A comparative clinical study to evaluate the effect of arka based apamarga kshara sutra and Z Plasty in shalyaja nadivrana with special reference to pilonidal sinus

Nadivrana is a disease of concern today which is defined as one which is having a track like a reed, the nature of which remains unhealed with the characteristics of discharge of pus caused due to the improper treatment of Pakwa Shopha. Nowadays, amongst all types of Nadivrana, the prevalence of Shalyaja Nadivrana which has baala (hair) embedded is higher in clinical practice. Lakshanas include ruja and puyasrava. Treatment includes- Upanaha, Chedana, Aaharana of Shalya, Ksharasutra, Varti, and Pratisaraniya Kshara. Shalyaja Nadivrana can be compared to the Pilonidal Sinus in contemporary sciences.

A pilonidal sinus is a cavity containing hair that is found typically above the level of the first piece of coccyx. A tuft of hair projects from its mouth. Amongst various sites like Webs of fingers, Axilla and Natal cleft, the commonest site is at the natal cleft. The Subject complains of blood stained foul discharge from the sinus at natal cleft. Pain and Tenderness are often associated with due to recurrent infection. The incidence of the disease at natal cleft is 26 per 1,00,000 population in India. The male is to female ratio is 3-4:19. Treatment options include- Excision of the Sinus, Open Surgery, Marsupialization, Z-plasty and Laser Ablation.

Amongst Shastra and Anushastra, Kshara is pradhana. Also, Kshara has Chedana, Bhedana, and Lekhana in addition to Shodhana, Ropana and Stambhanadi properties. Kshara sutra which imbibes all these properties is feasible, effective and can be performed on OPD basis. Z-Plasty is an effective treatment in contemporary science.

The treatment protocol of Nadivarna includes Kshara sutra. Apamarga kshara is mentioned in Ksharapakavidhi adhyayam. Arka ksheera can be used as a binding agent in the preparation of Kshara Sutra.

Shalyaja Nadivrana is a disorder that causes discomfort, pain and hampers day to day activities of the Subject. The suffering is due to the delayed approach of the Subject to the doctor. Hence, treatment of this is of utmost importance. As Shalyaja Nadivrana at natal cleft is one of the least explored area at par with contemporary science, so this study has been taken up to analyse the effect of Arka based Apamarga kshara sutra and Z-plasty in Shalyaja Nadivrana with special reference to Pilonidal sinus.