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Less invasive treatment for the pilonidal sinus combined use of negative-pressure wound therapy. EUROPEAN JOURNAL OF PLASTIC SURGERY 2020. [DOI: 10.1007/s00238-019-01560-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Caliskan M, Kosmaz K, Subasi IE, Acar A, Evren I, Bas G, Atayoglu AT. Comparison of Common Surgical Procedures in Non-complicated Pilonidal Sinus Disease, a 7-Year Follow-Up Trial. World J Surg 2019; 44:1091-1098. [DOI: 10.1007/s00268-019-05331-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Impact of geography and surgical approach on recurrence in global pilonidal sinus disease. Sci Rep 2019; 9:15111. [PMID: 31641150 PMCID: PMC6805955 DOI: 10.1038/s41598-019-51159-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 09/20/2019] [Indexed: 12/18/2022] Open
Abstract
Pilonidal sinus disease (PSD) is increasing globally. A recent meta-analysis and merged-data analysis showed that recurrence rates in PSD depend essentially on follow-up time and specific surgical procedures. However, the global distribution of surgical approaches and respective recurrence rates have never been studied in PSD. We aimed at studying the impact of geographic distribution of surgical approaches to treat PSD and subsequent geography-specific recurrence rates. We searched relevant databases as described previously. Recurrence rates were then associated with reported follow-up times and geographic origin. We simulated individual patients to enable analogy across data. Globally, recurrence rates range from 0.3% for Limberg/Dufourmentel approaches (95% CI 0.2–0.4) and flaps (95% CI 0.1–0.5) and up to 6.3% for incision (95% CI 3.2–9.3) at 12 months. Recurrence rates range from 0.3% for Karydakis/Bascom approaches (95% CI 0.0–0.8) up to 67.2% for incision (95% CI 7.5–100) in the USA, and 0.0% for primary asymmetric closure in Germany (95% CI 0.0–0.0). Our analysis shows that recurrence rates in PSD not only depend on therapeutic approaches and follow-up time but also on geography. Primary asymmetric closure and various flap techniques remain superior regardless of the geographical region. Some approaches have extraordinarily good outcomes in specific countries.
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Berthier C, Bérard E, Meresse T, Grolleau JL, Herlin C, Chaput B. A comparison of flap reconstruction vs the laying open technique or excision and direct suture for pilonidal sinus disease: A meta-analysis of randomised studies. Int Wound J 2019; 16:1119-1135. [PMID: 31230414 DOI: 10.1111/iwj.13163] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/22/2019] [Accepted: 05/28/2019] [Indexed: 12/14/2022] Open
Abstract
Many treatments have been described for pilonidal disease, but recurrence cannot be completely eliminated. The aim of this study was to perform a meta-analysis of randomised, controlled trials comparing flap repair vs the laying open technique and/or excision and direct closure techniques in the treatment of chronic pilonidal sinus disease. The primary outcome measure was the recurrence rate. Secondary outcomes were complete wound-healing time, duration of the incapacity to work, quality of life and patient satisfaction, postoperative pain, wound infection, bleeding or haematoma, skin wound complications, and duration of hospital stay. Seventeen studies were included. The meta-analysis demonstrated a lower risk of recurrence, a shorter duration of incapacity to work, a lower risk of wound infections, a lower risk of skin wound complications, and a shorter duration of hospitalisation in favour of flap vs direct closure. A shorter time to complete wound healing and a shorter duration of incapacity to work for flap vs the laying open technique were observed. Superiority of flap repair vs direct closure in pilonidal sinus treatment was demonstrated in this meta-analysis. These results suggest avoiding primary direct closure in clinical practice. Compared with the laying open technique, flaps result in faster healing and a shorter time to return to activities.
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Affiliation(s)
- Charline Berthier
- Department of Plastic Reconstructive Surgery and Burns, Rangueil University Hospital, Toulouse, France
| | - Emilie Bérard
- Department of Epidemiology, Health Economics and Public Health, University Hospital of Toulouse, Toulouse, France
| | - Thomas Meresse
- Department of Plastic Reconstructive Surgery and Burns, Rangueil University Hospital, Toulouse, France
| | - Jean-Louis Grolleau
- Department of Plastic Reconstructive Surgery and Burns, Rangueil University Hospital, Toulouse, France
| | - Christian Herlin
- Department of Plastic Reconstructive Surgery and Burns, Lapeyronie University Hospital, Montpellier, France
| | - Benoit Chaput
- Department of Plastic Reconstructive Surgery and Burns, Rangueil University Hospital, Toulouse, France
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Arpaci E, Altun S, Orhan E, Eyuboglu A, Ertas NM. A New Oval Advancement Flap Design for Reconstruction of Pilonidal Sinus Defect. World J Surg 2018; 42:3568-3574. [PMID: 29713735 DOI: 10.1007/s00268-018-4648-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUNDS Pilonidal sinus is a common chronic disease of the sacrococcygeal region. Although many surgical methods have been described for treating pilonidal sinus disease, controversy still exists as to the best surgical technique. The aim of this study is to present a new modified advancement flap technique named "omega flap" for the treatment of pilonidal sinus disease. MATERIALS AND METHODS This study included 18 patients with pilonidal sinus who were treated between March 2012 and August 2014. All cases underwent oval excision and omega advancement flap reconstruction. Defect size, postoperative complications, postoperative pain, painless sitting time, patient satisfaction and recurrence were evaluated retrospectively. RESULTS All patients were discharged on the first postoperative day. There was no flap necrosis. No recurrence and no major complication were observed during follow-up period. The outcomes were also satisfactory regarding functionally and aesthetically, and the patients were satisfied with the results. CONCLUSIONS Presented method has a different geometry than classical advancement flap methods. Our technique provides two-layered repair with minimal tension and off-midline closure for the reconstruction of pilonidal sinus defect. It is easily performed, reliable, associated with no recurrens and good aesthetic results.
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Affiliation(s)
- Enver Arpaci
- Department of Plastic and Reconstructive Surgery, School of Medicine, Baskent University, Hocacihan Mah. Sofa Sk. 50/18, Selçuklu-Konya, Turkey.
| | - Serdar Altun
- Department of Plastic and Reconstructive Surgery, School of Medicine, Firat University, Elazig, Turkey
| | - Erkan Orhan
- Department of Plastic and Reconstructive Surgery, Namık Kemal School of Medicine, Tekirdag, Turkey
| | - Atilla Eyuboglu
- Department of Plastic and Reconstructive Surgery, School of Medicine, Baskent University, Ankara, Turkey
| | - Nilgun Markal Ertas
- Department of Plastic and Reconstructive Surgery, School of Medicine, Baskent University, Ankara, Turkey
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Stauffer VK, Luedi MM, Kauf P, Schmid M, Diekmann M, Wieferich K, Schnüriger B, Doll D. Common surgical procedures in pilonidal sinus disease: A meta-analysis, merged data analysis, and comprehensive study on recurrence. Sci Rep 2018; 8:3058. [PMID: 29449548 PMCID: PMC5814421 DOI: 10.1038/s41598-018-20143-4] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 01/15/2018] [Indexed: 12/24/2022] Open
Abstract
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.
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Affiliation(s)
- V K Stauffer
- Lindenhofspital, Lindenhofgruppe, 3010, Bern, (VS), Switzerland
| | - M M Luedi
- Department of Anaesthesiology, Bern University Hospital Inselspital, University of Bern, 3010, Bern, (MML), Switzerland
| | - P Kauf
- Biomedical Statistics PROGNOSIX AG, 8001, Zurich, (PK, MS), Switzerland
| | - M Schmid
- Biomedical Statistics PROGNOSIX AG, 8001, Zurich, (PK, MS), Switzerland
| | - M Diekmann
- Department of Procto-Surgery, St. Marien-Krankenhaus Vechta, Teaching Hospital of the Hannover University, 49377, Vechta, (KW, DD), Germany
| | - K Wieferich
- Department of Procto-Surgery, St. Marien-Krankenhaus Vechta, Teaching Hospital of the Hannover University, 49377, Vechta, (KW, DD), Germany
| | - B Schnüriger
- Department of Visceral Surgery and Medicine, Bern University Hospital Inselspital, University of Bern, 3010, Bern, (BS), Switzerland
| | - D Doll
- Department of Procto-Surgery, St. Marien-Krankenhaus Vechta, Teaching Hospital of the Hannover University, 49377, Vechta, (KW, DD), Germany.
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Comparison of modified Limberg flap transposition and lateral advancement flap transposition with Burow’s triangle in the treatment of pilonidal sinus disease. Am J Surg 2015; 210:772-7. [DOI: 10.1016/j.amjsurg.2015.03.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 03/20/2015] [Accepted: 03/30/2015] [Indexed: 11/19/2022]
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Perforator flaps after excision of large epidermal cysts in the buttocks. Arch Plast Surg 2014; 41:140-7. [PMID: 24665422 PMCID: PMC3961611 DOI: 10.5999/aps.2014.41.2.140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 07/22/2013] [Accepted: 08/05/2013] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Epidermal cysts are commonly occurring masses usually less than 5 cm in diameter, but in predisposed patients, epidermal cysts can grow relatively large due to chronic infection. METHODS From June 2002 to July 2010, 17 patients received 19 regional perforator-based island flaps to cover defects due to the excision of large epidermal cysts (diameter >5 cm) in the buttocks. Eight patients had diabetes, and seven had rheumatoid arthritis. The pedicles were not fully isolated to prevent spasms or twisting. RESULTS All the flaps survived completely, except for one case with partial necrosis of the flap, which necessitated another perforator-based island flap for coverage. There were two cases of wound dehiscence, which were re-closed after meticulous debridement. There were no recurrences of the masses during follow-up periods of 8.1 months (range, 6-12 months). CONCLUSIONS In patients with large epidermal cysts and underlying medical disorders, regional perforator-based island flaps can be the solution to coverage of the defects after excision.
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Yazar M, Kurt Yazar S, Celet Ozden B, Guven E, Basaran K, Alyanak A, Aydin A. Cosmetic closure of pilonidal sinus defects with bilateral transpositional adipofascial flaps. J Plast Surg Hand Surg 2013; 47:292-6. [DOI: 10.3109/2000656x.2013.765884] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Aesthetic sculpting for the natal cleft and buttock lift using an innovative periosteal-dermal suture suspension technique. J Craniofac Surg 2012; 23:172-4. [PMID: 22337400 DOI: 10.1097/scs.0b013e3182418c6c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Natal cleft contouring poses a reconstructive challenge. Buttock aesthetics and the need for careful scar placement are part of the challenge faced by plastic surgeons. Various steps of the reconstructive ladder can be used with varying outcomes. We report a patient who underwent natal cleft reconstruction using a new suture technique and had a cosmetically pleasing outcome.
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El-Shaer WM. The modified gluteal sliding plication closure in the treatment of chronic pilonidal sinus. Int J Colorectal Dis 2010; 25:887-94. [PMID: 20221765 DOI: 10.1007/s00384-010-0911-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2010] [Indexed: 02/04/2023]
Abstract
BACKGROUND The surgical approach to pilonidal sinus disease is open to debate with no ideal treatment. The aim of this work is to present the efficacy of the modified gluteal sliding plication closure technique in treatment of pilonidal sinus disease as regards the complication and recurrence rates, while maintaining a more cosmetically acceptable midline scar. PATIENTS AND METHODS All patients between the year 2000 and 2008 with symptomatic pilonidal disease were treated by the modified gluteal sliding plication closure method, except for recurrent cases after previous flap surgery. Outcome measures included wound complications, recurrence rate, follow-up period, and functional recovery. Patient esthetic satisfaction rates as regards the scar and shape of the buttocks were included on a scale of good, fair, or bad. RESULTS Fifty-six patients, 41 male and 15 females, with 23 years median age (range, 17-45 years) were treated. After a median follow-up period of 12 months (range, 6-84 months), the incidence of recurrence was 1.8%, infection rate of 10.7%, paresthesia and seroma accumulation in 3.6% of cases. The median functional recovery achieved was 12 days (range, 10-45 days), while the esthetic satisfaction rates were good in 78.57%, fair in 17.86% and bad in 3.5% of cases. CONCLUSION This study presents a successful modified technique of primary closure which allows an extensive en bloc removal of diseased tissues and permits a safe and complete primary closure without undue tension and with respect of cosmetic principles.
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Affiliation(s)
- Wael M El-Shaer
- Department of General Surgery, Faculty of Medicine, Bani-Suef University, Giza, Egypt.
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Acartürk TO, Parsak CK, Sakman G, Demircan O. Superior gluteal artery perforator flap in the reconstruction of pilonidal sinus. J Plast Reconstr Aesthet Surg 2010; 63:133-9. [DOI: 10.1016/j.bjps.2008.07.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2008] [Revised: 06/22/2008] [Accepted: 07/29/2008] [Indexed: 11/28/2022]
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El-Khatib HA, Al-Basti HB. A perforator-based bilobed fasciocutaneous flap: an additional tool for primary reconstruction following wide excision of sacrococcygeal pilonidal disease. J Plast Reconstr Aesthet Surg 2009; 62:494-8. [DOI: 10.1016/j.bjps.2007.11.043] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2006] [Revised: 06/24/2007] [Accepted: 11/26/2007] [Indexed: 11/16/2022]
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Mahdy T. Surgical treatment of the pilonidal disease: primary closure or flap reconstruction after excision. Dis Colon Rectum 2008; 51:1816-22. [PMID: 18937009 DOI: 10.1007/s10350-008-9436-8] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Accepted: 06/30/2008] [Indexed: 02/08/2023]
Abstract
PURPOSE Controversy still exists regarding the best surgical technique for the treatment of pilonidal disease in terms of minimizing disease recurrence and patient discomfort. The present study analyzes the results of excision with primary closure and excision with flap reconstruction in the surgical treatment of sacrococcygeal pilonidal disease. METHODS From January 2003 to January 2006, 60 consecutive patients with primary pilonidal sinus disease received surgical treatment in the form of either excision and primary closure (group I, n = 20 patients) or excision and flap reconstruction (group II, n = 40 patients; modified Limberg flap n = 20, classic Limberg flap n = 10 and adipo-fasciocutaneous flap n = 10). Times for complete healing and return to work were recorded. To evaluate patient comfort, all patients were asked to complete a questionnaire including visual analog scale, time to sitting on toilet without pain, and time to walking without pain 3 months after surgery. RESULTS Mean follow-up was 21 months. A significant difference was observed between the two groups in terms of length of hospital stay (P < 0.003), time to complete healing (P < 0.001), time off work (P < 0.001), wound infection (P < 0.01), recurrence rates (P < 0.01), times to sitting on toilet without pain (P < 0.002), and walking without pain (P < 0.001). The mean (standard deviation) postoperative visual analog scale scores were 6.1 (1.2) in the primary closure group vs. 7.4 (1.3) in the flaps groups (P < 0.001). In the modified Limberg flap, no wound infection, wound breakdown, or recurrence of the disease occurred. CONCLUSIONS Flap reconstructions were superior to primary closure after excision of pilonidal sinus and that modified Limberg flap was superior with regard to wound infection and recurrence.
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Affiliation(s)
- T Mahdy
- Department of Surgery, Mansoura University Hospital, Mansoura, Egypt.
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Marzouk DM, Abou-Zeid AA, Antoniou A, Haji A, Benziger H. Sinus excision, release of coccycutaneous attachments and dermal-subcuticular closure (XRD procedure): a novel technique in flattening the natal cleft in pilonidal sinus treatment. Ann R Coll Surg Engl 2008; 90:371-6. [PMID: 18634729 DOI: 10.1308/003588408x285955] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The objective of this study was to analyse, prospectively, the outcome of a new technique - excision of pilonidal sinus and flattening the natal cleft by division of the coccycutaneous attachments at the lower end of the incision. PATIENTS AND METHODS Sixty-six consecutive patients with chronic pilonidal sinuses were treated between 1995 and 2001. The procedure consisted of an elliptical, wide, local excision, release of the coccycutaneous attachments and primary closure using dermal-subcuticular closure (XRD). Suction drains were used until drainage was minimal. The height of skin level at the lower angle of the wound from the coccyx was measured intra-operatively before and after division of the coccycutaneous attachments. Postoperatively, patients were assessed for hospital stay, return to normal activity, complications and recurrence. RESULTS Sixty-four patients (97%) were males, median age 27 years. The height of skin level rose from a mean of 1.8 cm (95% CI, 1.78-1.85) to a mean of 3.8 cm (95% CI, 3.77-3.88; P < 0.001). Morbidity affected 12 patients (18%), epidermal separation of the lower wound angles (6 patients), seromas (5 patients) and 1 wound dehiscence at 2 weeks. All other wounds healed primarily without dehiscence. There were no recurrences after a median follow-up of 22.5 months (range, 12-38 months). CONCLUSIONS Release of the coccycutaneous attachments is an easy technique to learn, which seems to be an effective way of flattening the natal cleft and may result in lower recurrence rate. This technique should be tried in uncomplicated pilonidal sinus disease before more complex procedures are attempted.
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Affiliation(s)
- Deya M Marzouk
- Department of Colorectal Surgery, Queen Elizabeth the Queen Mother Hospital, Margate, Kent, UK.
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Abstract
BACKGROUND "Adipofascial turnover flap" is a well-known procedure, but it is generally not used for the surgical treatment of pilonidal sinus disease. The "lumbar adipofascial turnover flap" has been used in this study for the reconstruction of uncomplicated pilonidal sinus disease. METHODS Ten cases (8 male and 2 female patients) were operated on by this technique. The reconstruction was performed with the lumbar adipofascial turnover flap. The flap sizes ranged from 4 x 7 cm to 5 x 9 cm (mean, 4.5 x 8 cm), and they were elevated with length-to-base ratio below 2:1. The follow-up period was 14 to 26 months. RESULTS Postoperative magnetic resonance imaging, computed tomography scan, and power Doppler ultrasound examinations revealed viability of the flaps in all patients. There was no distortion of anatomic landmarks in any of the cases. The esthetic results were satisfying for all patients as well. There was no recurrence in any cases. CONCLUSIONS The hospital stay and mean time off work were shorter compared with other methods of reconstruction and there was no recurrence. We advocate that the lumbar adipofascial turnover flap is an excellent choice for reconstruction of cases with uncomplicated pilonidal sinus disease.
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Affiliation(s)
- Aydin Turan
- Plastic and Reconstructive Surgery Clinic, SSK Vakif Gureba Hospital, Istanbul, Turkey.
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Affiliation(s)
- Marisa A Braun
- Department of Dermatology, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
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Sungur N, Koçer U, Uysal A, Arslan C, Cöloglu H, Ulusoy G. V-Y Rotation Advancement Fasciocutaneous Flap for Excisional Defects of Pilonidal Sinus. Plast Reconstr Surg 2006; 117:2448-54. [PMID: 16772955 DOI: 10.1097/01.prs.0000219170.74059.94] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pilonidal sinus is a common disease that mostly affects young people. Despite numerous treatment modalities, the best technique has not yet been determined and there are many recurrences, causing economic losses and serious discomfort for the patients. METHODS The authors used V-Y rotation flaps for coverage of the defects after excision and debridement of chronic pilonidal sinuses in eight patients. The results were evaluated and compared with previously reported studies regarding the grade of disease at presentation, duration of surgery, blood loss, hospitalization period and active mobilization periods, complications, and loss of sensitivity. RESULTS No major complications occurred; hospitalization and immobilization periods were acceptably convenient. Recurrence was not seen, and sensitivity of the gluteal region did not diminish. The outcome was also satisfactory regarding aesthetics, and all the patients were satisfied with the result. CONCLUSION The authors believe that the V-Y rotation advancement flap is a good alternative method for the treatment of pilonidal sinus.
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Affiliation(s)
- Nezih Sungur
- First Plastic and Reconstructive Surgery Department, Ankara Training and Research Hospital, Ulucanlar, Turkey
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20
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Singh R, Pavithran NM. Adipo-fascio-cutaneous Flaps in the Treatment of Pilonidal Sinus: Experience with 50 Cases. Asian J Surg 2005; 28:198-201. [PMID: 16024316 DOI: 10.1016/s1015-9584(09)60343-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To retrospectively analyse the results of pilonidal sinus managed using wide excision with primary eccentric closure with various adipo-fascio-cutaneous flaps. METHODS Data from 50 consecutive patients who had elective surgery for chronic pilonidal sinus with wide excision of all the sinuses and primary eccentric closure with various adipo-fascio-cutaneous flaps (40 lateral advancements, 4 Z-plasties, four rotations, 1 rhomboid and 1 V-Y advancement) were retrospectively analysed. Special emphasis was placed on partial obliteration of the natal cleft, duration of wound healing, postoperative morbidity and hospital stay, loss of work days, cosmetic outcome and recurrence. RESULTS In all patients, partial obliteration of the natal cleft was achieved by eccentric primary wound closure, with good cosmesis. Superficial necrosis of the flaps occurred in five patients (3 Z-plasties, 2 rotation flaps). None had collection, haematoma, infection or recurrence. CONCLUSION Complete eccentric excision and partial obliteration of the natal cleft using various adipo-fascio-cutaneous flaps ensured reliable wound healing with fewer dressings and morbidity, shortened hospital stay and early resumption of work, good cosmesis and prevention of early and late recurrence. The lateral advancement flap is a viable option in the treatment of chronic pilonidal sinus.
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Affiliation(s)
- Raghubir Singh
- Department of General Surgery, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India.
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Ichioka S, Okabe K, Tsuji S, Ohura N, Nakatsuka T. Triple Coverage of Ischial Ulcers with Adipofascial Turnover and Fasciocutaneous Flaps. Plast Reconstr Surg 2004; 114:901-5. [PMID: 15468396 DOI: 10.1097/01.prs.0000133178.86659.8e] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Despite a wide variety of flap options, ischial ulcers remain the most difficult pressure ulcers to treat. This article describes the authors' successful surgical procedure for coverage of ischial ulcers using adipofascial turnover flaps combined with a local fasciocutaneous flap. After debridement, the adipofascial flaps are harvested both cephalad and caudal to the defect. The flaps are then turned over to cover the exposed bone in a manner so as to overlap the two flaps. A local fasciocutaneous flap (Limberg flap) is applied to the raw surface of the turnover flaps. Twenty-two patients with ischial ulcers were treated using this surgical procedure. Overall, 86.4 percent of the flaps (19 of 22) healed primarily. Triple coverage with the combination of double adipofascial turnover flaps and a local fasciocutaneous flap allows for an easily performed and minimally invasive procedure, preservation of future flap options, and a soft-tissue supply sufficient for covering the prominence and bony prominence and filling dead space. This technique provides successful soft-tissue reconstruction for minor to moderate-size ischial pressure ulcers.
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Affiliation(s)
- Shigeru Ichioka
- Department of Plastic and Reconstructive Surgery, Saitama Medical School, Japan.
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Garrido A, Ali R, Ramakrishnan V, Spyrou G, Stanley PRW. Reconstruction of the natal cleft with a perforator-based flap. BRITISH JOURNAL OF PLASTIC SURGERY 2002; 55:671-4. [PMID: 12550122 DOI: 10.1054/bjps.2002.3943] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Recurrent chronic conditions of the natal cleft, such as pilonidal sinuses, are difficult problems to treat. The deep natal cleft and the rolling effect of one buttock surface over the other contribute to the high recurrence rate. Wide excision of the affected area is the treatment of choice; to cover the defect many techniques have been described that flatten the natal cleft and shift the suture line away from the midline to try to reduce recurrence. These techniques include Z-plasties, rhomboid flaps, V-Y flaps, gluteus maximus myocutaneous flaps and others. Five patients with recurrent natal-cleft problems were operated on over a 1 year period. After wide excision of the natal cleft, the defect was reconstructed with a parasacral perforator-based flap. Preoperatively, a perforator situated superolaterally to the defect is identified with a Doppler probe; the flap is then designed horizontally around the perforator and, after elevation, is rotated 908 over the defect. The mean hospital stay was 5 days. Follow-up ranged from 3 months to 15 months, with no signs of recurrence. We believe this to be a simple and reliable technique, with the advantages of placing the scars away from the midline and flattening the natal cleft - factors that help to prevent recurrence.
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Affiliation(s)
- A Garrido
- Department of Plastic and Reconstructive Surgery, Castle Hill Hospital, Cottingham, UK
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