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LORD DHANVANTARI

Dr. U.R.Sekhar.Namburi
M.D(Ay)
Asst. Prof. Dept. of P.G. Studies in Shalya Tantra
S.D.M. COLLEGE OF AYURVEDA & Hospital
HASSAN
INTRODUCTION

• Incidence – 0.75/1000 Individuals

• Age – Common age around 25 years

• Sex – Male

• Recurrence is more even the incidence is less.


DEFINITION OF NADI VRANA
NADA = means a “REED “
That which is having a track likes a reed.

The nature of the wound which remains unhealed


with the characteristic of oozing or discharge of pus is
called as Nadi vrana.

“NADI” – a track ;

“VRANA” - an ulcer
An ulcer which is having a tack is
called as “Nadivrana”.
ETIOLOGY

• If it is treated by quack
• When the surgeon drains the Apakwa Vrana
sopha.
• When the patient does Ahit ahara and vihara.
• Bhagna vrana upeksha- vrana created by
Bhagna treated improperly.
CLASSIFICATION
• Vataja
• Pittaja
• Kaphaja
• Vata-Pittaja
• Pitta-Kaphja
• Vata- Kaphja
• Sannipataja
• Shalyaja
PILONIDAL SINUS
IN
AYURVEDA
• Bala (hair) shalya is one among in
different types of shalyas

• The main cause of this sinus is hairs

• Here Pilonidal sinus can be considered


under the classification of shalyaja nadi
vrana
PILUS = Hair; means ‘ Nest of hair’
NIDUS = Nest

Cross section of P.Sinus


SITES
• Finger webs of barber.
• Axilla.
• Mid thigh amputation stump.
• Umbilicus
• Supra pubic region.
• Post anal region
DIRECTIONS OF SPREADING
CLINICAL FEATURES

• A symptomatic

• Chronic sepsis

• Acute Abscess
DIFFERENTIAL DIAGNOSIS

• Hidradenitis suppurative

• Fistula- in-Ano
COMPLICATIONS

• Most common complication is acute and


chronic infections.

• Malignant degeneration rarely occurs in


pilonidal disease, although verrucous
carcinoma (giant condyloma
acuminatum) has been described.
Materials:

-Gauze -Sinus forceps


-Scissors -Scalpel
-Measuring scale -Gloves
-Slough cutter -Kidney tray
-Pratisarneeyakshara- -Nimbu swarasa
(Apamrga kshara)
-Surgical pads
-Probing needles
-Artery forceps
SOURCE OF DATA

Patients were randomly selected from


OPD and IPD of SDM College of
Ayurveda and Hospital after the diagnosis.
MANAGEMENT
The treatment of pilonidal sinus can be
divided as:
1. Emergency treatment - For abscess
2. Elective Treatment
3. Radical excision
2. Elective Treatment

- This treatment consist of Conservative


Surgery which include.

- Excision of midline pits and clearing the


tracts

- Follicle Removal

- Phenol Injection

- Lying Open Tracks


3. Radical excision

• Excision and Healing by granulation


• Excision and Marsupialization
• Excision and Primary closure
• Closure by z- Plasty
• Resuture the Rhomboid Flap
• Myocutaneous Flap and Other Procedures
• Excision and split Skin grafting
SAMANYA CHIKITSA OF NADI VRANA

• The treatment of Nadi Vrana can be


performed by following methods:
• Surgical technique - Uthpatana karma.

• Para-surgical technique – Anusastra


karma.

• Medical technique – Anushadha karma.


The above upakrama can be performed in
three stages

• Pre operative

• Operative

• Post operative
PRE OPERATIVE

1. Pre operative check up check up was


done to rule out any systemic disorder
like diabetes etc
2. Pre operative anesthetic check.
3. Nil by mouth six hours before surgery.
4. Part preparation
5. Soap water enema
6. Inj. T.T
OPERATIVE

1. Patient was made to lie down in left


lateral position.
2. Painting was done with betadiene and
spirit.
3. Draping done.
4. Probing is done to see
the length of the tract
5. With the help of scalpel an
elliptical incision is made
around the post anal sinus.
6.The whole sinus tract will be excised
deep up to the presacral fascia.

7.During the whole surgical process


the haemostasis will be maintained.
8. After Application of the Apamarga
pratisarneeya kshara over wound.
Condition of the wound during the
application of the Kshara
Condition of the wound
Immediately after application of the
Kshara
Excised sinus

End of the surgery


POST OPERATIVE:

1. Daily dressing will be done.

2. Weekly shaving will be done to the post


anal area.
CONCLUSION
•Pilonidal sinus can be considered as
a shalyaja nadi vrana

•The application of the pratisarana kshara


curettes the lateral sinus and avoids
the recurrence.

•Compared to the other parallel treatment


procedures,the above said procedure
proved to be effective in the therapeutic
and recurrence aspect.