Management of Dermal Sinus Tracts in Children

Initial Management at Presentation

• Surgical resection at time of diagnosis: Although there is no consensus about the timing of surgery in uncomplicated, asymptomatic patients with dermal sinus tracts, it seems logical to proceed with surgery whenever the infant is physiologically ready for the procedure. The risk of complications is thought to be lower when surgery is performed prophylactically than when infection has complicated the anatomy (8, 16).
• Delay surgery if infection present: Although there is some controversy regarding proceeding with surgery in the presence of infection, it is usually advisable to postpone the surgical intervention for weeks until the infection is under control (14).

Adjunctive Therapies

• Steroids: Dexamethasone to be administered before and during surgery per surgeon’s preference.
• Antibiotics: Antibiotics are used for treatment of infectious lesions in complicated patients for whom surgery is not indicated. Commonly, antibiotics are used for a short term after surgery for noninfected patients and longer when infection is found at surgery.

Follow-up

• Yearly visits and imaging as indicated: After initial postoperative follow-up, annual visits are scheduled to look for signs of recurrence and/or infection. MRI scans are obtained when infection is present. If an abscess is found, scanning is done on a frequent basis to follow treatment. Otherwise, imaging is done as needed.
• Urological: Routine scheduled urological evaluations.