THE ELIMINATION OF CAUSAL FACTORS IN PILONIDAL SINUS TREATED BY Z-PLASTY

Partial Gluteus Muscle Flap for Treatment of Chronic, Recalcitrant Pilonidal Cyst Disease

Background

Pilonidal cyst disease is a challenging condition requiring excision and wound management when it is chronic and symptomatic. Primary closure of the excision site can lead to high recurrence rates, necessitating flap-based reconstruction. This article discusses the use of a partial gluteus maximus muscle flap to address recurrent pilonidal disease and reduce its recurrence.

Methods

From 2014 to 2021, 11 patients aged 14-31 with recurrent pilonidal cysts underwent two-stage surgery involving excision and wound debridement by general surgery, followed by plastic surgery for wound closure using the partial gluteus muscle flap.

Results

Eleven patients were included in the study (four women and seven men). The mean age was 23 ± 5.2, and the average body mass index was 28.59 (±6.7). The mean number of previous procedures was 2.25 (range, 2-3). Operative time was 158.7 ± 37 minutes. The average length of stay when both procedures were done in the same admission was 8 ± 6 days (range 3-21 days) and when procedures were done separately, the length of hospital stay after the wound closure using a partial gluteus muscle flap was 3 days, and the range for reliable follow-up was 1.6-7 years postoperatively. In our study cohort of 11 patients, the majority, specifically seven individuals, experienced uneventful healing. However, a subset of patients encountered complications. Three patients developed an infection recurrence: one was treated conservatively, and one required reoperation with resolution of symptoms, and one patient also experienced wound dehiscence, which was closed with a small procedure.

Conclusion

Partial gluteal muscle flap offers a promising approach for treating recalcitrant, difficult-to-treat pilonidal disease in young adults, enhancing wound healing and reducing the risk of recurrence.

Evaluation of the efficacy of the Z-plasty surgical technique vs. secondary wound healing mechanism in the treatment of the pilonidal sinus: a clinical trial

Background

The most important step in treating a pilonidal sinus is eradication by surgical excision. Over the years, various surgical techniques have been reported for wound closure, yet their management still poses a challenge. The current study compares the results of two different methods of wound management: secondary wound healing versus the Z-plasty surgical technique.

Material and method

The current clinical trial recruited 84 uncomplicated pilonidal sinus patients who were to undergo complete surgical excision of the pilonidal sinus. For wound healing, the 84 subjects were equally divided into two groups of 42 patients each. One group was selected for Z-plasty surgical wound closure and the other for the secondary healing mechanism. Outcomes measured consisted of demographic data, length of operation, complications, severity of pain, number of dressings, recurrence, and complete healing time.

Result

Age or sex distribution and the median BMI (kg/m²) did not significantly differ between the two groups. The length of the operation for Z-plasty subjects was significantly longer (P <0.0001). The median number of dressing changes for secondary wound healing patients was 38.69, which was significantly higher than the 4.95 dressing changes for the Z-plasty group. The total time recorded for complete wound healing was 21.61±4.27 days in the Z-plasty group and 41.23±24.28 days for secondary wound healing subjects, which was statistically significant. Twenty-four hours postoperation, patients in the secondary wound healing group had significantly more pain, and the Visual Analogue Scale scores of the Z-plasty and secondary wound healing groups were 3.42±0.76 and 6.09±1.2, respectively. Concerning the recurrence rate, there were no significant differences between the two groups. SPSS version 22 performed the analyses, and the independent t-test compared the continuous variables. A P value less than 0.05 was considered statistically significant.

Conclusion

Z-plasty is a safe and effective procedure in terms of wound complications and recurrence rate. This method is also cost-effective and better received by patients.

Outcome of Surgical Management of Sacrococcygeal Pilonidal Sinus Disease with Rotation Flap in 52 Patients-A Retrospective Study

Background  Surgical treatment of sacrococcygeal pilonidal sinus disease (SPSD) consists of radical excision of the entire tract and treatment of the resultant raw area. Here, the authors have reviewed the results of the rotation flap for closure of the SPSD. Aim  This study aims to evaluate the outcomes following SPSD excision and rotation flap closure. Materials and Methods  All patients were treated for SPSD with excision and closure using a rotation flap from January 2010 to September 2018. Cases having a follow-up of at least 6 months post surgery were evaluated. Result  A total of 52 patients were included in the study; 42 cases were of primary disease while 10 were of recurrent disease. The patients' follow-up records on the 3rd day, 10th day, 1 month, and 6 months were evaluated. None of the patients showed any signs of recurrence on follow-ups. One patient developed a hematoma on the third day post surgery which was treated conservatively. One patient developed a seroma in the perianal region on the fifth postoperative day which required aspiration. Both these patients healed well subsequently. Conclusion  Rotation flap is a (simple and reliable) treatment option for closure of postexcision SPSD defect. It not only takes the tension away from suture line, but also pushes the gluteal fat from the sides into the midline, obliterating the deep crevice of the natal cleft which is believed to be one of the important factors in the causation of SPSD, thus minimizing recurrence.

Laying Open and Curettage under Local Anesthesia to Treat Pilonidal Sinus: Long-Term Follow-Up in 111 Consecutively Operated Patients

(1) Background: Several techniques for the treatment of pilonidal sinus disease (PSD) are in vogue, though none have emerged as the gold standard. Laying open (deroofing) and curettage under local anesthesia is one of the most straightforward procedures to treat PSD. In this study, the long-term follow-up in a large series was analyzed. (2) Methods: The laying open approach was performed for all types of consecutive PSD patients-simple, complicated, and abscess. The primary outcome parameter of the study was the healing rate. The secondary outcome parameters were operating time, hospital stay, time to resumption of normal work, and healing time. (3) Results: 111 (M/F-92/19, mean age-22.9 ± 5.7 years) consecutive patients were operated on and followed for 38 months (6-111 months). Of these, 24 had pilonidal abscesses, 87 had chronic pilonidal disease, while 22 had recurrent disease. Operating time and hospital stay were 24 ± 7 min and 66 ± 23 min, respectively. On average, patients could resume normal work in 3.6 ± 2.9 days and the healing time was 43.8 ± 7.4 days. Three patients were lost to follow-up. Complete resolution of the disease occurred in 104/108 (96.3%) patients, while 4 (3.7%) had a recurrence. One recurrence was due to a missed tract, while three recurrences presented after complete healing had occurred. Two patients with recurrence were operated on again with the same procedure, and both healed completely. Thus, the overall success rate of this procedure was 98.1% (106/108) with a recurrence rate after first surgery of 3.7% over a median follow-up of 38 months. (4) Conclusions: Pilonidal disease managed by laying open (deroofing) with curettage under local anesthesia is associated with a high cure rate. This procedure is effective in treating all kinds of pilonidal disease (simple, complicated, and abscess).

The EPIC procedure (Endoscopic-assisted Pilonidal Irrigation and Cleaning): a simple and effective treatment for pilonidal disease

BACKGROUND

Pilonidal disease (PD) is a common condition of the sacrococcygeal region leading to inflammation and abscess formation. PD is a topic of renewed interest due to the lack of satisfactory management options. Minimally invasive techniques have recently been investigated, with promising results in adult and pediatric populations. Our technique, the "EPIC procedure," Endoscopic-assisted Pilonidal Irrigation and Cleaning, involves removal of hair under direct visualization using a small endoscope while flushing saline through the cavity via an angiocatheter. We aim to show that the EPIC procedure is a safe and effective operation for the treatment of pilonidal disease in the pediatric population.

MATERIALS AND METHODS

We performed a retrospective chart review including 20 consecutive patients. All had a primary sacrococcygeal pilonidal sinus; all underwent the EPIC procedure. Post-operative care instructions included daily bathing and weekly depilatory application. We evaluated gender, age, weight, disease severity, operative duration, recurrence of PD, and other complications.

RESULTS

In the 20 patients studied, 22 EPIC procedures were performed. The median follow-up duration was 27.95 (range 0.63-45.27) months. The mean operative duration was 28.8 (SD 10.2) min. There was a 15% recurrence rate (95% CI 0.00%, 30.65%).

CONCLUSIONS

The EPIC procedure is an endoscopic-assisted operation that simplifies previously published techniques in pursuit of reduced operative complexity, cost, and time, with comparable recurrence and complication rates. All three recurrences occurred in patients that did not follow instructions for post-operative depilatory care. Two of these patients underwent repeat EPIC procedure and had no further complications. The third was lost to follow-up. The EPIC procedure provides a simple, effective, and minimally invasive approach to the treatment of pilonidal disease.

Pilonidal Disease Treatment By Radial Laser Surgery (FilaC™): The First Finnish Experience

BACKGROUND AND AIMS

Pilonidal disease is common, and it afflicts especially young adults, causing disability. Several types of treatment methods are applicable, but no consensus exists regarding the best method. The aim of our study was to assess the novel radial laser probe treatment in pilonidal disease and report the success rate and recurrence rate.

METHODS

We studied retrospectively 86 patients who, according to our hospital patient records, underwent radial laser probe surgery between January 2017 and September 2019.

RESULTS

In a mean follow-up time of 14 months, the success rate at 2 months was 86%. Most operations were done under local anesthesia on a day-surgery basis. The recovery time was rapid, and median sick leave was 12 days. Of those initially successfully treated, 3% developed a recurrence. Altogether 17% of the patients underwent a re-operation. Spillage of pus during surgery, however, reduced the success rate to 53%.

CONCLUSION

Radial laser probe treatment is a quick, safe, and minimally invasive treatment choice for pilonidal disease, especially when no active infection is present.

Fasciocutaneous Elliptical Rotation Flap for Pilonidal Sinus Disease and Its Outcomes

Objectives

Sacrococcygeal pilonidal sinus is a common disease especially in the Caucasians of the Middle East. It has been reported in the incidence of 12-26 in a 100.000 population. Previously thought to be due to etiological reasons of congenital origin, it is now widely accepted as an acquired disease. The optimal treatment for pilonidal sinus disease still has no consensus. The elliptical rotation flap was first described by Nessar in the surgery of pilonidal sinus and reported successful results, but it has weak points. The purpose of this study was to share the findings of the fasciocutaneous elliptic rotation flap technique retrospectively.

Material and Methods

One hundred and eighty-six patients (149 were males and 37 were females) operated for pilonidal disease with fasciocutaneous elliptic rotation flap between 2013 and 2018 were included into this study. Data of the patients including operation time, wound issues (infection, seroma, wound separation), time required to return to daily activities, complete healing time and recurrence rates were recorded retrospectively.

Results

The patients' complete healing time was 13 ± 3 days and mean follow-up was 19 (6-37) months. Mean operative time was 43 ± 13 minutes. Mean time of drain removal was 2.20 ± 1.18 days. There were no flap necrosis or ischemia. Postoperative infection developed in two patients (1%). Seroma developed in 7 (3.8%) patients. Partial wound dehiscence occurred in 5 (3.2%) patients. None of the cases developed hematoma or complete dehiscence. No recurrence was observed in postoperative follow-ups.

Conclusion

Fasciocutaneous elliptical rotation flap is a method that has follow-up results similar to both the elliptical rotation flap technique and its modification and can be safely preferred in the treatment of pilonidal sinus with its other advantages.

Outcomes of Coccygectomy Using the "Z" Plasty Technique of Wound Closure

STUDY DESIGN

Technical note.

OBJECTIVES

Coccygectomy for chronic coccydynia has a high rate of successful clinical outcome. However, the procedure is associated with increased incidence of wound dehiscence and surgical site infection. The main objective was to evaluate the clinical outcomes of coccygectomy using the Z plasty technique of wound closure.

METHODS

Patients with chronic coccydynia refractory to conservative treatment underwent coccygectomy followed by Z plasty technique of wound closure between January 2013 and February 2018. Primary outcome measure was evaluation of the wound healing in the postoperative period and at follow-up; secondary outcome measure included visual analogue scale (VAS) score for coccygeal pain.

RESULTS

Ten patients (male:female 6:4) fulfilled the inclusion criteria. The mean age of patients was 40.78 years (range 19-55 years). The mean follow-up was 1.75 years (range 6 months to 5 years). All wounds healed well with no incidence of wound dehiscence or surgical site infections. The mean VAS improved from 7.33 ± 0.5 to 2.11 ± 1.2 (P < .05). Nine patients reported excellent outcomes and 1 patient reported poor outcome with regards to relief from coccydynia.

CONCLUSION

Z plasty technique of wound closure is recommended as procedure of choice to avoid wound healing problems and surgical site infections associated with coccygectomy. Coccygectomy remains a successful treatment modality for chronic coccydynia.

A new minimally invasive treatment of pilonidal sinus disease with the use of a diode laser: a prospective large series of patients

AIM

Various surgical techniques are available for the management of pilonidal sinus, but there is still controversy concerning the optimal surgical approach. The aim of our study was to evaluate the safety, efficacy and clinical outcome of a laser procedure for the treatment of pilonidal sinus.

METHOD

Patients suffering from pilonidal sinus were operated on with sinus laser therapy (SiLaT) in our institute. SiLaT was applied under local anaesthesia after a small skin incision of 0.5-1 cm and careful cleaning of the sinus tracts with a curette. A radial fibre connected to a diode laser set at a wavelength of 1470 nm was then introduced into the tracts. The laser energy was delivered in continuous mode.

RESULTS

Two-hundred and thirty-seven patients (183 male, median age 24 years, range 14-58) suffering from pilonidal sinus were operated on using the SiLaT laser procedure in our referral Institute and prospectively evaluated. A high healing rate was observed after the first session (90.3%, 214 of 237) with a median healing time of 47 days (range 30-70 days). A second treatment was offered for patients failing in the first session; this was successful in 78.3% (18/23). The duration of the procedure ranged between 20 and 30 min and had limited morbidity (wound infection in 7.2%, 17 of 237).

CONCLUSION

SiLaT proved to be a safe and effective procedure for treating patients suffering from pilonidal sinus. Clinical results showed low morbidity and recurrence rates comparable to the published literature for other modern techniques.

Common surgical procedures in pilonidal sinus disease: A meta-analysis, merged data analysis, and comprehensive study on recurrence

We systematically searched available databases. We reviewed 6,143 studies published from 1833 to 2017. Reports in English, French, German, Italian, and Spanish were considered, as were publications in other languages if definitive treatment and recurrence at specific follow-up times were described in an English abstract. We assessed data in the manner of a meta-analysis of RCTs; further we assessed non-RCTs in the manner of a merged data analysis. In the RCT analysis including 11,730 patients, Limberg & Dufourmentel operations were associated with low recurrence of 0.6% (95%CI 0.3-0.9%) 12 months and 1.8% (95%CI 1.1-2.4%) respectively 24 months postoperatively. Analysing 89,583 patients from RCTs and non-RCTs, the Karydakis & Bascom approaches were associated with recurrence of only 0.2% (95%CI 0.1-0.3%) 12 months and 0.6% (95%CI 0.5-0.8%) 24 months postoperatively. Primary midline closure exhibited long-term recurrence up to 67.9% (95%CI 53.3-82.4%) 240 months post-surgery. For most procedures, only a few RCTs without long term follow up data exist, but substitute data from numerous non-RCTs are available. Recurrence in PSD is highly dependent on surgical procedure and by follow-up time; both must be considered when drawing conclusions regarding the efficacy of a procedure.

Laying open (deroofing) and curettage under local anesthesia for pilonidal disease: An outpatient procedure

AIM

To test the efficacy of lay open (deroofing, not excision) with curettage under local anesthesia (LOCULA) for pilonidal sinus as an outpatient procedure.

METHODS

LOCULA procedure was done for all types of pilonidal disease. The primary outcome measure was cure rate. The secondary outcome measures were hospital stay, operating time, return to work, healing time and complication rate.

RESULTS

Thirty-three (M/F-30/3, mean age-23.4 ± 5.8 years) consecutive patients were operated and followed for 24 mo (6-46 mo). Eleven were pilonidal abscess and 22 were chronic pilonidal disease. Six had recurrent disease. Operating time and the hospital stay was 22.3 ± 5.6 min and 63.8 ± 22.3 min respectively. The patients could resume normal work in 4.3 ± 3.2 d and the healing time was 42.9 ± 8.1 d. Thirty (93.8%) patients had complete resolution of the disease and two (6.2%) had a recurrence. Both the recurrences happened in patients who had complete healing but ignored the prescribed recommendations. One out of these got cured after getting operated again with the same procedure. Thus the overall success rate of this procedure was 96.9%.

CONCLUSION

Lay open (deroofing) with curettage procedure under local anesthesia is an effective procedure to treat both simple and complicated pilonidal sinus and abscess. It is a simple procedure, has a high cure rate (up to 97%), doesn't require admission and is associated with minimal morbidity and scarring. Considering the distinct advantages, this procedure has the potential to become the first line procedure for treating pilonidal disease.

Karydakis procedure for sacrococcygeal pilonidal sinus disease: Our experience

Aim:

The purpose of this study was to evaluate patients with sacrococcygeal pilonidal sinus disease (SPSD) who underwent Karydakis procedure at our centre with reference to the perioperative findings, early and late postoperative results and recurrence.

Materials and Methods:

A total of 103 patients presenting with SPSD at our centre underwent Karydakis flap repair from January 2001 to December 2010. These patients were then followed-up and evaluated with respect to operative time, drain use, hospital stay, suture removal, complications, and recurrence.

Results:

The mean operative time was 74.9 min with a median hospital stay of 5 days. Drains were removed at a median of 7 days and sutures at a median of 15 days. Twenty-one patients presented with serous collection in the wound. Six patients had wound infection. Patients were followed-up for a median of 29 months. No recurrences were noted in any of the cases.

Conclusion:

Karydakis flap procedure is a relatively simple procedure for SPSD with reproducible low recurrence rates.

Application of fasciocutaneous V-Y advancement flap in primary and recurrent sacrococcygeal pilonidal sinus disease

BACKGROUND

Pilonidal sinus disease is a common disease of young adults, which most frequently occurs in the sacrococcygeal region on the skin's midline. Various procedures, ranging from simple incision and curettage to complex flaps for natal cleft obliteration, have been described in the literature.

MATERIAL/METHODS

We aimed to present the dermographic characters, post-operative complications, length of stay in hospital, time of return to daily activities, and recurrence rates of the patients in which we applied sinus excision and fasciocutaneous V-Y advancement flap due to primary complicated or recurrent sacrococcygeal pilonidal sinus disease.

RESULTS

Patients with primary complicated and recurrent pilonidal sinus received a fasciocutaneous V-Y advancement flap in the general surgery service of our hospital. Eleven patients had recurrent disease. Thirty-seven patients received a unilateral V-Y flap and 8 patients received a bilateral V-Y flap. None of the patients had post-operative flap necrosis or wound opening. Two of the patients had a self-draining simple seroma and 3 of the patients had delayed wound healing in the perianal region of the incision, which was treated with dressing. The mean time required to return to daily activities was 7 days, and return to work took 17 days. In the mean 25-month follow-ups of the patients, no recurrences were detected.

CONCLUSIONS

We think that fasciocutaneous V-Y advancement flap is an easily learned and practicable method that reduces the recurrences in the patients with primary complicated and recurrent pilonidal sinus, length of stay in hospital, and time to return to daily activities and work in the post-operative period.

A Retrospective Study of 40 Cases of Pilonidal Sinus with Excision of Tract and Z-plasty as Treatment of Choice for Both Primary and Recurrent Cases

Pilonidal sinus is a common chronic disease of the sacrococcygeal region. The treatment varies according to the clinical presentation of the disease. Although many surgical methods have been suggested, an ideal method is still lacking because of high recurrence rates. The aim of this work is to assess the role of Z-plasty in promoting primary healing in pilonidal disease and to evaluate morbidity and recurrence. This study included 40 patients (36 males and 4 females) who underwent excision of sinus and Z-plasty closure for sacrococcygeal pilonidal sinus. The follow-up period ranged from 6 to 12 months. There were 36 males and 4 females with a median age of 25 years. The mean hospital stay was 2 days. The mean time to return to work after discharge from the hospital was 14 days. There were no recurrences, and all patients were satisfied with the cosmesis. Two patients (5 %) had numbness over the flap. Necrosis of flaps did not occur in any patient. Only three patients were noticed to have wound infection (7.5 %). Five patients (12.5 %) developed wound seroma. Although requiring some technical expertise, excision of sinus and Z-plasty offer superior results with respect to recurrence in the hospital stay and cosmesis of patients with pilonidal sinus.

V-y advancement flap technique in resurfacing postexcisional defect in cases with pilonidal sinus disease-study of 25 cases

We report our experience of technique of V-Y-plasty in treatment of pilonidal sinus. A retrospective study of 25 patients performed from 2005 to 2010 at Deenanath Mangeshkar Hospital and Sassoon General Hospitals, Pune, was performed. The unilateral or bilateral V-Y advancement flap technique was used in the management of these patients. The outcome was assessed on the basis of efficacy of flap surgery in achieving wound healing and recurrence. The follow-up ranged from 6 months to 5 years. The study included 25 cases of pilonidal sinus. Nineteen patients (76%) underwent unilateral V-Y-plasty and six patients (24%) underwent bilateral V-Y-plasty. Eighty-four percent cases were from the age group of 21-30 years. Sixty-eight percent patients were mobilized on the fourth postoperative day and 32% patients were mobilized on the third postoperative day. No recurrence was found in any of the patients. Itching and hypertrophic scar were found in two cases (8%), and decreased sensation was found in one patient (4%). The V-Y advancement flap technique for the treatment of pilonidal sinus is efficient and can reduce recurrence. Unilateral/bilateral V-Y flap achieves suture line away from midline, obliteration of natal fold and coverage of defect without tension. In follow-up none of the patients showed recurrence. This technique has distinctly less morbidity and avoids of multiple dressings, reducing the total cost of the treatment. V-Y advancement flap is distinctly better choice among the available flaps as it is less time-consuming, requires less technical expertise as compared to Z-plasty and perforator flaps, and is reliable and easy to plan.

Secondary healing versus midline closure and modified Bascom natal cleft lift for pilonidal sinus disease

BACKGROUND AND AIMS

Pilonidal sinus disease is a common disease in young employed male adults. Ongoing discomfort usually indicates an operative intervention. The main drawback is however the complication of wound healing. Numerous techniques for surgical treatment have been proposed, which underlies the lack of a superior technique.

MATERIAL AND METHODS

A retrospective study was performed on the medical notes of 62 patients operated for a pilonidal sinus between May 2005 and December 2006. Used techniques were: 'modified Bascom procedure', 'excision and primary closure' and 'excision with secondary wound healing'. Patients' characteristics, operative parameters and data on outcome were included. The primary endpoint was wound healing.

RESULTS

Twenty-five patients underwent the modified Bascom procedure, 19 underwent surgical excision with primary midline closure and 18 underwent surgical excision with secondary wound healing. There were no demographical differences between the groups of patients. The modified Bascom technique showed a significantly reduced wound healing time (29 days) compared to primary closure (52 days, p < 0.01) and secondary healing (62 days, p < 0.01). The duration of this modified procedure was significantly longer (49, 33 and 24 minutes respectively, p < 0.01).

CONCLUSIONS

Wound healing remains an important problem in the surgical treatment of pilonidal disease. Significant faster convalescence can be achieved using the modified Bascom procedure. Wide local excision as primary therapy should not be advocated.

Sinus excision and primary closure versus laying open in pilonidal disease: a prospective randomized trial

BACKGROUND

Surgical excision is the standard treatment for chronic pilonidal disease, but all excisional techniques are associated with tissue loss, risk of wound break down, and chronic healing problems.

OBJECTIVE

The aim of the study was to compare sinus excision and primary closure vs a laying open technique in a prospective randomized trial.

DESIGN, PATIENTS, AND INTERVENTIONS

Eighty patients were randomly assigned to sinus excision and primary closure (n = 39) or laying open (n = 41). Follow-up was performed 1, 3, and 12 months after surgery.

MAIN OUTCOME MEASURE

The main outcome measure was the healing rate after 1 year.

RESULTS

The healing rate was significantly higher after excision and closure than after laying open at 1 month (20 of 39 vs 8 of 41; P = .005) and 3 months (36 of 38 vs 28 of 39; P = .013) after surgery. At follow-up 12 months after surgery no difference was seen in healing rate between the treatment arms (33 of 37 vs 37 of 38; P = .198).

CONCLUSIONS

This prospective randomized trial shows that sinus excision and primary closure results in faster healing than laying open does, but there is no difference in healing rate after 1 year. The laying open procedure is minimally invasive with small risks for the patient, and it might therefore be considered more frequently as the first choice of treatment (www.clinicaltrials.gov. Unique identifier: NCT00997048).

Surgical treatment of pilonidal sinus with a fasciocutaneous rotation flap based on an inferior pedicle

Pilonidal sinus is a common disorder of the sacrococcygeal region and several surgical treatments have been described. However, rates of recurrences and complications vary, so there is no consensus on one specific approach. In this prospective study from 1 August 2000 to 1 August 2003, 60 patients with pilonidal sinus were treated by our new surgical technique. All patients were operated on by the first author or under his supervision. A vertical elliptical excision was made, and the defect repaired by a fasciocutaneous rotation flap based on the inferior pedicle under general anaesthesia. All patients were discharged from hospital on the first postoperative day. By the 12th day, the wound had healed completely. There were no recurrences during one years' follow-up. Postoperative pain was negligible and the scar was cosmetically acceptable. The inferiorly-based rotation flap is an ideal technique for treatment of pilonidal sinus, cures the disease, has low recurrence rates, little postoperative pain, and few complications. Stay in hospital was short and patients returned to their regular activities in a short time.

Sacrococcygeal pilonidal sinus treated by a new fascio-cutaneous flap

PURPOSE

This study reported the technical details and preliminary clinical outcomes of a new fascio-cutaneous transposition flap for the surgical treatment of pilonidal sinus.

METHODS

Fifty-two patients with pilonidal sinus were surgically treated. During the surgical procedure, an inferiorly pedicled, fascio-cutaneous flap with specific geometric characteristics was prepared and transposed. Postoperative pain, complications, duration of hospital stay, and time off worked were assessed. Patients were followed for eighteen months after surgery.

RESULTS

The mean hospital stay was 2 days. Drains and sutures were removed after 3 and 12 days, respectively. No flap ischemia, wound dehiscence or major complications were observed. Tension on suture lines and pain after surgery were negligible. Wound infections occurred in 4 patients (7.7 percent) and were managed by removing a few sutures. Seroma was detected in 6 patients (11.5 percent). The mean time patients missed work was 7 days. No recurrence was observed during the follow-up period of 18 months.

CONCLUSIONS

With no disease recurrence, minimal complication rate, time off work, and acceptable aesthetic outcome, this fascio-cutaneous transposition flap technique is a safe and effective method for surgically treating pilonidal sinus.

Lower recurrence rate for Limberg vs. V-Y flap for pilonidal sinus

PURPOSE

Pilonidal sinus is a disease that does not have a standardized surgical treatment method. This study was designed to compare the outcomes of Limberg fasciocutaneous transposition and V-Y fasciocutaneous advancement flaps in the treatment of patients with pilonidal sinus.

METHODS

A total of 111 patients (98 males; 88.3 percent; mean age, 27.1 years) who received reconstruction after pilonidal sinus excision in our clinics with Limberg flap (Group 1, n = 66, 59.5 percent) or V-Y flaps (Group 2, n = 45, 40.5 percent) between 1997 and 2004 were investigated retrospectively.

RESULTS

No significant difference was detected between Groups 1 and 2 in terms of gender, history of infection or abscess, mean duration of operation, requirement for analgesics, wound-related complications, such as necrosis, seroma, and infection, and average time off work. Mean follow-up periods were 45.4 vs. 48.8 months in Group 1 and Group 2, respectively (P = 0.337). On the other hand, rate of recurrence was significantly lower in Group 1 (n = 1, 1.5 percent) compared with Group 2 (n = 5, 11.1 percent; P = 0.039).

CONCLUSIONS

We conclude that, if the defect is to be reconstructed with a flap in pilonidal sinus cases, reconstruction with Limberg flap should be preferred over reconstruction with V-Y flap because of its lower rate of recurrence.

Elliptical rotation flap for pilonidal sinus

BACKGROUND

The treatment of the symptomatic pilonidal sinus is surgical with one of the most extensive being excision of the diseased tissue down to the sacral fascia. The closure of the defect is the matter of debate. An elliptical rotation flap has been used for pilonidal sinus treatment with no recurrence rate.

METHODS

From April 1996 to June 2001, 20 patients were treated with this technique. The surgical procedure is a vertical elliptical excision of the diseased tissue and an elliptical cutaneous rotation flap to close the defect.

RESULTS

Twenty patients underwent with this technique, mean age 23.4 years (range 18 to 34). Mean follow-up was 42 months. All patients were discharged on the first postoperative day. Primary healing was achieved in all of the patients in 2 weeks. No recurrence was observed.

CONCLUSIONS

Elliptical rotation flap is recommended for patients selected for defect closure. It offers improved patient comfort, shorter hospital stay, and no recurrence rate.

Surgical treatment of sacrococcygeal pilonidal sinus with the Limberg transposition flap

BACKGROUND

Pilonidal sinus is a common chronic disease of the sacrococcygeal region. Although many surgical methods have been suggested, an ideal method is still lacking because of high recurrence rates.

METHODS

This prospective study was conducted in 63 patients who were treated with the use of a rhomboid excision and Limberg flap closure for sacrococcygeal pilonidal sinus. The follow-up period ranged from 4 to 52 months (mean, 25 months).

RESULTS

The mean hospital stay was 3 days (range, 2-7 days) and the mean time to return to work was 15 days (range, 12-26 days). Early wound complications and recurrence were encountered in 6% and 3%, respectively. Nineteen percent had numbness at the operation site and 63% were not pleased with cosmetic appearance of the scars.

CONCLUSIONS

The results favor rhomboid excision and Limberg flap closure in the treatment of sacrococcygeal pilonidal sinus, especially in recurrent cases and in patients with extensive involvement. Low recurrence rates, shorter hospital stay, and time off from work may outweigh the disadvantages related to unfavorable cosmetic appearance.

Tratamento cirúrgico da doença pilonidal sacrococcígea: estudo comparativo entre as técnicas de marsupialização e de incisão e curetagem

OBJETIVO: Comparar duas técnicas cirúrgicas empregadas, no tratamento da doença pilonidal, a de marsupialização e da incisão e curetagem, analisando seus resultados imediatos, e tardios. MÉTODO: A casuística de 52 pacientes que apresentaram doença pilonidal sacrococcígea em suas diferentes fases, divididos em dois grupos. Grupo A, com 23 doentes submetidos à técnica de marsupialização, e grupo B, formado por 29 doentes operados pela técnica de incisão e curetagem. Todos tiveram seguimento pós-operatório de um a três anos, no período de 1981 a 1999 pelo Serviço de Gastroenterologia Cirúrgica do Hospital do Servidor Público Estadual "Francisco Morato de Oliveira" de São Paulo. A média de idade do grupo A foi de 25,39 ± 8,92 anos e a do grupo B foi de 25,52 ± 9,98 anos. A distribuição por sexo foi de 28 mulheres e 24 homens. Segundo a raça, foram 42 brancos e 10 negros. RESULTADOS: A média de tempo de duração de cirurgia, para o grupo A, submetido à marsupialização, foi de 38,91 ± 19,77 minutos, e para o grupo B, doentes submetidos à incisão e curetagem, foi de 47,34 ± 14,34 minutos. A média do tempo de internação para o grupo A foi de 3,26 dias e para o grupo B 1,28 dia. Quanto ao uso de antibiótico, em ambos grupos não foi observada diferença estatística (p>0,05). O tempo médio de cicatrização da ferida operatória nos doentes submetidos à técnica de marsupialização foi de 29,30 ±13,24 dias e para os doentes submetidos a incisão e curetagem foi de 40,76 ± 26,56 dias. A dor pós-operatória incidiu com 72,4% dos doentes do grupo B, e de 17,4% do grupo A, observando-se significância estatística (p=0,0001). O grupo de doentes submetidos à marsupialização não apresentou sangramento, enquanto no grupo da incisão e curetagem 20,7% dos enfermos tiveram sangramento (p=0,2829). A incidência de infecção pós-operatória não diferiu em ambos grupos (4,4% e 3,5%, respectivamente). O grupo B apresentou maiores índices de recidivas (17,6%) em relação ao grupo A (4,3%) com diferença estatisticamente significante (p=0,3364). CONCLUSÕES: Os procedimentos cirúrgicos empregados são de fácil execução, com períodos per-operatórios aceitáveis. A cicatrização parece ser mais eficiente nos doentes operados pela técnica de marsupialização. A técnica de incisão e curetagem apresentou maior número de complicações: dor e sangramento com maior freqüência que na técnica de marsupialização. A técnica de incisão e curetagem apresentou maior recidiva que a técnica de marsupialização.

Sacral adipofascial turn-over flap for the excisional defect of pilonidal sinus

The aim of pilonidal sinus surgery includes complete resection of the lesion and filling of the resultant soft-tissue defect by some means; this has a major influence on whether a lesion will occur after surgical treatment. The creation of a sacral adipofascial turn-over flap for the excisional defect has been performed in seven cases of pilonidal sinus since November of 1992. During the postoperative follow-up period, which ranged from 10 months to 7 years 11 months (mean duration, 5 years 2 months), partial dehiscence of the wound as a result of fatlysis was observed and treated conservatively in one case; however, primary healing was obtained in the other cases. No recurrence was seen in any of the seven cases. This procedure is not indicated in patients in whom wide skin resection is required because of the excessive tension associated with skin closure in such cases. However, the method is convenient, less invasive, and reliable, and therefore considered to be useful in the treatment of pilonidal sinus.

Pilonidal sinus: experience with the Limberg flap

A personal series of 162 patients with chronic pilonidal disease was treated by rhombic excision and Limberg transposition flap. Each sinus was totally excised and covered primarily by a fasciocutaneous Limberg flap. Full primary healing was obtained in 161 out of 162 patients. One patient had ischaemia which resulted in necrosis of the flap tips that healed later with a scar. Minor infection occurred in 12 patients (7%). The average hospital stay was 4.2 days, and no patient remained in hospital more than 12 days. The mean follow-up period was 18 months, and three recurrences (2%) have occurred. Surgery for pilonidal sinus should not only eradicate the presenting sinus formation but should also aim to eliminate factors that predispose to formation of another sinus. This can be achieved using a Limberg flap which reduces the depth of the cleft and ensures that all parts of the wound and all suture holes are away from the midline.

Easy and successful treatment of pilonidal sinus after explanation of its causative process

Hair insertion causes pilonidal sinus, it prevents spontaneous recovery, delays healing of any wound in the depth of the natal cleft, and is the cause of recurrence. An understanding of the hair insertion process made it possible to avoid hair insertion in 6545 cases of the condition with the use of the advancing flap operation. Results have proved this to be an easy and successful way of treating and preventing recurrence of pilonidal sinus. Furthermore, that understanding has introduced the possibility of preventing pilonidal sinus, through ways simpler than the simplest operation.

Pilonidal disease: 25 cases treated by the Dufourmentel technique

Twenty-five patients with pilonidal disease were treated by the Dufourmentel technique between 1984 and 1989. In this series, 18 patients (72 percent) were women and 7 (28 percent) were men (mean age, 24 years); hospital stay averaged 4 days. There were no recurrences and no reports of surgical wound infection. Diagnosis was confirmed histologically in all cases.

Treatment of pilonidal sinus by excision and rhomboid flap

A series of 23 patients with chronic pilonidal disease have been treated by excision and transposition rhomboid flap. Full primary healing was obtained in all patients, with only two cases of wound seroma. The average hospital stay was 9 days. The mean follow-up period was 12 months, and no late recurrences have occurred.

The rationale of using the rhomboid fasciocutaneous transposition flap for the radical cure of pilonidal sinus

A simple, safe technique for complete excision of pilonidal pathology and immediate fasciocutaneous rhomboid flap closure is presented. Twenty-five patients were treated. All wounds healed by first intention, with no patient remaining in the hospital for more than 10 days. Earlier cases were followed up for 2 years. No recurrence has yet been encountered.

Gluteus maximus myocutaneous flap for the treatment of recalcitrant pilonidal disease

The treatment of a patient for multiple recurrent pilonidal disease failed all forms of conventional therapy. After re-excision, a gluteus maximus myocutaneous flap, measuring 15 X 15 cm and based on the superior gluteal artery, was swung to cover the defect. Complete relief from severe pain was obtained immediately. No recurrence is noted after two and one-half years of follow-up.

Radical cure of pilonidal sinus by a transposition rhomboid flap

A new operation for pilonidal sinus is described. This utilizes a rhomboid transposition flap to cover the defect left after radical excision. The results show healing by first intention in 29 out of 30 patients. No patient remained in hospital for more than ten days. Minor infection took place in five cases and major infection in one case. Patients have been followed for up to three years. No recurrence has yet been encountered. The reasons for the success of this operation are discussed.