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Roberson JL, Farzaneh C, Neylan CJ, Judy R, Walker V, Damrauer SM, Levin MG, Maguire LH. Genome-Wide Association Study Identifies Genes for Hair Growth and Patterning are Associated With Pilonidal Disease. Dis Colon Rectum 2024; 67:1149-1157. [PMID: 38902823 DOI: 10.1097/dcr.0000000000003308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
BACKGROUND Pilonidal sinus disease is a highly morbid condition characterized by the formation of chronic sinus tracts throughout the sacrococcygeal region. Despite its commonality and strong association with family history, no prior investigation of genetic risk factors for pilonidal sinus disease exists. OBJECTIVE To identify genetic risk factors for pilonidal sinus disease. DESIGN A genome-wide association study. SETTINGS The United Kingdom Biobank, FinnGen Biobank, and Penn Medicine BioBank. PATIENTS There were 772,072 participants. MAIN OUTCOME MEASURE Genome-wide significant variants ( p < 5 × 10 -8 ) were mapped to genes using physical distance and gene expression in skin. Genetic correlation between pilonidal sinus disease and morphometric, androgen-driven, and hair phenotypes was estimated with linkage disequilibrium score regression. Finally, a genome-first approach to rare predicted deleterious variants in hair shaft genes TCHH , PADI3 , and TGM3 was conducted for association with pilonidal sinus disease via the Penn Medicine BioBank. RESULTS A genome-wide association study comprising 2835 individuals with pilonidal sinus disease identified 5 genome-wide significant loci, prioritizing HDAC9, TBX15, WARS2, RP11-293M10.1 , PRKAR1B , TWIST1, GPATCH2L, NEK9 , and EIF2B2 , as putative causal genes; several of these genes have known roles in balding and hair patterning. There was a significant correlation between the genetic background of pilonidal sinus disease and the androgen-driven hair traits of male pattern baldness and young age at first facial hair. In a candidate analysis of genes associated with syndromic hair disorders, rare coding variants in TCHH , a monogenic cause of uncombable hair syndrome, were associated with increased prevalence of pilonidal sinus disease (OR 4.81 [95% CI, 2.06-11.2]). LIMITATIONS This study is limited to European ancestry. However, because there is a higher incidence of pilonidal sinus disease in men of European ancestry, this analysis is focused on the at-risk population. CONCLUSIONS Genetic analysis of pilonidal sinus disease identified shared genetic architecture with hair biology and androgen-driven traits. As the first study investigating the genetic basis of pilonidal sinus disease, this provides biological insight into the long-appreciated connection between the disease state, male sex, and hair. See Video abstract. UN ESTUDIO DE ASOCIACIN DEL GENOMA COMPLETO IDENTIFICA GENES DEL CRECIMIENTO Y EL PATRN DEL PELO ASOCIADOS A LA ENFERMEDAD PILONIDAL ANTECEDENTES:La enfermedad del seno pilonidal es una condición muy mórbida caracterizada por la formación de tractos sinusales crónicos en toda la región sacrococcígea. A pesar de su frecuencia y su fuerte asociación con los antecedentes familiares, no se han investigado previamente los factores de riesgo genéticos de la enfermedad sinusal pilonidal.OBJETIVO:Identificar factores genéticos de riesgo para la enfermedad del seno pilonidal.DISEÑO:Estudio de asociación de genoma completo.CONJUNTOS:Biobanco del Reino Unido, Biobanco FinnGen y Biobanco PennMedicine.PACIENTES:772.072 participantes.MEDIDA DE RESULTADO PRINCIPAL:Las variantes significativas en todo el genoma (p < 5x10-8) se asignaron a genes utilizando la distancia física y la expresión génica en la piel. La correlación genética entre la enfermedad del seno pilonidal y los fenotipos morfométricos, androgénicos y de cabello se estimó con regresión de puntuación LD. Por último, se realizó una aproximación genómica a variantes deletéreas raras predichas en los genes del tallo piloso TCHH, PADI3 y TGM3 para su asociación con la enfermedad del seno pilonidal a través del Biobanco PennMedicine.RESULTADOS:El estudio de asociación de todo el genoma, que incluyó a 2.835 individuos con enfermedad del seno pilonidal, identificó 5 loci significativos en todo el genoma, dando prioridad a HDAC9, TBX15, WARS2, RP11-293M10.1, PRKAR1B, TWIST1, GPATCH2L, NEK9 y EIF2B2, como genes causales putativos; varios de estos genes tienen funciones conocidas en la calvicie y el patrón del cabello. Se observó una correlación significativa entre los antecedentes genéticos de la enfermedad del seno pilonidal y los de los rasgos calvicie de patrón masculino y edad temprana del primer vello facial impulsados por andrógenos. En un análisis de genes candidatos asociados a trastornos capilares sindrómicos, las variantes raras de codificación en TCHH, una causa monogénica del síndrome capilar incombustible, se asociaron a una mayor prevalencia de la enfermedad del seno pilonidal (OR 4,81 [IC del 5%, 2,06-11,2]).LIMITACIONES:Este estudio se limita a la ascendencia europea. Sin embargo, debido a que hay una mayor incidencia de la enfermedad sinusal pilonidal en los hombres de ascendencia europea, este análisis se centra en la población de riesgo.CONCLUSIÓN:El análisis genético de la enfermedad del seno pilonidal identificó una arquitectura genética compartida con la biología del cabello y los rasgos impulsados por andrógenos. Siendo el primer estudio que investiga las bases genéticas de la enfermedad del seno pilonidal, esto proporciona una visión biológica de la conexión, apreciada desde hace tiempo, entre el estado de la enfermedad, el sexo masculino y el cabello. (Traducción-Dr. Aurian Garcia Gonzalez ).
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Affiliation(s)
- Jeffrey L Roberson
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Cyrus Farzaneh
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Division of Colon and Rectal Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christopher J Neylan
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Renae Judy
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Venexia Walker
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
| | - Scott M Damrauer
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Department of Surgery, Corporal Michael J. Crescenz Memorial Veterans Affairs Medical Center, Philadelphia, Pennsylvania
- Department of Genetics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Michael G Levin
- Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Lillias H Maguire
- Division of Colon and Rectal Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Surgery, Corporal Michael J. Crescenz Memorial Veterans Affairs Medical Center, Philadelphia, Pennsylvania
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Liang NE, Abrajano C, Dalusag KS, Chiu B. Management and outcomes of pilonidal patients with secondary sinuses-a cohort study. Pediatr Surg Int 2024; 40:227. [PMID: 39145895 DOI: 10.1007/s00383-024-05821-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/10/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND Patients with pilonidal disease (PD) can present with concurrent draining secondary sinus at the superior gluteal cleft. The natural disease course in the setting of this severe phenotype is poorly characterized. We present the largest cohort of patients with PD and concurrent secondary sinus. METHODS Patients with PD and concurrent secondary sinus who underwent Gips procedure with secondary sinus excision from 2019 to 2023 were prospectively followed. Patient demographics, drainage recurrence, symptom resolution, treatment, and follow-up period were recorded. Recurrent drainage from previous secondary sinus site was defined as isolated painless serous drainage after the wound had closed for > 3 weeks; recurrent PD was characterized as recurrent pain and bloody drainage after excision. RESULTS One hundred and five patients (seventy-one males) with a median age of 17.2 years [interquartile range (IQR):15.4-19.0] underwent excision of their disease and were followed for a median of 367.0 days (IQR: 173.2-658.8). Without regular epilation, six patients (5.7%, five males, one female) had recurrent PD. With regular epilation, three patients (2.8%, three males) had recurrent PD. Eight patients (7.5%, six males, two females) had recurrent secondary sinus site drainage. Median time to recurrent drainage was 75.5 days (IQR: 65.2-216.2) after excision and for recurrent drainage to resolve was 72 days (IQR: 49-81). Recurrent secondary sinus site drainage was treated with antibiotics, silver nitrate, debridement, or no treatment. CONCLUSION Patients who present with PD in the setting of concurrent secondary sinus have a unique, more severe disease phenotype. Excision can be complicated by recurrent drainage from the secondary sinus site that can resolve without repeat surgical excision.
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Affiliation(s)
- Norah E Liang
- Department of Surgery, Stanford University School of Medicine, 453 Quarry Road, Stanford, CA, 94305, USA
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Claire Abrajano
- Department of Surgery, Stanford University School of Medicine, 453 Quarry Road, Stanford, CA, 94305, USA
| | - Kyla Santos Dalusag
- Department of Surgery, Stanford University School of Medicine, 453 Quarry Road, Stanford, CA, 94305, USA
| | - Bill Chiu
- Department of Surgery, Stanford University School of Medicine, 453 Quarry Road, Stanford, CA, 94305, USA.
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Zouboulis CC, Bechara FG, Fritz K, Goebeler M, Hetzer FH, Just E, Kirsten N, Kokolakis G, Kurzen H, Nikolakis G, Pinter A, Podda M, Rosinski K, Schneider-Burrus S, Taube KM, Volz T, Winkler T, Kristandt A, Presser D, Zouboulis VA. S2k‐Leitlinie zur Therapie der Hidradenitis suppurativa/Acne inversa – Kurzfassung. J Dtsch Dermatol Ges 2024; 22:868-892. [PMID: 38857106 DOI: 10.1111/ddg.15412_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/27/2024] [Indexed: 06/11/2024]
Abstract
ZusammenfassungDie S2k‐Leitlinie der Hidradenitis suppurativa/Acne inversa (HS/AI) soll eine akzeptierte Entscheidungshilfe für die Auswahl/Durchführung einer geeigneten/suffizienten Therapie liefern. Hidradenitis suppurativa/Acne inversa ist eine chronisch‐rezidivierende, entzündliche, potenziell mutilierende Hauterkrankung des terminalen Haartalgdrüsenapparats, mit schmerzhaften, entzündlichen Läsionen in den apokrinen drüsenreichen Körperregionen. Ihre Punktprävalenz in Deutschland ist 0,3%, sie wird mit einer Verspätung von 10,0 ± 9,6 Jahren diagnostiziert. Abnormale Differenzierung der Keratinozyten des Haartalgdrüsenapparats und eine begleitende Entzündung bilden die zentrale pathogenetische Grundlage. Primäre HS/AI‐Läsionen sind entzündliche Knoten, Abszesse und drainierende Tunnel. Rezidive in den letzten 6 Monaten mit mindestens zwei Läsionen an den Prädilektionsstellen verweisen auf eine HS/AI mit einer 97‐prozentigen Genauigkeit. HS/AI‐Patienten leiden an einer deutlichen Einschränkung der Lebensqualität. Zur korrekten Therapieentscheidung sollen Klassifikation und Aktivitätsbewertung mit einem validierten Instrument erfolgen, wie dem International Hidradenitis Suppurativa Severity Scoring System (IHS4). Hidradenitis suppurativa/Acne inversa wird nach der Ausprägung der nachweisbaren Entzündung in zwei Formen eingeteilt: aktive, entzündliche (milde, mittelschwere und schwere nach IHS4) und vorwiegend inaktive, nicht entzündliche (Hurley‐Grad‐I, ‐II und ‐III) HS/AI. Orale Tetrazykline oder eine 5‐tägige intravenöse Therapie mit Clindamycin sind mit der Effektivität von Clindamycin/Rifampicin vergleichbar. Subkutan applizierbares Adalimumab, Secukinumab und Bimekizumab sind für die Therapie der HS/AI zugelassen. Für die vorwiegend nicht entzündliche Erkrankungsform stehen verschiedene operative Verfahren zur Verfügung. Medikamentöse/chirurgische Kombinationen gelten als ganzheitliches Therapieverfahren.
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Affiliation(s)
- Christos C Zouboulis
- Hochschulklinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Dessau, Deutschland
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
| | - Falk G Bechara
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum, Bochum, Deutschland
| | - Klaus Fritz
- Zentrum für Dermatologie, Laser und Ästhetische Medizin, Landau, Deutschland
- Dermatologie II, Colentina Klinik, Carol-Davila-Universität für Medizin und Pharmazie, Bukarest, Rumänien
| | - Matthias Goebeler
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | | | - Elke Just
- Deutsche Akne Inversa Patientenvereinigung in Gründung, Kreis Coesfeld, Deutschland
| | - Natalia Kirsten
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Institut für Versorgungsforschung (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
| | - Georgios Kokolakis
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Klinik für Dermatologie, Venerologie und Allergologie, Charité-Universitätsmedizin Berlin, Berlin, Deutschland
| | - Hjalmar Kurzen
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Haut- und Laserzentrum, Freising, Deutschland
| | - Georgios Nikolakis
- Hochschulklinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Dessau, Deutschland
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
| | - Andreas Pinter
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Frankfurt, Frankfurt am Main, Deutschland
| | - Maurizio Podda
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Hautklinik, Klinikum Darmstadt, Deutschland
| | | | - Sylke Schneider-Burrus
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Zentrum für Dermatochirurgie, Havelklinik Berlin, Berlin, Deutschland
| | - Klaus-M Taube
- Universitätsklinik und Poliklinik für Dermatologie und Venerologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - Thomas Volz
- Klinik für Dermatologie und Allergologie, Technische Universität München, München, Deutschland
| | | | - Anna Kristandt
- Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Deutschland
| | - Dagmar Presser
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Viktor A Zouboulis
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Medizinische Fakultät, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
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Zouboulis CC, Bechara FG, Fritz K, Goebeler M, Hetzer FH, Just E, Kirsten N, Kokolakis G, Kurzen H, Nikolakis G, Pinter A, Podda M, Rosinski K, Schneider-Burrus S, Taube KM, Volz T, Winkler T, Kristandt A, Presser D, Zouboulis VA. S2k guideline for the treatment of hidradenitis suppurativa / acne inversa - Short version. J Dtsch Dermatol Ges 2024; 22:868-889. [PMID: 38770982 DOI: 10.1111/ddg.15412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/27/2024] [Indexed: 05/22/2024]
Abstract
The S2k guideline on hidradenitis suppurativa/acne inversa (HS/AI) aims to provide an accepted decision aid for the selection/implementation of appropriate/sufficient therapy. HS/AI is a chronic recurrent, inflammatory, potentially mutilating skin disease of the terminal hair follicle-glandular apparatus, with painful, inflammatory lesions in the apocrine gland-rich regions of the body. Its point prevalence in Germany is 0.3%, it is diagnosed with a delay of 10.0 ± 9.6 years. Abnormal differentiation of the keratinocytes of the hair follicle-gland apparatus and accompanying inflammation form the central pathogenetic basis. Primary HS/AI lesions are inflammatory nodules, abscesses and draining tunnels. Recurrences in the last 6 months with at least 2 lesions at the predilection sites point to HS/AI with a 97% accuracy. HS/AI patients suffer from a significant reduction in quality of life. For correct treatment decisions, classification and activity assessment should be done with a validated tool, such as the International Hidradenitis Suppurativa Severity Scoring System (IHS4). HS/AI is classified into two forms according to the degree of detectable inflammation: active, inflammatory (mild, moderate, and severe according to IHS4) and predominantly inactive, non-inflammatory (Hurley grade I, II and III) HS/AI. Oral tetracyclines or 5-day intravenous therapy with clindamycin are equal to the effectiveness of clindamycin/rifampicin. Subcutaneously administered adalimumab, secukinumab and bimekizumab are approved for the therapy of HS/AI. Various surgical procedures are available for the predominantly non-inflammatory disease form. Drug/surgical combinations are considered a holistic therapy method.
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Affiliation(s)
- Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - Falk G Bechara
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Klaus Fritz
- Dermatology and Laser Consultation Center, Landau, Germany
- Dermatology II, Colentina Clinical Hospital, Carol-Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Matthias Goebeler
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Venereology and Allergology, Würzburg University Hospital, Würzburg, Germany
| | | | - Elke Just
- German Acne Inversa Patient Association in Formation, Kreis Coesfeld, Germany
| | - Natalia Kirsten
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Georgios Kokolakis
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Hjalmar Kurzen
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Freising Skin and Laser Center, Freising, Germany
| | - Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - Andreas Pinter
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Maurizio Podda
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Medical Center Darmstadt, Darmstadt, Germany
| | | | - Sylke Schneider-Burrus
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Center for Dermatosurgery, Havelklinik Berlin, Berlin, Germany
| | - Klaus-M Taube
- Department of Dermatology and Venereology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Thomas Volz
- Department of Dermatology and Allergology, Technical University of Munich, Munich, Germany
| | | | - Anna Kristandt
- Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Dagmar Presser
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Venereology and Allergology, Würzburg University Hospital, Würzburg, Germany
| | - Viktor A Zouboulis
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Faculty of Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Farhat S, De la Fuente Hagopian A, Andrawes P, Dinh TA. Partial Gluteus Muscle Flap for Treatment of Chronic, Recalcitrant Pilonidal Cyst Disease. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5887. [PMID: 38859808 PMCID: PMC11164014 DOI: 10.1097/gox.0000000000005887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 04/17/2024] [Indexed: 06/12/2024]
Abstract
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.
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Affiliation(s)
- Souha Farhat
- From the Institute for Reconstructive Surgery, Houston Methodist Hospital, Houston, Tex
| | | | - Peter Andrawes
- From the Institute for Reconstructive Surgery, Houston Methodist Hospital, Houston, Tex
| | - Tue A. Dinh
- From the Institute for Reconstructive Surgery, Houston Methodist Hospital, Houston, Tex
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Xu M, Wang Y, Ma X, Liu Y, Xue C, Dai H. Simplified and modified Limberg flap plus vacuum-assisted closure for treatment of sacrococcygeal pilonidal sinus disease. Int Wound J 2024; 21:e14353. [PMID: 37691134 PMCID: PMC10784422 DOI: 10.1111/iwj.14353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 07/31/2023] [Accepted: 08/04/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Pilonidal sinus disease (PSD), a chronic inflammatory disease, affects the sacrococcygeal soft tissue, especially in young adults. The ideal treatment for PSD remains divergence. This study evaluated the application of a simplified modified Limberg flap combined with vacuum-assisted closure for treating PSD. METHODS This prospective study was conducted from 1 June 2017 to 31 March 2022 in Changhai Hospital, Naval Military Medical University, Shanghai, China. The study included 88 male patients (91.7%) and 8 female patients (8.3%). The 96 patients ranged in age from 15 to 34 years (mean ± SD, 23 ± 4.4). Under general anaesthesia, all patients underwent simplified modified Limberg flap reconstruction with vacuum-assisted closure. The patient's weight, surgical time, extubation time, hospital stay, time to return to normal life or work, wound infection, wound dehiscence and recurrence rate were recorded. The visual analogue scale (VAS) score and the Vancouver scar score were used to score patients' pain and scars in the surgical area. RESULTS The volume of resected diseased tissue was 13.5-120 (mean ± SD, 34.993 ± 24.406) cm2 . The average surgical time during the treatment period was 97.68 ± 18.72 min, and the average extubation time was (6.36 ± 1.55) days, the mean hospital stay was 19.4 days; no patients were lost to follow-up. None of the patients experienced post-operative recurrence, wound infection, seroma or hematoma. Six patients (6.3%) experienced wound dehiscence at the flap tip around the natal cleft. The mean time to the resumption of daily activities was 26.3 days. The average VAS pain score was (6.00 ± 1.53) points, and the average Vancouver scar score was (5.96 ± 1.51) points, 12 patients (12.5%) were dissatisfied with their aesthetic results, and the average beauty satisfaction score is (6.64 ± 1.28) points. CONCLUSIONS Simplified modified Limberg flap reconstruction with vacuum-assisted closure surgery is an effective and innovative method for the treatment of PSD, with a low recurrence rate and rapid recovery.
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Affiliation(s)
- Mingze Xu
- Department of Plastic Surgery, Changhai HospitalNaval Military Medical UniversityShanghaiPeople's Republic of China
| | - Yuchong Wang
- Department of Plastic Surgery, Changhai HospitalNaval Military Medical UniversityShanghaiPeople's Republic of China
| | - Xinyi Ma
- Department of Plastic Surgery, Changhai HospitalNaval Military Medical UniversityShanghaiPeople's Republic of China
| | - Yanjun Liu
- Department of Plastic Surgery, Changhai HospitalNaval Military Medical UniversityShanghaiPeople's Republic of China
| | - Chunyu Xue
- Department of Plastic Surgery, Changhai HospitalNaval Military Medical UniversityShanghaiPeople's Republic of China
| | - Haiying Dai
- Department of Plastic Surgery, Changhai HospitalNaval Military Medical UniversityShanghaiPeople's Republic of China
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Ureña-Paniego C, Gamissans-Cañada M, Molina-Leyva A, Romaní J. Pilonidal Sinus Disease is Associated with Severe Hidradenitis Suppurativa in a Spanish Cohort. Acta Derm Venereol 2023; 103:adv6569. [PMID: 37766657 PMCID: PMC10549763 DOI: 10.2340/actadv.v103.6569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 04/19/2023] [Indexed: 09/29/2023] Open
Abstract
Hidradenitis suppurativa is a chronic inflammatory disorder of the hair follicle with a high level of morbidity. Pilonidal sinus disease is a comorbid disorder and may be the reason for first contact with the healthcare system of patients with hidradenitis suppurativa. The aim of this study was to evaluate the frequency of association of pilonidal sinus disease and hidradenitis suppurativa and to explore whether pilonidal sinus disease defines a different clinical profile for patients with hidradenitis suppurativa. A cross-sectional study in which data regarding past history of pilonidal sinus disease, clinical and sociodemographic information were recorded during the first visit to the Hidradenitis Suppurativa Clinic of 2 tertiary hospitals. A total of 839 patients were included in the study. Of these, 51.7% (434/839) were male and mean age was 37.3 ± 13.6 years. Pilonidal sinus disease was present in 32.6% (269/839) of the patients and was associated with an early debut of hidradenitis suppurativa, a higher Hurley stage, inflammatory phenotype and a greater number of fistulas and perianal involvement. Elapsed time between pilonidal sinus disease and diagnosis of hidradenitis suppurativa was associated with higher disease severity. Pilonidal sinus disease is a frequent comorbidity and risk marker for hidradenitis suppurativa disease severity. Pilonidal sinus disease could be a sentinel event to identify patients who would benefit from close treatment and follow-up.
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Affiliation(s)
- Clara Ureña-Paniego
- Hidradenitis Suppurativa Clinic, Dermatology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Marta Gamissans-Cañada
- Hidradenitis suppurativa Clinic, Hospital Universitari Parc Taulí, Autonomous University of Barcelona, Sabadell, Barcelona, Spain
| | - Alejandro Molina-Leyva
- Hidradenitis Suppurativa Clinic, Dermatology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain; European Hidradenitis Suppurativa Foundation (EHSF). Dessau-Roßlau, Germany.
| | - Jorge Romaní
- HHidradenitis suppurativa Clinic, Hospital Universitari Parc Taulí, Autonomous University of Barcelona, Sabadell, Barcelona, Spain
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8
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Jastrząb B, Szepietowski JC, Matusiak Ł. Hidradenitis suppurativa and follicular occlusion syndrome: Where is the pathogenetic link? Clin Dermatol 2023; 41:576-583. [PMID: 37690621 DOI: 10.1016/j.clindermatol.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
The follicular occlusion tetrad complex encompasses several entities (hidradenitis suppurativa, acne conglobata, dissecting cellulitis of the scalp, and pilonidal cyst) that share common clinical features, risk factors, and pathophysiology. Follicular occlusion is a crucial triggering mechanism in the etiology in each of these disorders, leading to development of distinctive skin lesions such as deep-seated nodules, abscesses, comedones, and draining sinuses, often with accompanying scarring. Despite the fact that the follicular occlusion tetrad components manifest multiple similarities, they also exhibit many differences among themselves and require individual approaches and treatment.
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Affiliation(s)
- Beata Jastrząb
- Department of Dermatology, Venereology, and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology, and Allergology, Wroclaw Medical University, Wroclaw, Poland.
| | - Łukasz Matusiak
- Department of Dermatology, Venereology, and Allergology, Wroclaw Medical University, Wroclaw, Poland
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9
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Rafeeqi T, Abrajano C, Salimi-Jazi F, Garza D, Hartman E, Hah K, Wilcox M, Diyaolu M, Chao S, Su W, Hui T, Mueller C, Fuchs J, Chiu B. Adoption of a standardized treatment protocol for pilonidal disease leads to low recurrence. J Pediatr Surg 2023; 58:532-536. [PMID: 35868880 DOI: 10.1016/j.jpedsurg.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/10/2022] [Accepted: 06/20/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pilonidal disease may present as acute abscesses or chronic draining sinuses. There is no standardized treatment and recurrence rates can be as high as 30%. Within our five-hospital network we have established a standardized treatment protocol including minimally invasive surgical trephination and aggressive epilation. We hypothesize that such a treatment protocol can be established across different hospital settings and lead to low overall recurrence. METHODS Patients with pilonidal disease were enrolled in the study on presentation to our hospital network. Those that underwent initial surgery outside our hospital system or were noncompliant with our treatment protocol were excluded. Patients were grouped based on surgeon and treating facility. Frequency of recurrence per surgeon and per hospital was calculated and compared. RESULTS Out of 132 patients, 80 patients were included (45 female, 35 male) while 52 were excluded because of initial surgery at a non-network hospital or for protocol noncompliance. Median age was 17 (16-19) years and median length of follow-up was 352 (261-496) days. There were 6 patients who experienced at least one recurrence. There was an overall 8% recurrence rate with no significant difference noted between surgeons or hospitals (p = 0.15, p = 0.64, respectively). CONCLUSIONS We have successfully implemented a standardized treatment protocol for pilonidal disease across different hospital settings and by different surgeons, with an overall low recurrence rate. Our findings suggest that adoption of a standardized protocol for treatment of pilonidal disease can lead to low recurrence. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Talha Rafeeqi
- Division of Pediatric Surgery, Department of Surgery, Stanford University, 453 Quarry Road, Palo Alto, CA 94304, United States
| | - Claire Abrajano
- Division of Pediatric Surgery, Department of Surgery, Stanford University, 453 Quarry Road, Palo Alto, CA 94304, United States
| | - Fereshteh Salimi-Jazi
- Division of Pediatric Surgery, Department of Surgery, Stanford University, 453 Quarry Road, Palo Alto, CA 94304, United States
| | - Deanna Garza
- Division of Pediatric Surgery, Department of Surgery, Stanford University, 453 Quarry Road, Palo Alto, CA 94304, United States
| | - Emi Hartman
- Division of Pediatric Surgery, Department of Surgery, Stanford University, 453 Quarry Road, Palo Alto, CA 94304, United States
| | - Kira Hah
- Division of Pediatric Surgery, Department of Surgery, Stanford University, 453 Quarry Road, Palo Alto, CA 94304, United States
| | - Melissa Wilcox
- Division of Pediatric Surgery, Department of Surgery, Stanford University, 453 Quarry Road, Palo Alto, CA 94304, United States
| | - Modupeola Diyaolu
- Division of Pediatric Surgery, Department of Surgery, Stanford University, 453 Quarry Road, Palo Alto, CA 94304, United States
| | - Stephanie Chao
- Division of Pediatric Surgery, Department of Surgery, Stanford University, 453 Quarry Road, Palo Alto, CA 94304, United States
| | - Wendy Su
- Division of Pediatric Surgery, Department of Surgery, Stanford University, 453 Quarry Road, Palo Alto, CA 94304, United States
| | - Thomas Hui
- Division of Pediatric Surgery, Department of Surgery, Stanford University, 453 Quarry Road, Palo Alto, CA 94304, United States
| | - Claudia Mueller
- Division of Pediatric Surgery, Department of Surgery, Stanford University, 453 Quarry Road, Palo Alto, CA 94304, United States
| | - Julie Fuchs
- Division of Pediatric Surgery, Department of Surgery, Stanford University, 453 Quarry Road, Palo Alto, CA 94304, United States
| | - Bill Chiu
- Division of Pediatric Surgery, Department of Surgery, Stanford University, 453 Quarry Road, Palo Alto, CA 94304, United States.
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Tricarico PM, Moltrasio C, Gradišek A, Marzano AV, Flacher V, Boufenghour W, von Stebut E, Schmuth M, Jaschke W, Gams M, Boniotto M, Crovella S. Holistic health record for Hidradenitis suppurativa patients. Sci Rep 2022; 12:8415. [PMID: 35589750 PMCID: PMC9120068 DOI: 10.1038/s41598-022-11910-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/03/2022] [Indexed: 11/25/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a recurrent inflammatory skin disease with a complex etiopathogenesis whose treatment poses a challenge in the clinical practice. Here, we present a novel integrated pipeline produced by the European consortium BATMAN (Biomolecular Analysis for Tailored Medicine in Acne iNversa) aimed at investigating the molecular pathways involved in HS by developing new diagnosis algorithms and building cellular models to pave the way for personalized treatments. The objectives of our european Consortium are the following: (1) identify genetic variants and alterations in biological pathways associated with HS susceptibility, severity and response to treatment; (2) design in vitro two-dimensional epithelial cell and tri-dimensional skin models to unravel the HS molecular mechanisms; and (3) produce holistic health records HHR to complement medical observations by developing a smartphone application to monitor patients remotely. Dermatologists, geneticists, immunologists, molecular cell biologists, and computer science experts constitute the BATMAN consortium. Using a highly integrated approach, the BATMAN international team will identify novel biomarkers for HS diagnosis and generate new biological and technological tools to be used by the clinical community to assess HS severity, choose the most suitable therapy and follow the outcome.
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Affiliation(s)
- Paola Maura Tricarico
- Department of Advanced Diagnostics, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy.
| | - Chiara Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Anton Gradišek
- Department of Intelligent System, Jožef Stefan Institute, Jamova Cesta 39, 1000, Ljubljana, Slovenia
| | - Angelo V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università Degli Studi Di Milano, Milan, Italy
| | - Vincent Flacher
- Laboratory CNRS I2CT/UPR3572 Immunology, Immunopathology and Therapeutic Chemistry, Strasbourg Drug Discovery and Development Institute (IMS), Institut de Biologie Moléculaire Et Cellulaire, University of Strasbourg, Strasbourg, France
| | - Wacym Boufenghour
- Laboratory CNRS I2CT/UPR3572 Immunology, Immunopathology and Therapeutic Chemistry, Strasbourg Drug Discovery and Development Institute (IMS), Institut de Biologie Moléculaire Et Cellulaire, University of Strasbourg, Strasbourg, France
| | - Esther von Stebut
- Department of Dermatology, University of Cologne, Kerpenerstr. 62, 50935, Cologne, Germany
| | - Matthias Schmuth
- Department of Dermatology, Venereology and Allergy, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, Austria
| | - Wolfram Jaschke
- Department of Dermatology, Venereology and Allergy, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, Austria
| | - Matjaž Gams
- Department of Intelligent System, Jožef Stefan Institute, Jamova Cesta 39, 1000, Ljubljana, Slovenia
| | - Michele Boniotto
- INSERM, IMRB, Translational Neuropsychiatry, F-94010, University Paris Est Créteil, Créteil, France
| | - Sergio Crovella
- Biological Sciences Program, Department of Biological and Environmental Sciences, College of Arts and Sciences, University of Qatar, Doha, Qatar
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John K, John E, Lange D, Friedling F, Meyer F, Stadie V. Differenzialdiagnostische Fallstricke aus der klinischen Dermatologie. AKTUELLE DERMATOLOGIE 2022. [DOI: 10.1055/a-1460-0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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12
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Gulcu B, Ozturk E. Endoscopic Pilonidal Sinus Treatment: Rapid Recovery, Satisfactory Success, and High Quality of Life. Surg Laparosc Endosc Percutan Tech 2021; 31:711-715. [PMID: 34310558 DOI: 10.1097/sle.0000000000000974] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/18/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE In the treatment of pilonidal sinus disease (PD), endoscopic pilonidal sinus treatment (EPSIT), a skin-sparing minimally invasive technique, has attracted attention as an effective treatment. The aim of this study to evaluate the treatment success, cosmetic outcomes, and the quality of life in the patients who underwent an EPSIT for PD. MATERIALS AND METHODS The prospectively maintained data of 86 patients who underwent EPSIT for PD were retrospectively analyzed. The primary end-point of this study was complete wound healing, while the secondary end-points were the quality of life and cosmetic outcomes. RESULTS Seventy-two (83.7%) patients were male, and the median age was 28 (16 to 52). The median operative time was 32 (24 to 44) minutes, the median time to return to daily activities was 1 (1 to 4) day, and the median time to return to work was 3 (1 to 11) days. Fifty-two patients (60.4%) required no analgesics. No wound complication was observed. The median follow-up period was 12 (3 to 23) months. The complete wound healing rate was 94.2%, incomplete wound healing rate was 4.6% and the recurrence rate was 1.2%. Treatment failure was observed in 5 of the 6 patients with >3 pits located in the midline. The first-year median Wound evaluation scale score was 0 (0 to 4). The quality of life [physical function, physical role difficulty, pain, general health perception, energy/vitality, social functioning, emotional role, and mental health (P<0.0001)] significantly increased from preoperative levels a month after the EPSIT procedure. CONCLUSION EPSIT, a minimally invasive treatment modality for the treatment of sacrococcygeal PD, is an effective treatment that does not hamper the daily life of the patients, presents high success rates, and has satisfactory cosmetic outcomes.
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Affiliation(s)
- Baris Gulcu
- Department of Surgery, Bursa Medicana Hospital, Bursa
| | - Ersin Ozturk
- Department of Surgery, Bursa Medicana Hospital, Bursa
- Department of Surgery, KTO Karatay University School of Medicine, Konya, Turkey
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13
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Frew JW, Marzano AV, Wolk K, Join-Lambert O, Alavi A, Lowes MA, Piguet V. A Systematic Review of Promising Therapeutic Targets in Hidradenitis Suppurativa: A Critical Evaluation of Mechanistic and Clinical Relevance. J Invest Dermatol 2021; 141:316-324.e2. [PMID: 32919760 DOI: 10.1016/j.jid.2020.06.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 06/17/2020] [Accepted: 06/22/2020] [Indexed: 01/14/2023]
Abstract
This systematic review identifies and critically evaluates the mechanistic and clinical evidence of new promising therapeutic targets in hidradenitis suppurativa (HS). Evidence for these targets is largely based on observational data with limited ex vivo and translational data from clinical trials. A number of placebo-controlled studies have been completed or are underway utilizing IL-1, IL-23, IL-17, complement, and Jak inhibition, although there is concern regarding elevated placebo response rates and the questionable validity of clinical scores in some participant subsets. Knowledge gaps are identified suggesting a direction for future mechanistic studies in HS, including more comprehensive inflammatory endotype profiling of disease.
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Affiliation(s)
- John W Frew
- Laboratory of Investigative Dermatology, Rockefeller University, New York, New York, USA.
| | - Angelo V Marzano
- Dermatology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Physiopathology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Kerstin Wolk
- Psoriasis Research and Treatment Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Olivier Join-Lambert
- Groupe de Recherche sur l'Adaptation Microbienne (GRAM 2.0, EA 2656), Department of Microbiology, Normandie University, UNICAEN, UNIROUEN, CHU de Caen Normandie, Caen, France
| | - Afsaneh Alavi
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Dermatology, Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada
| | - Michelle A Lowes
- Laboratory of Investigative Dermatology, Rockefeller University, New York, New York, USA
| | - Vincent Piguet
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Dermatology, Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada
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14
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Ommer A, Iesalnieks I, Doll D. S3-Leitlinie: Sinus pilonidalis. 2. revidierte Fassung 2020. COLOPROCTOLOGY 2020. [DOI: 10.1007/s00053-020-00488-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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15
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Frew J, Navrazhina K. Into the (gluteal) fold: pilonidal disease and hidradenitis suppurativa – association or continuum? Br J Dermatol 2019; 181:1121. [DOI: 10.1111/bjd.18300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- J.W. Frew
- Laboratory of Investigative Dermatology Rockefeller University New York U.S.A
| | - K. Navrazhina
- Laboratory of Investigative Dermatology Rockefeller University New York U.S.A
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16
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Benhadou F, Van der Zee H, Pascual J, Rigopoulos D, Katoulis A, Liakou A, Daxhelet M, Romanelli M, Iannone M, Kinyó Á, Nikolakis G, Zouboulis C, Dessinioti C, Zisimou C, Antoniou C, Alavi A, Mintoff D, Aquilina S, Matusiak L, Szepietowski J, Sinclair R, Husein‐ElAhmed H, von Laffert M, Revuz J, Danby B, Puig L, Theut Riis P, Jemec G, Straalen K, Wigny K, Marmol V, Guillem P. Pilonidal sinus disease: an intergluteal localization of hidradenitis suppurativa/acne inversa: a cross‐sectional study among 2465 patients. Br J Dermatol 2019; 181:1198-1206. [DOI: 10.1111/bjd.17927] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2019] [Indexed: 12/14/2022]
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17
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Khafagy A, Al Haddad E, AlSabah S. The endoscopic treatment of pilonidal sinus disease: a short-term case-series study. Ann Saudi Med 2019; 39:192-196. [PMID: 31215233 PMCID: PMC6832333 DOI: 10.5144/0256-4947.2019.192] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 05/05/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Pilonidal disease (PNS) is a common inflammatory disease that can significantly impact the quality of life of the patient. Previous open techniques for the management of this condition have been unsatisfactory, with high recurrence rates reported. OBJECTIVE Investigate a new endoscopic procedure for the management of PNS disease. DESIGN Case series. SETTING Single hospital in Kuwait. PATIENTS From April 2014 to October 2017, patients with symptomatic chronic or recurrent PNS were consecutively enrolled to undergo the endoscopic pilonidal sinus treatment (EPSiT) procedure. MAIN OUTCOME MEASURES Control of pain, wound complications, recurrence rate over a 6-month follow up. SAMPLE SIZE 35 patients. RESULTS The mean age of the patients was 22 years, with 33 (94%) males. Fourteen (40%) presented with recurrent disease and were recommended to undergo an EPSiT procedure. A single tract was used in 32 (91%) of the cases, with an average operative time of 51 mins. On follow-up 5 patients reported minimal pain judging by the need of only mild analgesics for the control of pain. No patient experienced early wound complications necessitating hospitalization. There were 2 (6%) recurrences encountered by the time of the 6-month follow-up period. CONCLUSION In these early results, the EPSiT procedure provided effective healing with acceptable recurrence rates and aesthetics. In addition, the procedure allows the surgeon to see the PNS, fistula tracts or any abscess cavities. LIMITATIONS Short follow-up period with a small number of patients CONFLICTS OF INTEREST: None.
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Affiliation(s)
| | - Ellana Al Haddad
- From the Department of Surgery, Kuwait Ministry of Health, Kuwait
| | - Salman AlSabah
- From the Department of Surgery, Kuwait Ministry of Health, Kuwait
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18
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Liao LY, Li TS, Chen HC. Idea and innovation: Secure fixation between dermis and periosteum using perforator flap to prevent recurrence of pilonidal sinus disease. Int Wound J 2018; 16:862-865. [PMID: 30240147 DOI: 10.1111/iwj.12981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 07/30/2018] [Indexed: 11/28/2022] Open
Abstract
In the past decades, numerous surgical techniques and conservative treatments for pilonidal sinus disease (PSD) had been discussed and published. There is still no consensus yet of the best techniques because of high recurrence rates and prolonged wound healing. In the case of complicated discharging sinus or recurrent PSD resistant to treatment with antibiotics, we recommend radical excision followed by a regional flap, which can obliterate the dead space with well-vascularised tissue. In this article, we presented the technique of snug suture fixation between the dermis and periosteum using a superior gluteal artery perforator (SGAP) flap. The study demonstrates a few key concepts on the prevention of PSD recurrence, an off-midline, well-perfused flap that allows flattened natal cleft and obliteration of gluteal cleft and eventually showed good aesthetic results. We aim to demonstrate a reliable surgical technique for wound closure of recurrent pilonidal sinus after radical excision followed by reconstruction with an SGAP flap. The history, surgery, and images are described, and the literature is reviewed. The pitfalls of disease recurrence will be discussed in this literature. Keys to successful treatment will be elaborated. An 18-year-old female with recurrent pilonidal sinus disease over right medial gluteal region presented with sacral pain and infection. She developed progressive swelling and burst of abscess from several sinus tracts and did not respond to the treatment with antibiotics alone. After radical excision of the entire pilonidal sinus and adjacent fibrotic tissue, a deep and large defect was measured. A superior gluteal perforator flap was designed based on three perforators from the superior gluteal artery. A medial 3 cm of the SGAP flap was de-epithelised to provide soft tissue bulk to obliterate the deep cavity. Strong sutures were applied to secure the flap to the periosteum. There was no recurrence at 3 years of follow up. The patient stood the operation well and had prompt recovery.
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Affiliation(s)
- Li-Ying Liao
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Tzong-Shiun Li
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Hung Chi Chen
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan
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Abstract
BACKGROUND Pilonidal disease (PD) is a recalcitrant condition associated with significant morbidity. It affects 26 in 100,000 individuals; however, there is no consensus on optimal surgical treatment, and up to half of patients struggle with recurrence. This review appraises the current literature on techniques and outcomes of PD surgery, to better guide decision making. METHODS A literature review using directed search terms was performed to identify studies addressing PD management, in accordance with the PRISMA guidelines. Data on techniques, outcomes, and complications were collected. RESULTS Open healing remains the most widely used treatment method and achieves reliable outcomes at the expense of prolonged wound healing, between 21 and 71 days. Asymmetric closure reduces healing time to 10 to 23 days and produces significantly fewer recurrences relative to midline closure (P < 0.05). Outcomes are similar between various asymmetric techniques; the Bascom cleft lift, Karydakis flap, and Limberg transposition are commonly used approaches which all demonstrate recurrence rates under 6%. Deroofing is associated with a significantly lower rate of complications than any closure procedure at 1.4% (P < 0.05), with recurrence in only 1% to 10% of patients, and represents a favorable treatment alternative. CONCLUSIONS Despite the heterogeneous nature of studies on PD, certain techniques have been consistently shown to optimize postoperative outcomes. Deroofing sinuses and allowing secondary healing results in low rates of recurrence with minimal morbidity. When closure is preferred, off-midline flaps provide more effective coverage than midline repair. Treatment recommendations should be guided by individualized patient preferences and be grounded in high-quality data.
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20
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Abstract
Pilonidal sinus is a very common inflammatory disease of the gluteal region. The ideal method of pilonidal sinus treatment should have a low recurrence rate with minimum excision. Moreover, the treatment method should have a short hospitalization time, should let the patient return to his normal life rapidly, should cause minimum loss of labour and should result a small scar only. In the presented review, modalities in pilonidal sinus treatment in the light of current information in the literature are evaluated.
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Affiliation(s)
- Arda Isik
- Department of General Surgery, School of Medicine, Erzincan University, Erzincan, Turkey.
| | - Oguz Idiz
- Department of General Surgery, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | - Deniz Firat
- Department of General Surgery, Sevket Yılmaz Training and Research Hospital, Bursa, Turkey
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21
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Chen W, Plewig G. Should hidradenitis suppurativa/acne inversa best be renamed as “dissecting terminal hair folliculitis”? Exp Dermatol 2017; 26:544-547. [DOI: 10.1111/exd.13211] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2016] [Indexed: 02/04/2023]
Affiliation(s)
- WenChieh Chen
- IZZ Immunologie-Zentrum Zürich; Zurich Switzerland
- Department of Dermatology and Allergy; Technical University of Munich; Munich Germany
| | - Gerd Plewig
- Department of Dermatology and Allergy; Ludwig-Maximilian-University of Munich; Munich Germany
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22
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Meinero P, Stazi A, Carbone A, Fasolini F, Regusci L, La Torre M. Endoscopic pilonidal sinus treatment: a prospective multicentre trial. Colorectal Dis 2016; 18:O164-70. [PMID: 26946340 DOI: 10.1111/codi.13322] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 02/11/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Pilonidal disease (PD) is a common inflammatory disease of the gluteal fold, resulting in recurrent acute/chronic infection at the level of the natal cleft. In this study, endoscopic pilonidal sinus treatment (EPSiT), a new endoscopic minimally invasive procedure, was evaluated for its effectiveness in treating PD. METHODS Two hundred and fifty prospective patients with chronic PD were enrolled in a prospective multicentre study conducted at a secondary and tertiary colorectal surgery centre. The primary end-point of this study was wound healing, and the short-/long-term outcomes such as healing time, morbidity rate and recurrence rate were analysed. The secondary end-point of this study was quality of life (QoL). RESULTS The complete wound healing rate was 94.8%, and the mean complete wound healing time was 26.7 ± 10.4 days. The incomplete healing rate (5.2%) was significantly related to the number of external openings (P = 0.01). There was no difference in the failure rate when EPSiT was performed as the first-line treatment for PD or when it was used after unsuccessful procedures (P = n.s.). Recurrence occurred in 12 cases (5%). The QoL significantly increased from preoperative levels 15 days after the EPSiT procedure (45.3 vs 7.9; P < 0.0001). CONCLUSIONS The EPSiT procedure is a safe and effective technique for treating PD. It provides better short- and long-term outcomes than various other techniques that are more invasive. EPSiT is a minimally invasive outpatient procedure, which is associated with a quick recovery and a good QoL outcome.
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Affiliation(s)
- P Meinero
- Colorectal Unit Sanatrix Clinic, Rome and Sestri Levante Hospital, Genova, Italy.,Department of Surgery, EOC Hospital, Mendrisio, Switzerland
| | - A Stazi
- Pelvic Care Center, Madonna delle Grazie Hospital, Velletri, Rome, Italy
| | - A Carbone
- Colorectal Unit Sanatrix Clinic, Rome and Sestri Levante Hospital, Genova, Italy.,Sapienza University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - F Fasolini
- Department of Surgery, EOC Hospital, Mendrisio, Switzerland
| | - L Regusci
- Department of Surgery, EOC Hospital, Mendrisio, Switzerland
| | - M La Torre
- Colorectal Unit Sanatrix Clinic, Rome and Sestri Levante Hospital, Genova, Italy.,Sapienza University of Rome, Policlinico Umberto I Hospital, Rome, Italy
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Boer J, Nazary M, Riis PT. The Role of Mechanical Stress in Hidradenitis Suppurativa. Dermatol Clin 2016; 34:37-43. [DOI: 10.1016/j.det.2015.08.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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24
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Martorell A, García-Martínez F, Jiménez-Gallo D, Pascual J, Pereyra-Rodriguez J, Salgado L, Vilarrasa E. Actualización en hidradenitis supurativa (I): epidemiología, aspectos clínicos y definición de severidad de la enfermedad. ACTAS DERMO-SIFILIOGRAFICAS 2015; 106:703-15. [DOI: 10.1016/j.ad.2015.06.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 06/25/2015] [Accepted: 06/30/2015] [Indexed: 12/19/2022] Open
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25
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Martorell A, García-Martínez F, Jiménez-Gallo D, Pascual J, Pereyra-Rodriguez J, Salgado L, Vilarrasa E. An Update on Hidradenitis Suppurativa (Part I): Epidemiology, Clinical Aspects, and Definition of Disease Severity. ACTAS DERMO-SIFILIOGRAFICAS 2015. [DOI: 10.1016/j.adengl.2015.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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26
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Ommer A, Berg E, Breitkopf C, Bussen D, Doll D, Fürst A, Herold A, Hetzer F, Jacobi T, Krammer H, Lenhard B, Osterholzer G, Petersen S, Ruppert R, Schwandner O, Sailer M, Schiedeck T, Schmidt-Lauber M, Stoll M, Strittmatter B, Iesalnieks I. S3-Leitlinie: Sinus pilonidalis. COLOPROCTOLOGY 2014. [DOI: 10.1007/s00053-014-0467-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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27
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Abstract
Pilonidal disease is a frequent suppurative condition that occurs twice as often in men as in women, usually between the ages of 15 and 30. Pilonidal disease is located beneath the skin of the sacro-coccygeal region. It presents acutely as an abscess under tension while the chronic form gives rise to intermittent discharge from pilonidal sinus(es). Diagnosis is clinical and usually straightforward. In the large majority of cases, treatment is surgical but there is no consensus as to the 'ideal' technique. Acute abscess must be evacuated and an off-midline incision seems preferable. Excision is the standard definitive treatment but the choice of wide versus limited excision depends on the school of thought. The widespread practice in France is to leave the wound open, relying on postoperative healing by secondary intention. This technique has a low rate of recurrence but has the disadvantages of requiring local nursing care; the healing process is prolonged, usually associated with a temporary but prolonged cessation of activity. Primary wound closure techniques are less restrictive but their recurrence rate is probably higher. A direct midline suture is best after a small excision, but for a more extended wound, plastic reconstruction techniques are preferred; data in the literature favor asymmetric closure techniques such as those described by Karydakis and Bascom.
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Affiliation(s)
- V de Parades
- Service de proctologie médico-chirurgicale, institut Léopold-Bellan, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France.
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28
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Petit A. [What's new in clinical dermatology?]. Ann Dermatol Venereol 2013; 139 Suppl 5:S177-87. [PMID: 23522704 DOI: 10.1016/s0151-9638(12)70132-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Medical articles published between September 2011 and September 2012 were selected based on themes related to clinical dermatology. Therapeutics, pediatrics, oncology, sexually transmitted diseases, and major system diseases such as sarcoidosis and connective tissue disease were not retained. The subjects reviewed were: (i) epidemiology, particularly the risks of exposure to infectious agents; (ii) diagnostic tools, dominated by dermoscopy and teledermatology; (iii) the description of new disorders and the reassessment of older diseases; (iv) complementary tests in certain types of dermatosis; (v) a few large "works in progress" in dermatology, where clinical aspects and biological research intertwine and contribute one to the other.
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Affiliation(s)
- A Petit
- Service de Dermatologie, Hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France.
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