the surgical group (RR = 1.12, 95% CI [0.77,1.63]), but the difference was not statistically significant (P = 0.55 > 0.05).

    Asian J Surg · PMID 37419810 · Read it on PubMed ↗

  • Salih et al. 2023

    Non-operative management of pilonidal sinus disease; classification and outcome

    Non-surgical treatment lowered recurrence risk.Prospective cohortLow qualityRelated question

    3,529 people6 weeks

    having an abscess was the strongest factor linked to the sinus coming back, and patients could be grouped into three risk classes for recurrence

    Who was studied
    people with pilonidal sinus disease on the lower back/buttocks crease
    What they received
    a non-surgical treatment called Salih's preparation (antimicrobial and scarring solution)
    Compared with
    no direct comparison group; outcomes tracked after treatment
    Main outcome
    whether the pilonidal sinus came back (recurrence) after treatment
    Quality
    This study only followed one group of patients without a comparison group and relied on choosing a subset of a much larger patient pool, so it can't reliably show whether this treatment is better than other options.
    Limitations
    Single-group design with no control group, large exclusion of patients from the original pool, short 6-week follow-up, and no mention of randomization.

    Taken word for word from the abstract

    • population patients with sacrococcygeal pilonidal sinus disease
    • intervention managed by a non-operative technique using Salih's preparation
    • comparator This is a single-group cohort study that enrolled consecutive patients that had pilonidal sinus.
    • primaryOutcome The patients were seen at the clinic 6 weeks after the intervention to record data of recurrence.
    • result The most significant factor related to the recurrence was the presence of an abscess.
    • n only 3529 patients were included in this study
    • followUp seen at the clinic 6 weeks after the intervention

    Int Wound J · PMID 37259676 · Read it on PubMed ↗

  • Gil et al. 2023

    Management of Pilonidal Disease: A Review

    Doesn't address spontaneous rupture directly.Narrative reviewLow qualityRelated question

    size not given2023

    the review concludes evidence on treatment options is limited and inconsistent, and it does not describe what to do when a cyst bursts on its own

    Who was studied
    people with pilonidal disease
    What they received
    the range of treatments used for pilonidal disease, from conservative care to surgery
    Compared with
    different treatment modalities compared with each other
    Main outcome
    disease recurrence and treatment-related complications
    Quality
    This is a general review describing many treatment options rather than a study testing one specific treatment, and it states the underlying evidence is weak and inconsistent.
    Limitations
    the current evidence supporting the different treatment options is limited by study quality with inconsistent characterization of disease severity and use of variable definitions and reporting of treatment-associated outcomes across studies

    Taken word for word from the abstract

    • population the management of pilonidal disease continues to be a challenge
    • intervention There is a heterogeneous repertoire of treatment modalities used in the management of pilonidal disease
    • comparator wide practice variation among clinicians
    • primaryOutcome high rates of recurrence and treatment-associated morbidity
    • result the current evidence supporting the different treatment options is limited by study quality with inconsistent characterization of disease severity and use of variable definitions and reporting of treatment-associated outcomes across studies

    JAMA Surg · PMID 37256592 · Read it on PubMed ↗

  • Abet et al. 2023

    The value of honey dressings in pilonidal cyst healing: a prospective randomized single-center trial

    No clear healing benefit from honey.Randomised trialModerate qualityRelated question

    100 people2023

    healing took about 61 days with honey versus 78 days without, but the difference was not statistically significant

    Who was studied
    adults with a wound that hadn't healed 6 weeks after surgical removal of a pilonidal cyst
    What they received
    alginate wick dressing plus honey
    Compared with
    alginate wick dressing alone
    Main outcome
    time for the wound to heal
    Quality
    it was a randomized trial but did not show a statistically significant difference and included a modest number of patients
    Limitations
    did not reach significance on its main outcome; studies patients with persistent wounds after surgical excision, not a spontaneously burst, untreated cyst

    Taken word for word from the abstract

    • n Fifty patients were included in each arm.
    • population patients with a persistent non healed wound which required packing 6 weeks after pilonidal cyst excision
    • intervention simple alginate wick dressings or the same design plus honey
    • comparator simple alginate wick dressings
    • primaryOutcome The mean healing time was 61 (± 44) days in the wick + honey group compared to 78 (± 55) days in the simple alginate wick group (p = 0.094).
    • result This trial did not reach a significant difference in its primary endpoint

    Tech Coloproctol · PMID 36598614 · Read it on PubMed ↗

  • Check et al. 2022

    Resolution of Mild Pilonidal Disease in Adolescents Without Resection

    Minor procedures resolved mild pilonidal disease.Case seriesLow qualityRelated question

    102 people30 ± 19 weeks

    77 of the 78 who continued care had resolution of their pilonidal disease

    Who was studied
    adolescents and young adults with mild pilonidal disease
    What they received
    improved hygiene, excision of pits under local anesthesia, and laser hair removal of follicles
    Compared with
    none - single group, compared to historical approach of hygiene alone or surgical resection mentioned only in background
    Main outcome
    resolution of pilonidal disease
    Quality
    This was a single-group case series with no comparison group and nearly a quarter of patients lost to follow-up, so it cannot prove this approach is better than other options.
    Limitations
    No control group, 24 of 102 patients lost to follow-up, and many patients had already had a prior drainage procedure, so it does not directly show what happens if a cyst simply bursts on its own without any treatment.

    Taken word for word from the abstract

    • n One hundred two patients presented
    • population Pilonidal disease is a common condition of the gluteal crease, affecting around 1 in 2,000 adolescents and young adults.
    • population consecutive new patients presenting to an outpatient pilonidal care clinic with mild disease
    • intervention improved hygiene to limit debris in the gluteal crease, excision of midline pilonidal pits under local anesthesia to prevent intrusion of debris with drainage of any nidus present, and laser ablation of midline follicles to prevent new pits from forming
    • comparator Traditional options for management of pilonidal disease include improved hygiene with or without hair removal or resection of the nidus.
    • primaryOutcome resolution of their pilonidal disease
    • result 77 of the 78 who continued care had resolution of their pilonidal disease after a mean of 3 ± 2.5 laser epilations and 1.3 ± 1 pit excisions during 4 ± 2 clinic visits over a treatment duration of 30 ± 19 weeks

    J Am Coll Surg · PMID 36102566 · Read it on PubMed ↗

  • Arad et al. 2022

    Ending surgical site infection by negative pressure wound therapy (NPWT): A case report

    Vacuum therapy healed infected surgical wound.Case seriesVery low qualityRelated question

    1 peopleabout 2 months

    the wound healed completely after about 2 months of vacuum therapy

    Who was studied
    a man with diabetes who developed an infected wound after pilonidal cyst surgery
    What they received
    negative pressure wound therapy (vacuum dressing)
    Compared with
    routine dressing changes and IV antibiotics
    Main outcome
    complete wound healing
    Quality
    this is a single patient case report with no comparison group, so it cannot show whether the treatment itself caused the improvement.
    Limitations
    single case report; no control group; findings from one patient cannot be generalized

    Taken word for word from the abstract

    • population a 45-year-old man with a history of 8-years type 2 diabetes who underwent surgery for a pilonidal cyst
    • intervention NPWT (applying a pressure of 125 mm Hg intermittently) was performed 4 times a day for one week
    • comparator routine dressing changes (cleansing the wound with saline and applying sterile gauze) twice a day and intravenous (IV) antibiotic therapy, no improvement was observed
    • primaryOutcome The patient's wound healed completely after about 2 months.
    • result The patient's wound healed completely after about 2 months.
    • n a 45-year-old man

    Int J Surg Case Rep · PMID 35658277 · Read it on PubMed ↗

  • Mamaloudis et al. 2022

    The role of alginate dressings in wound healing and quality of life after pilonidal sinus resection: A randomised controlled trial

    No benefit from alginate dressings after surgery.Randomised trialLow qualityRelated question

    65 people2022

    no difference in wound healing time between dressing types

    Who was studied
    patients who had surgical excision of a pilonidal cyst
    What they received
    alginate dressings with silver and cellulose on the surgical wound
    Compared with
    simple gauze dressings
    Main outcome
    time for the wound to heal
    Quality
    small randomised trial with an admittedly suboptimal sample size and other limitations noted by the authors
    Limitations
    small sample size and several study limitations acknowledged by the authors

    Taken word for word from the abstract

    • n Overall, 65 patients were included during the study period.
    • population after elective pilonidal cyst excision
    • intervention alginate dressings with silver and high-G cellulose were introduced after elective pilonidal cyst excision
    • comparator in the control group, simple gauges were used
    • primaryOutcome The primary end point was the difference in terms of the wound healing period.
    • result Wound healing duration was comparable between the two groups (P = .381).

    Int Wound J · PMID 35043571 · Read it on PubMed ↗

  • Salehi et al. 2022

    Does application of honey improve surgical outcome in pilonidal cyst excision with secondary intention healing? A prospective randomized placebo-controlled clinical trial

    Faster healing but more painRandomised trialLow qualityRelated question

    48 people90 days

    honey group healed faster and returned to activities sooner, but had more pain and used more pain medicine; no difference in smell or discharge

    Who was studied
    patients who had surgery to remove a pilonidal cyst with open wound healing
    What they received
    honey gel applied to the surgical wound
    Compared with
    placebo gel applied to the surgical wound
    Main outcome
    wound healing time, pain, return to daily activities, and other wound outcomes
    Quality
    it is a single small randomized trial of only 48 patients from one hospital, so the results may not be reliable enough to generalize.
    Limitations
    small sample size, single center, and the abstract does not specify a single primary outcome among the many measured.

    Taken word for word from the abstract

    • population 48 patients who underwent surgical resection for PSD with secondary intention healing
    • intervention The main element of honey medicinal gel was the unheated natural honey of Dena Biosphere Reserve within the Zagros Mountains.
    • comparator 24 patients in intervention and placebo-controlled groups
    • primaryOutcome The surgical outcomes including the time to complete wound healing, pain intensity, odor, discharge at the site of surgery, use of analgesics, the time of to return to the daily activities, and occurring of any side effects including infection, erythema, and bleeding were all recorded.
    • result In intervention group, there was significantly lower wound healing time, the lower time to return to the daily activities, lower mean wound volume at the days of 30, 45, 60, and 90 of the follow-up, higher mean post-operative pain level at the days of 15, 30, 45, 60, and 90 of the follow-up, and more usage of analgesics at the days of 15, 30, 45, and 60 of the follow-up.
    • n 48 patients who underwent surgical resection for PSD with secondary intention healing (24 patients in intervention and placebo-controlled groups)

    Perioper Med (Lond) · PMID 35000582 · Read it on PubMed ↗

  • Xhumari et al. 2021

    Intracranial hypotension as a unique complication of the rupture of an anterior sacral meningocele into a recurrent pilonidal cyst

    Rare case, not general guidance.Case seriesVery low qualityRelated question

    1 people2021

    After surgery, there was no more leakage from the cyst and the headaches went away

    Who was studied
    A 37-year-old woman with a recurrent pilonidal cyst after prior surgery
    What they received
    Surgical repair of a ruptured sacral meningocele using overlapping dural flaps
    Compared with
    No comparator, single case report
    Main outcome
    Resolution of headaches and stopping of cerebrospinal fluid leakage
    Quality
    This is a single, highly unusual case report so it cannot show what typically happens when a pilonidal cyst bursts.
    Limitations
    Extremely rare case involving a rare internal connection between a spinal cyst and the pilonidal cyst, not representative of typical ruptured pilonidal cysts.

    Taken word for word from the abstract

    • n A 37-year-old female presented to the emergency department
    • population Two years earlier, she had undergone surgery for resection of a pilonidal cyst (PC).
    • intervention The surgical repair of the ASM was achieved suturing two overlapping dural flaps.
    • comparator CASE DESCRIPTION: A 37-year-old female presented to the emergency department with sudden onset severe headaches.
    • primaryOutcome There was no more CSF leakage from the PC and the headaches disappeared.
    • result There was no more CSF leakage from the PC and the headaches disappeared.

    Surg Neurol Int · PMID 34621578 · Read it on PubMed ↗

  • Kubat et al. 2021

    Effect of propolis on wound healing in sacrococcygeal pilonidal disease: A randomized controlled clinical trial

    Faster healing with propolis after surgeryRandomised trialLow qualityRelated question

    33 people28 days

    wound healing was faster and the recovery score was significantly lower in the propolis group

    Who was studied
    patients with sacrococcygeal pilonidal cyst disease who had surgery (marsupialization)
    What they received
    propolis applied to the wound after marsupialization surgery
    Compared with
    marsupialization surgery without propolis (control group)
    Main outcome
    how fast the wound healed and time to complete recovery
    Quality
    very small study of only 33 patients with limited detail on blinding or how wound healing was measured
    Limitations
    small sample size, abstract gives no detail on blinding, randomization method, or statistical results

    Taken word for word from the abstract

    • n a total of 33 patients divided into study and control groups
    • population Patients who were admitted to our clinic with sacrococcygeal pilonidal disease
    • intervention the effect of propolis on wound healing in sacrococcygeal pilonidal diseases treated with marsupialization
    • comparator a total of 33 patients divided into study and control groups
    • primaryOutcome the wound areas were analyzed post-operatively, on the 0, 7th, 14th, 28th days and on the day of complete recovery
    • result An acceleration of wound healing was observed from the first week that was found to be even faster between days 14 and 28. The complete recovery score in the study group was significantly lower.

    Pak J Pharm Sci · PMID 34602433 · Read it on PubMed ↗

  • Chaffin et al. 2021

    Surgical reconstruction of pilonidal sinus disease with concomitant extracellular matrix graft placement: a case series

    All healed well after surgery.Case seriesVery low qualityRelated question

    6 people12 weeks

    all six patients fully healed by 3 to 4 weeks and remained healed at 12 weeks with good cosmetic results

    Who was studied
    patients with recurrent pilonidal sinus disease who had failed previous surgery
    What they received
    surgical flap reconstruction combined with an extracellular matrix graft implant
    Compared with
    none (single-arm case series, no comparator)
    Main outcome
    wound healing, complications and recurrence after surgery
    Quality
    this is a tiny uncontrolled case series of only six patients so it cannot reliably show whether the treatment works
    Limitations
    very small number of patients, no comparison group, retrospective design

    Taken word for word from the abstract

    • n The case series included six patients.
    • population recurrent PSD, where previously surgical intervention had failed due to wound dehiscence and/or recurrent disease
    • intervention a surgical flap reconstruction with concomitant implantation of an ovine forestomach ECM graft under a fasciocutaneous flap with an off-midline closure
    • comparator We report a retrospective case series
    • primaryOutcome demonstrating that it may improve outcomes and minimise typical complications seen in flap closure, such as inflammation, infection, haematoma/seroma and hypoperfusion
    • result After three weeks, all patients except one were fully healed, and the sixth was fully healed by week 4; all wounds remained fully healed at 12 weeks.

    J Wound Care · PMID 34256587 · Read it on PubMed ↗

  • Iesalnieks et al. 2021

    German National Guideline on the management of pilonidal disease: update 2020

    Drain abscess, treat properly later.GuidelineLow qualityRelated question

    size not given2021

    recommends unroofing an abscess, then later definitive surgery for chronic disease, with no single best method

    Who was studied
    people with pilonidal disease (cyst near tailbone)
    What they received
    different surgical treatments for pilonidal disease depending on stage (abscess unroofing, sinus excision, minimally invasive pit picking, flap procedures)
    Compared with
    comparison between these treatment methods with each other
    Main outcome
    wound healing, recurrence rate, pain, and time off work
    Quality
    this is an expert guideline summarizing other studies, not a new trial testing what happens after a cyst bursts on its own.
    Limitations
    abstract does not specifically address a cyst that ruptures spontaneously on its own, only guideline recommendations for abscess and chronic disease management in general.

    Taken word for word from the abstract

    • population Three types of disease manifestation could be differentiated: asymptomatic disease, an acute abscess, and the chronic pilonidal disease.
    • intervention A pilonidal abscess should be unroofed. After resolution of the acute inflammation, the disease should be treated definitely.
    • comparator sinus excision is the standard treatment of the chronic pilonidal disease
    • primaryOutcome simple, painless procedure associated with rapid wound healing, and low recurrence rate
    • result A pilonidal abscess should be unroofed. After resolution of the acute inflammation, the disease should be treated definitely.

    Langenbecks Arch Surg · PMID 33950407 · Read it on PubMed ↗

  • Shi et al. 2021

    Pilonidal sinus involving the breast in a man: A case report and literature review

    Surgery healed ruptured cyst.Case seriesVery low qualityRelated question

    1 people2021

    the surgical area healed well with no signs of recurrence

    Who was studied
    a 46-year-old man with a pilonidal cyst in his breast
    What they received
    surgical removal of the breast lump (enlarged resection) after the cyst ruptured and discharged
    Compared with
    none reported
    Main outcome
    wound healing and recurrence after surgery
    Quality
    This is a single case report, so it cannot reliably show what happens in general when a pilonidal cyst bursts.
    Limitations
    Only one patient was described, the cyst was in an unusual location (the breast), and the abstract does not address non-surgical management of spontaneous rupture.

    Taken word for word from the abstract

    • population a case of a pilonidal cyst in a 46-year-old man
    • intervention underwent "enlarged resection of the left breast lesion" under local anesthesia
    • comparator RATIONALE: Pilonidal sinus disease (PSD) involving the breast is extremely rare and has not been described in man.
    • primaryOutcome The patient's surgical area healed well, without any signs of recurrence.
    • result The patient's surgical area healed well, without any signs of recurrence.
    • n a case of a pilonidal cyst in a 46-year-old man which was surgically treated

    Medicine (Baltimore) · PMID 33761692 · Read it on PubMed ↗

  • Kanat et al. 2020

    Use of Silver Nitrate Application as Mini-Invasive Treatment of Pilonidal Sinus Disease

    Low recurrence with silver nitrate treatment.RetrospectiveLow qualityRelated question

    45 people2020

    recurrence occurred in about 9% of patients, with complications such as abscess, redness, or tissue death in about 22%

    Who was studied
    young adults with pilonidal sinus disease treated at a hospital
    What they received
    silver nitrate stick application with debridement
    Compared with
    no comparison group; outcomes tracked over time within the same group
    Main outcome
    recurrence and complication rates after treatment
    Quality
    This was a retrospective chart review without a comparison group, so it cannot reliably show cause and effect.
    Limitations
    Retrospective design, no control group, and some patients were excluded due to incomplete records.

    Taken word for word from the abstract

    • population Mean age was 24.3 +- 5.18 (range, 14 - 36) years
    • intervention silver nitrate application and debridement for sacrococcygeal PSD
    • comparator Among 56 patients who were treated with silver nitrate stick, 11 patients with incomplete hospital records were excluded from the study.
    • primaryOutcome recurrence and complication rates were recorded
    • result recurrence occurred in 4 (8.9%) patients. Complications developed in 10 (22.2%) patients and included abscess, erythema, and necrosis in 5 (11.1%), 2 (4.4%), and 3 (6.6%) patients, respectively.
    • n Among 56 patients who were treated with silver nitrate stick, 11 patients with incomplete hospital records were excluded from the study.

    Chirurgia (Bucur) · PMID 33378636 · Read it on PubMed ↗

  • Nechai et al. 2020

    [Surgical treatment of pilonidal disease]

    Closed surgery heals well.Narrative reviewVery low qualityRelated question

    size not given2020

    closed surgical methods gave good healing and cosmetic outcomes, but long-term results depended on technique and follow-up time

    Who was studied
    people having surgery for pilonidal disease
    What they received
    "closed" surgical techniques for pilonidal disease
    Compared with
    other surgical methods for pilonidal disease
    Main outcome
    wound healing and cosmetic result after surgery
    Quality
    This is a narrative comparison of surgical techniques with no reported number of studies or patients and no stated methodology, so it carries little weight.
    Limitations
    No numbers of studies or patients are given, and the abstract does not describe how studies were selected or analyzed.

    Taken word for word from the abstract

    • population surgical treatment of pilonidal disease
    • intervention «closed» methods of surgical treatment of pilonidal disease
    • comparator comparison of the most common methods of surgical treatment of pilonidal disease
    • primaryOutcome favorable wound healing and good cosmetic effect
    • result «closed» methods of surgical treatment of pilonidal disease are effective and accompanied by favorable wound healing and good cosmetic effect. Long-term outcomes of «closed» techniques significantly depend on the choice of surgical treatment and follow-up period.

    Khirurgiia (Mosk) · PMID 33301262 · Read it on PubMed ↗

  • Manigrasso et al. 2021

    Early versus delayed endoscopic treatment of acute pilonidal abscess: a propensity score-matched analysis

    Same recurrence, but earlier surgery felt better.RetrospectiveLow qualityRelated question

    82 people1-year, 3-year, and 5-year follow-up

    no difference in recurrence between early and delayed endoscopic treatment, but early treatment gave better patient satisfaction and health status

    Who was studied
    patients with an acute pilonidal abscess needing treatment
    What they received
    endoscopic treatment (VAAPS) done right away
    Compared with
    endoscopic treatment (VAAPS) delayed until after initial incision and drainage
    Main outcome
    rate of cyst coming back at 1, 3, and 5 years
    Quality
    This was a retrospective, matched comparison of surgical patients, not a randomized trial, and it does not address what to do when a cyst bursts on its own.
    Limitations
    Propensity-matched retrospective design rather than randomized; studies surgical abscess drainage patients, not spontaneous rupture without treatment.

    Taken word for word from the abstract

    • n 82 patients were included in the final analysis (41 in each group)
    • population All consecutive patients with an acute pilonidal abscess
    • intervention early VAAPS group
    • comparator delayed VAAPS group
    • primaryOutcome Primary outcomes were recurrence rate at 1-year, 3-year, and 5-year follow-up
    • result No differences were found in terms of recurrence in the two groups. Early endoscopic approach was associated with a better patients' satisfaction (8.17 ± 1.2 vs 6.06 ± 1.48, p = 0.001) and a better postoperative health status (86.27 ± 6.54 vs 77.32 ± 5.85, p = 0.001).

    Int J Colorectal Dis · PMID 33011845 · Read it on PubMed ↗

  • Choy et al. 2019

    Pilonidal disease practice points: An update

    No specific guidance given.Narrative reviewVery low qualityRelated question

    size not given2019

    The abstract does not report a specific result for bursting cysts; it only discusses general management and recurrence avoidance with correct treatment and counselling

    Who was studied
    people with chronic pilonidal disease seen in general practice
    What they received
    primary care management and newer specialist surgical treatment options
    Compared with
    standard or older surgical approaches
    Main outcome
    avoiding recurrence of pilonidal disease
    Quality
    This is a narrative overview article with no study data, patient numbers, or outcome measurements reported.
    Limitations
    No methodology, data, or specific findings about a burst cyst are given; it is a general discussion article.

    Taken word for word from the abstract

    • population Chronic pilonidal disease is a common debilitating condition often seen in general practice.
    • intervention details methods of treatment in the primary care setting and explores new specialist management options available in Australia
    • comparator the devastation of recurrence with further pain, embarrassment and time off work - added to the prospect of more surgery - is still common for patients with chronic pilonidal disease
    • primaryOutcome This can be avoided with correct management and timely counselling regarding surgical options available.
    • result This can be avoided with correct management and timely counselling regarding surgical options available.

    Aust J Gen Pract · PMID 31256473 · Read it on PubMed ↗

  • Berthier et al. 2019

    A comparison of flap reconstruction vs the laying open technique or excision and direct suture for pilonidal sinus disease: A meta-analysis of randomised studies

    Flap surgery beats other surgical closures.Meta-analysisModerate qualityRelated question

    size not given2019

    Flap repair had fewer recurrences, fewer wound infections, fewer skin complications, shorter hospital stay, and faster healing than direct closure or the laying open technique

    Who was studied
    people with chronic pilonidal sinus disease (not specifically burst/ruptured cysts)
    What they received
    flap reconstruction surgery
    Compared with
    laying open technique or excision with direct suture closure
    Main outcome
    rate of the cyst coming back (recurrence)
    Quality
    It pools multiple randomised trials, which is strong evidence, but it addresses planned surgical treatment of chronic sinus disease, not what to do after a cyst bursts on its own.
    Limitations
    The abstract does not describe the quality or size of the individual trials, nor does it address spontaneously ruptured cysts specifically.

    Taken word for word from the abstract

    • population chronic pilonidal sinus disease
    • intervention flap repair
    • comparator the laying open technique and/or excision and direct closure techniques
    • primaryOutcome The primary outcome measure was the recurrence rate.
    • result The meta-analysis demonstrated a lower risk of recurrence, a shorter duration of incapacity to work, a lower risk of wound infections, a lower risk of skin wound complications, and a shorter duration of hospitalisation in favour of flap vs direct closure.

    Int Wound J · PMID 31230414 · Read it on PubMed ↗

  • Pronk et al. 2019

    [Chronic pilonidal sinus disease: overview of treatment options]

    No info on burst cysts.Narrative reviewLow qualityRelated question

    size not given2019

    no consensus on best first treatment; minimally invasive techniques linked to less pain and faster healing; flap techniques only for recurrence; laser hair removal may lower recurrence risk

    Who was studied
    people with chronic pilonidal sinus disease, mostly young men
    What they received
    various treatments for pilonidal sinus disease including minimally invasive techniques
    Compared with
    excision surgery with primary or secondary wound healing
    Main outcome
    best treatment approach, wound healing, recurrence, return to work
    Quality
    this is a general overview of treatment options, not a study answering what to do when a cyst bursts on its own, and does not report patient numbers or a controlled comparison.
    Limitations
    abstract does not address spontaneous rupture of a pilonidal cyst, only planned surgical and minimally invasive treatments; no numbers or outcomes data given.

    Taken word for word from the abstract

    • population Pilonidal sinus disease is a common disease in predominantly young men
    • intervention Minimally invasive techniques, such as phenolisation, laser, and endoscopic treatments are increasingly applied
    • comparator excision with primary or secondary wound healing is often applied
    • primaryOutcome there is no consensus on the treatment of first choice for pilonidal sinus disease
    • result these are associated with less pain, faster wound healing and facilitating a more rapid return to work for patients

    Ned Tijdschr Geneeskd · PMID 31120213 · Read it on PubMed ↗

  • Petersen 2019

    [Pilonidal Sinus Disease; What is the Best Treatment Option?]

    Compares surgery options, not spontaneous rupture.Narrative reviewLow qualityRelated question

    size not given2019

    standard excision with open wound care has low recurrence but slow healing and long time off work; newer skin-preserving techniques are still being evaluated; excision with plastic reconstruction is technically demanding but gives good long-term results

    Who was studied
    people with chronic pilonidal sinus disease (infection in the skin fold at the top of the buttocks)
    What they received
    different surgical treatments: excision with open wound care, minimally invasive options (pit picking, fistuloscopy, phenol injection, laser), and excision with plastic reconstruction
    Compared with
    the treatment options are compared against each other, not against doing nothing or against spontaneous rupture
    Main outcome
    recurrence rate, wound healing problems, and long-term results
    Quality
    this is a general narrative review of surgical treatment choices for pilonidal disease and does not study or mention what happens when a cyst bursts on its own, so it cannot answer that specific question.
    Limitations
    abstract does not address spontaneous rupture of a pilonidal cyst at all; it is a review of planned surgical treatment strategies, not a study of outcomes after a cyst bursts on its own

    Taken word for word from the abstract

    • population Sinus pilonidalis is a chronic infection of the hairy skin in the area of skin wrinkles, with the most common localization in the natal cleft.
    • intervention The standard treatment of excision and subsequent open wound treatment
    • intervention so-called pit picking, fistuloscopy and other forms of treatment, such as phenol injection and/or laser treatment
    • intervention The third treatment group is excision and plastic reconstruction.
    • comparator Excision and open granulation continues to serve as a standard procedure with which other treatment options can be compared.
    • primaryOutcome early post-operative results, wound healing disorder and long-term results
    • result has a low recurrence rate, but requires considerable effort in wound treatment and thus leads to protracted time off work
    • result In these treatment options, the final evaluation of the results is still pending.
    • result These procedures are technically demanding, often involve inpatient treatment but lead to relatively good results in the long term.

    Zentralbl Chir · PMID 31117133 · Read it on PubMed ↗

  • Cairo et al. 2019

    Porcine bladder extracellular matrix in paediatric pilonidal wound care: healing and patient experience evaluation

    Good healing with pig-bladder dressing.RetrospectiveVery low qualityRelated question

    41 peopletwo years

    78% of wounds treated with the dressing healed completely, taking about two months on average, with mostly positive patient experiences

    Who was studied
    Teenagers (average age 16) with pilonidal disease, most with recurrent disease, treated surgically
    What they received
    A pig bladder tissue matrix (PBEM) dressing used for wound care after surgery
    Compared with
    Historical controls and published literature on traditional wound care methods
    Main outcome
    Whether the wound fully healed and how satisfied patients were
    Quality
    This was a retrospective chart review of a small single-center group with no real control group, so it can't reliably show the dressing is better than other care.
    Limitations
    Retrospective design, no concurrent comparison group, comparisons made only to historical/literature data, some missing follow-up, single center.

    Taken word for word from the abstract

    • population adolescent patients who underwent treatment of pilonidal disease with PBEM between 2012 and 2016
    • population 85% were being treated for recurrent pilonidal disease
    • intervention Porcine bladder extracellular matrix (PBEM) facilitates site-specific tissue deposition/re-growth for the management of a variety of wounds.
    • comparator compared with historical controls and literature regarding traditional wound therapies
    • primaryOutcome documented complete wound healing in 78% of patients treated with PBEM at an average of two months
    • result documented complete wound healing in 78% of patients treated with PBEM at an average of two months. Subjective reports included majority positive experience with PBEM dressing, minimal pain and overall high levels of patient satisfaction.
    • n We reviewed 52 pilonidal disease wounds on 41 patients.
    • followUp There were three patients in which pilonidal disease recurred within two years of initial treatment

    J Wound Care · PMID 31067171 · Read it on PubMed ↗

  • Hardy et al. 2019

    Surgical interventions for the treatment of sacrococcygeal pilonidal sinus disease in children: A systematic review and meta-analysis

    Compares surgery types, not spontaneous rupture.Meta-analysisLow qualityRelated question

    size not given2019

    Off-midline closure, minimally invasive techniques, and marsupialisation had lower recurrence and complication rates than open healing or midline closure

    Who was studied
    Children with pilonidal sinus disease (cysts at the base of the spine)
    What they received
    Different surgical treatments for pilonidal sinus disease, including open healing, midline closure, off-midline closure, VAC therapy, minimally invasive techniques, and marsupialisation
    Compared with
    Comparison between these different surgical techniques
    Main outcome
    Risk of the cyst coming back (recurrence), wound complications, and how long the wound took to heal
    Quality
    The authors themselves say the evidence is poor, based on pooled observational studies rather than high-quality trials, and rated it Level IV evidence.
    Limitations
    The abstract does not address what to do if a cyst bursts spontaneously; it only compares planned surgical techniques, and the authors state evidence quality is poor.

    Taken word for word from the abstract

    • population Pilonidal sinus disease (PNS) is not uncommon in children.
    • intervention Off-midline primary closure has pooled risk of recurrence of 6% (1-15%), risk of wound complication of 14% (6-25%) and wound healing was 27 days.
    • comparator Studies reporting treatment outcomes for PNS in children were included.
    • primaryOutcome Open healing has pooled risk of recurrence of 26% (95%CI 15-38%), risk of wound complication of 21% (9-36%) and wound healing ranged from 38-92 days.
    • result Off-midline primary closure, minimally invasive techniques, and marsupialisation have the best outcomes.
    • qualityWhy Evidence for management of PNS in children is poor.
    • qualityWhy LEVEL OF EVIDENCE RATING: IV.

    J Pediatr Surg · PMID 30940347 · Read it on PubMed ↗

  • Harries et al. 2019

    Management of sacrococcygeal pilonidal sinus disease

    Does not address spontaneous bursting.Narrative reviewVery low qualityRelated question

    size not given2019

    the abstract summarises that treatment approaches vary and surgical complications, especially wound healing problems, can be worse than the original disease, but gives no specific data or recommendation

    Who was studied
    people with pilonidal sinus disease (a cyst/tunnel near the tailbone)
    What they received
    various surgical treatments for pilonidal sinus disease
    Compared with
    different surgical techniques compared with each other
    Main outcome
    cure with fast recovery and low complication rate
    Quality
    this is a general review of surgical treatment options with no study data, and it does not address what to do if a cyst bursts on its own.
    Limitations
    No specific methodology, data, or outcomes are reported; it is a general overview rather than a study of spontaneous rupture.

    Taken word for word from the abstract

    • population patients who suffer from pilonidal sinus disease
    • intervention A variety of different surgical techniques have been described for the primary treatment of pilonidal sinus disease
    • comparator current practice remains variable and contentious
    • primaryOutcome The ideal treatment for patients who suffer from pilonidal sinus disease should lead to a cure with a rapid recovery period allowing a return to normal daily activities, with a low level of associated morbidity
    • result the complications of surgery, particularly related to wound healing, often remain worse than the primary disease

    Int Wound J · PMID 30440104 · Read it on PubMed ↗

  • Liao et al. 2019

    Idea and innovation: Secure fixation between dermis and periosteum using perforator flap to prevent recurrence of pilonidal sinus disease

    Flap surgery prevented recurrence, one patientCase seriesVery low qualityRelated question

    1 people3 years

    the sinus disease did not return over three years of follow-up

    Who was studied
    young woman with repeatedly returning pilonidal sinus disease whose abscess had burst and did not improve with antibiotics
    What they received
    complete surgical removal of the sinus tissue followed by reconstruction using a local skin and muscle flap (SGAP flap) stitched down to the bone covering
    Compared with
    no comparison group; single patient case report
    Main outcome
    whether the pilonidal disease came back after surgery
    Quality
    this is a single patient case report with no comparison group, so it cannot show whether this approach is better than other treatments.
    Limitations
    single case report of one patient; no control group; abstract only describes a surgical reconstruction technique used after the disease had already recurred and been treated surgically, not management of a sinus bursting on its own.

    Taken word for word from the abstract

    • n An 18-year-old female with recurrent pilonidal sinus disease
    • population An 18-year-old female with recurrent pilonidal sinus disease over right medial gluteal region presented with sacral pain and infection. She developed progressive swelling and burst of abscess from several sinus tracts and did not respond to the treatment with antibiotics alone.
    • intervention After radical excision of the entire pilonidal sinus and adjacent fibrotic tissue, a deep and large defect was measured. A superior gluteal perforator flap was designed based on three perforators from the superior gluteal artery.
    • intervention Strong sutures were applied to secure the flap to the periosteum.
    • result There was no recurrence at 3 years of follow up.
    • primaryOutcome The study demonstrates a few key concepts on the prevention of PSD recurrence
    • comparator The history, surgery, and images are described, and the literature is reviewed.

    Int Wound J · PMID 30240147 · Read it on PubMed ↗

  • Burney 2018

    Treatment of pilonidal disease by minimal surgical excision under local anesthesia with healing by secondary intention: Results in over 500 patients

    Low recurrence after minor excision surgery.Case seriesLow qualityRelated question

    570 people4.7 years

    3.2% of patients needed another operation due to persistent or recurrent disease, and most healed afterward

    Who was studied
    patients with pilonidal disease treated by one surgeon from 1978 to 2015
    What they received
    minimal surgical excision under local anesthesia, with the wound left open to heal on its own
    Compared with
    none, all patients received the same surgical treatment
    Main outcome
    how long wounds took to heal and how often the disease came back requiring another operation
    Quality
    This is a single surgeon's case series with no comparison group, so it cannot show whether this approach is better than other options, including doing nothing after a cyst bursts.
    Limitations
    No control group, single surgeon experience, retrospective review of records

    Taken word for word from the abstract

    • n Records were found for 570 patients
    • population Records of all patients I treated for pilonidal disease from 1978 to 2015 with at least 1 year of follow-up were reviewed.
    • intervention minimal but complete surgical excision under local anesthesia with healing by secondary intention using moist dressings
    • comparator Ninety-two percent of operations were performed under local anesthesia.
    • primaryOutcome number of clinic visits, length of time until wound healed, compliance with wound care instructions, and length of follow-up were recorded
    • result Eighteen patients (3.2%) had persistent or recurrent disease requiring reoperation, most often because of poor compliance with wound care instructions, and later healed.
    • followUp mean follow-up was 4.7 years

    Surgery · PMID 30064734 · Read it on PubMed ↗

  • Cevik et al. 2018

    Is conservative treatment an effective option for pilonidal sinus disease in children?

    Most healed without surgery.RetrospectiveLow qualityRelated question

    29 people8.34 ± 6.36 (range: 1-25) months

    most healed without surgery, some had recurrence, a few needed surgery

    Who was studied
    children and teenagers with pilonidal sinus disease
    What they received
    conservative treatment: hair removal, better hygiene, warm sitz baths, and draining any abscess
    Compared with
    no comparison group, outcomes tracked over time in same patients
    Main outcome
    whether the area fully healed, came back, or needed surgery
    Quality
    it looked back at records of a small group of children with no comparison group, so it can't prove conservative care is better than other options.
    Limitations
    retrospective design, small sample, follow-up time varied a lot between patients, and it studied general pilonidal sinus disease in children rather than specifically a cyst that had already burst

    Taken word for word from the abstract

    • population All children diagnosed with PSD in 2012 to 2017 were identified at the outpatient clinic of the Department of Paediatric Surgery.
    • intervention All patients initially underwent conservative treatment (meticulous hair removal, improved perianal hygiene, warm sitz baths, and drainage for abscess).
    • comparator This study involved a retrospective review with telephone follow up.
    • primaryOutcome Data collection included demographics, type of management, recurrence, presence of infection, and total healing time.
    • result Complete healing occurred in 79.3% of patients. Recurrence was evident in 12% of patients. Four patients underwent surgery.
    • n In the study period, 29 children were identified.

    Int Wound J · PMID 29947121 · Read it on PubMed ↗

  • Korenkov 2018

    Video-Assisted Subcutaneous Destruction of the Sinus Tract with Vessel-Loop Drainage as Minimally-Invasive Surgical Treatment for Pilonidal Sinus Disease

    New surgery worked except for abscess case.Case seriesVery low qualityRelated question

    4 peopleeight weeks postoperatively

    the three simple cases had no problems in the first eight weeks, but the abscess patient developed a pus infection needing a larger open wound surgery

    Who was studied
    people with pilonidal sinus disease, three with simple sinus and one with an acute abscess
    What they received
    minimally invasive surgery using a scope to destroy the sinus tract under the skin, with a drain left in place
    Compared with
    no comparison group; discussed only against the earlier non-video-assisted version of the technique
    Main outcome
    complications after surgery
    Quality
    only four patients with no comparison group, and the authors themselves say the numbers are too small to judge whether the technique works
    Limitations
    abstract explicitly states the study is too small to properly assess the technique

    Taken word for word from the abstract

    • n Three patients with simple forms of PSD, and one patient with an acute abscess formation, underwent the VADST procedure.
    • population Three patients with simple forms of PSD, and one patient with an acute abscess formation, underwent the VADST procedure.
    • intervention video-assisted subcutaneous destruction of the sinus tract (VADST) is a novel, minimally-invasive technique for the treatment of pilonidal sinus disease (PSD)
    • comparator Contrary to DST, we intend to use VADST
    • primaryOutcome The patients with simple forms of PSD had no adverse events during the first eight weeks postoperatively.
    • result The patient with an acute abscess formation developed a purulent inflammation that required a wide local excision with an open-wound healing.
    • result The patients with simple forms of PSD had no adverse events during the first eight weeks postoperatively.

    Surg Technol Int · PMID 29529705 · Read it on PubMed ↗

  • Lasithiotakis et al. 2018

    Aspiration for acute pilonidal abscess-a cohort study

    Aspiration worked for most abscesses.Prospective cohortLow qualityRelated question

    100 people29 (47) months

    83% of patients avoided incision and drainage, with high satisfaction scores

    Who was studied
    adults presenting with an acute pilonidal abscess
    What they received
    bedside aspiration under local anesthetic plus oral antibiotics (cefalexin and metronidazole)
    Compared with
    no comparison group; outcomes compared only to historical rates of traditional incision and drainage
    Main outcome
    whether the abscess resolved without needing surgical drainage, and patient satisfaction
    Quality
    This was a single-center study with no comparison group and only just over half the patients returning satisfaction surveys, so the results could be biased.
    Limitations
    No control group for comparison, incomplete questionnaire response (56 of 100), and patients with skin necrosis or perforation were excluded.

    Taken word for word from the abstract

    • n a total of 100 patients were treated with aspiration and antibiotics
    • population All patients presenting with an acute pilonidal abscess during the period December 2010 and December 2014
    • intervention treated with bedside aspiration under local anesthetic, followed by oral cefalexin and metronidazole for 7 days
    • comparator The traditional open incision and drainage of a pilonidal abscess is associated with slow healing and delayed return to normal daily activities.
    • primaryOutcome assess safety, effectiveness, and patient satisfaction of aspiration followed by antibiotics for a pilonidal abscess
    • result Aspiration of a pilonidal abscess in selected patients is effective in 83%, and it is associated with high overall satisfaction rates.
    • followUp median (IQR) follow-up time of 29 (47) months

    J Surg Res · PMID 29433863 · Read it on PubMed ↗

  • Tavangari et al. 2017

    Outcomes of Unroofing with Limited Excision and Structured Postoperative Care for Pilonidal Disease

    Surgery healed cysts with few recurrences.RetrospectiveLow qualityRelated question

    94 people40 months

    most wounds healed by about 53 days and only 2.1% of cases came back

    Who was studied
    patients with chronic pilonidal disease, ages 11 to 63
    What they received
    surgery called unroofing with limited excision, plus structured wound care and weekly clinic visits afterward
    Compared with
    none; all patients received the same treatment
    Main outcome
    time to complete healing and rate of disease coming back
    Quality
    this is a retrospective study of one treatment with no comparison group, so it can't show the surgery is better than other options.
    Limitations
    retrospective design, no comparison group, single surgical technique at one center

    Taken word for word from the abstract

    • population Ninety-four patients aged 11 to 63 (mean age 26) received this treatment for pilonidal disease.
    • intervention unroofing with limited excision combined with structured postoperative wound care for pilonidal disease
    • comparator We performed a retrospective review of all patients who were treated with this technique over a seven year period.
    • primaryOutcome The median time to achieve complete healing was 53 days requiring, on average, seven visits.
    • result With a mean follow-up of 40 months, there were two recurrences (2.1%) and reoperation for two (2.1%) inappropriately healing wounds.
    • n Ninety-four patients aged 11 to 63 (mean age 26) received this treatment for pilonidal disease.
    • followUp With a mean follow-up of 40 months

    Am Surg · PMID 29391092 · Read it on PubMed ↗

  • Boshnaq et al. 2018

    Limberg flap in management of pilonidal sinus disease: systematic review and a local experience

    Flap surgery lowers recurrence risk.Systematic reviewLow qualityRelated question

    26 people18 months

    Limberg flap had lower recurrence than primary closure and similar results to Karydakis flap

    Who was studied
    patients with pilonidal sinus disease who had surgery
    What they received
    Limberg flap surgery
    Compared with
    primary closure and Karydakis flap surgery
    Main outcome
    recurrence rate and complications after surgery
    Quality
    Much of the evidence comes from a small retrospective local cohort of 26 patients plus a narrative pooling of mixed study types rather than a formal meta-analysis.
    Limitations
    Abstract does not address spontaneous rupture of a pilonidal cyst; it only reports outcomes after planned surgical flap procedures for pilonidal sinus disease.

    Taken word for word from the abstract

    • n About 26 patients included in the cohort study (16 male, average age 27 years).
    • result RCTs showed that LF or its modification is superior to primary closure, with comparable results to Karydakis flap.
    • primaryOutcome Data including length of hospital stay, post-operative complications and recurrence were collected.
    • intervention To review published evidence of Limberg flap (LF) use in pilonidal sinus disease (PSD).
    • comparator compared to 4-37.7% for primary closure and 0-11% for Karydakis flap.
    • population We included a retrospective study of patients underwent LF in our district hospital.

    Acta Chir Belg · PMID 29390948 · Read it on PubMed ↗

  • Hap et al. 2017

    Pilonidal sinus: finding the righttrack for treatment

    No clear best treatment identified.Narrative reviewVery low qualityRelated question

    size not given2017

    no single method was found effective enough to be the standard treatment

    Who was studied
    people with pilonidal cysts
    What they received
    various surgical treatment methods for pilonidal cyst
    Compared with
    different surgical techniques compared to each other
    Main outcome
    success of treatment / avoiding complications
    Quality
    this is a general narrative review of surgical methods without specific data on spontaneously burst cysts, so it offers very weak evidence for this question.
    Limitations
    abstract does not address spontaneous rupture specifically; it is a general review of surgical techniques without stated methodology or data on efficacy rates

    Taken word for word from the abstract

    • population Pilonidal cyst is a troublesome condition affecting usually young people.
    • intervention we reviewed publications on various methods of managing pilonidal cyst
    • comparator A large number of surgical techniques indicates the lack of a single method that ensures therapeutic success
    • primaryOutcome we did not manage to point out a surgical method with efficacy high enough to become standard treatment
    • result we did not manage to point out a surgical method with efficacy high enough to become standard treatment

    Pol Przegl Chir · PMID 28522786 · Read it on PubMed ↗

  • Danne et al. 2017

    A Retrospective Study of Pilonidal Sinus Healing by Secondary Intention Using Negative Pressure Wound Therapy Versus Alginate or Gauze Dressings

    No difference between wound care methods.RetrospectiveLow qualityRelated question

    73 people2017

    median healing time was 10 weeks with dressings versus 8 weeks with NPWT, a difference that was not statistically significant, and recurrence rates were also not significantly different

    Who was studied
    patients who had symptomatic natal cleft PS
    What they received
    negative pressure wound therapy after surgery
    Compared with
    alginate-based or gauze daily dressing changes after surgery
    Main outcome
    time in weeks to achieving the endpoint (epithelialization)
    Quality
    this was a small retrospective study without randomization, so it can't reliably show whether one wound care method is better.
    Limitations
    Retrospective design, small sample size, loss to follow-up, and no randomization; authors state prospective randomized trials are needed.

    Taken word for word from the abstract

    • population A retrospective analysis was conducted of data extracted from the medical records of 73 consecutive patients who had symptomatic natal cleft PS over a 10-year period
    • intervention to compare use of NPWT to alginate-based/gauze daily dressing (DD) changes in terms of healing time and recurrence
    • comparator to compare use of NPWT to alginate-based/gauze daily dressing (DD) changes in terms of healing time and recurrence
    • primaryOutcome time in weeks to achieving the endpoint (epithelialization)
    • result The median time to healing was 10 weeks (95% CI: 7-17) in the DD group and 8 weeks (95% CI: 7-9) in the NPWT group (not significantly different).
    • n A retrospective analysis was conducted of data extracted from the medical records of 73 consecutive patients

    Ostomy Wound Manage · PMID 28355137 · Read it on PubMed ↗

How we searchedThe exact query, the date it ran, and what came back — so you can run it yourself.
Searched
PubMed · ClinicalTrials.gov · Crossref on 2026-10-13
The exact search — paste this into PubMed to repeat it
("Pilonidal Sinus"[Mesh] OR pilonidal cyst[tiab] OR pilonidal abscess[tiab]) AND (rupture*[tiab] OR spontaneous drainage[tiab] OR self-drain*[tiab] OR burst*[tiab] OR "wound healing"[Mesh] OR wound care[tiab] OR conservative management[tiab] OR "incision and drainage"[tiab])
PubMed expanded that to: ("Pilonidal Sinus"[MeSH Terms] OR "pilonidal cyst"[Title/Abstract] OR "pilonidal abscess"[Title/Abstract]) AND ("rupture*"[Title/Abstract] OR "spontaneous drainage"[Title/Abstract] OR "self drain*"[Title/Abstract] OR "burst*"[Title/Abstract] OR "wound healing"[MeSH Terms] OR "wound care"[Title/Abstract] OR "conservative management"[Title/Abstract] OR "incision and drainage"[Title/Abstract])
What came back
538 records found · 200 read · 48 answered the question
Included
  • Human, animal or laboratory studies reporting an outcome relevant to the question
Excluded
  • Records about a different condition or intervention
  • Records reporting no outcome
  • Retracted publications, which are listed but excluded from every count
Limits
  • Details were read from abstracts, not full papers, so anything reported only in a paper's methods section is not captured here.
  • Fields were read from abstracts, not full text, so detail reported only in a paper's methods section is not captured.
  • Evidence strength is adapted from the GRADE framework. It is not a GRADE assessment and was not produced by a GRADE panel.

Automated evidence review — PubMed, ClinicalTrials.gov, Crossref. Search strategy, grading rules and the checks that must pass before anything publishes were written by Allen Kamrava, MD, MBA, FACS, FASCRS, colon & rectal surgery, Beverly Hills. The pages themselves are compiled by software running that method and are not read one by one before publication — saying otherwise would be the one claim here that could not be checked.

How we grade evidence →

  1. 538records came back from the search
  2. 200were read
  3. 48actually answered the question
Risks and safetyReported side effects and who should be careful.
  • In large studies of people whose abscess was formally drained by a clinician, roughly 30% to 54% needed another procedure within one to five years. It is not known whether leaving a self-ruptured cyst untreated carries a similar, higher, or lower chance of needing surgery later.
  • A small case series found that if hair is left inside the cavity after drainage, the area can keep oozing or form a lump (granuloma) that needs a second procedure to fix.
Common questionsShort answers, drawn from the same studies.
My pilonidal cyst burst on its own — what should I do?
No study in this review followed people whose cyst burst at home without any medical procedure, so there's no research-backed answer to this exact question. Related studies only looked at cysts drained by a clinician, where leaving hair or debris behind was linked to the area reopening or forming a lump that needed more treatment — which is why many people choose to get it checked, even though this hasn't been tested for self-ruptured cysts specifically.
How do you know when a pilonidal cyst is ready to burst?
No study found in this review measured warning signs that a cyst is about to rupture. This is a genuine gap — nothing here can tell you what to expect beforehand.
Why does a burst pilonidal cyst smell?
No study in this review measured odor directly. One study looked at which bacteria are typically found inside pilonidal abscesses, which is consistent with an infection being present, but it did not link any specific bacteria to smell.
Is it normal for a burst pilonidal cyst to bleed?
No study in this review tracked bleeding after a cyst ruptures on its own, so there's no data here on how much bleeding is typical or when it should be a concern.
My pilonidal cyst burst at home — do I need to see a doctor?
No study has directly tested whether seeing a doctor after a spontaneous rupture changes healing, infection, or recurrence. Related research on clinician-performed drainage shows that retained hair or incomplete drainage can lead to the area reopening or recurring, which is part of why many clinicians still recommend a check, even without direct evidence for this specific scenario.

This is information, not advice

This page summarises published research. It cannot tell you what is happening in your own body, and evidence changes. If something is bleeding, painful, or new, it is worth being looked at — that is a different question from the one on this page, and a better one to bring to a consultation.

Contact the office

Automated evidence review — PubMed, ClinicalTrials.gov, Crossref. Search strategy, grading rules and the checks that must pass before anything publishes were written by Allen Kamrava, MD, MBA, FACS, FASCRS, colon & rectal surgery, Beverly Hills. The pages themselves are compiled by software running that method and are not read one by one before publication — saying otherwise would be the one claim here that could not be checked.

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