Non-operative management of pilonidal sinus disease; classification and outcome

Pilonidal Sinus in the Cheek: A Report of a Rare Case

Pilonidal sinus (PNS) is a common inflammatory condition that predominantly affects males. It typically occurs beneath the skin of the sacrococcygeal region. We present a rare case of a 40-year-old patient with a painless, suppurating swelling on the cheek for two days, accompanied by itching. Under local anesthesia, incision and drainage were performed, as the patient declined excision. Medical advice was provided, and the patient was encouraged to follow up. The cheek is an extremely rare location for a PNS. Diagnosis can be challenging due to its unusual presentation. However, special care should be taken during surgical excision, as preserving the cosmetic appearance is a priority.

Evaluation of Outcomes for Karydakis Operation for Pilonidal Sinus Disease-Comparison of Original Reports With Later Results

BACKGROUND

Karydakis published his advancement flap technique to treat pilonidal sinus disease (PSD) in 1973 (GEK73) and reported a very low recurrence rate in 1992 (GEK92) in a large series of cases. Since then, the procedure has been widely adapted without replicating his results.

AIM

To compare the outcomes of the Karydakis 1992 report to the global literature and evaluate reasons for the major discrepancy in recurrence rates.

METHODS

From an international database including all PSD studies, we identified 113 other studies encompassing 9878 patients undergoing the Karydakis advancement flap surgery. Recurrence rates at 5- and 10-year follow-ups were compared to the data presented in the Karydakis 1992 paper.

RESULTS

The Karydakis 1992 study reports a recurrence rate < 1% with a follow-up ranging between 2 and 20 years. In the global literature, the 10-year recurrence rate is 8.8% in RCTs and 14.6% in nonRCTs which is 11.6- and 19.2-fold higher.

CONCLUSION

The standard for recurrence rates after the Karydakis advancement flap set by Karydakis has not since been replicated in the global literature. For surgeons and patients alike it is important to have realistic expectations of short- and long-term outcomes.