A 33 year old male patient aged, came to the Surgery O.P.D at Dr. D.Y. Patil Ayurvedic Hospital, Nerul, Navi Mumbai with complaints of recurrent discharge from a boil over an operated site along with pain and discomfort in October 2008.
He gave a history of Z-plasty performed for Pilonidal sinus performed in 2005. The disease re-occurred after 3 years in 2008 and this was confirmed by CT Scan. The patient was not willing for surgery again and requested Ayurvedic treatment. Hence, Kshar Sutra procedure was offered.
Before planning treatment other etiologies like Tuberculosis, Pelvic inflammation causing abscess, HIV, diabetes mellitus, foreign body or trauma were ruled out.
After confirmation of the pilonidal sinus by CT Scan, the two external openings were excised under local anesthesia and the embedded hair follicles were removed . The Kshar Sutra was tied covering the entire underlying track for simultaneous cutting and healing . Appropriate dressing was given under aseptic conditions. The patient was discharged on the day after the procedure.
External openings coinciding with natal cleft excised under LA (embedded hair follicles were removed).
Ligation of Kshar Sutra in the underlying track (sinus)
Patient was asked to attend surgical clinic for dressing on alternate days. Seitz bath (hip) with lukewarm water was advocated before dressing. The Kshar Sutra was changed weekly for 3 sittings . To promote healing and reduce pain & inflammation oral antibiotics, anti-inflammatory drugs and multi vitamins were also prescribed.
Second changing of Kshar Sutra (after 7 days)
The tracks cut through and simultaneously healed by 4 weeks . However, it was observed that healing rate was slow compare to cutting rate and the patient was observed for a period of one year to check for recurrence.
Completely healed track (after 21 days)
Kshar Sutra is a medicated thread (seton) coated with herbal Alkaline drugs like Apamarga (Kshar) (Ash of Achyranthus ascera), Snuhi (Euphorbia nerufolia) latex and Haridra (Curcuma longa) powder in a specific order. This combination of medicines on the thread helps in debridement and lysis of tissues, exerts antifungal, anti bacterial, and anti inflammatory. Another mechanism proposed for the Kshara Sutra is that it destroys the residual glands in the epithelium.