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Rhomboid flap procedure for pilonidal sinus: results from 67 cases.

Sixty-seven patients with chronic pilonidal sinuses were treated by excision and rhomboid flap transposition (RFT). Primary healing was obtained in all patients except two who developed a seroma and one who had a partial dehiscence of the surgical wound due to a hematoma, which necessitated drainage through the margin of the flap. The average stay was 5.3 days (range 1-16). All patients returned to normal activities within 2 weeks of surgery. No late recurrence occurred after a mean follow-up of 74.4 months (range 8-137).

Adolescent↗

[Infected pilonidal sinus].

During the past 11 years (1985-1996), 324 patients with pilonidal sinus were treated. In 272 cases primary wound closure was performed, in contrast to 52 cases with secondary wound healing. One hundred and fourteen patients were additionally treated with an antibiotic carrier (group 1), 158 were not (group 2). In group 1 primary healing occurred in only 66% of cases vs 69% in group 2. We found wound complications with a lag time of 4 days in comparison with group 2. Serious wound secretion persisted longer in group 1, resulting in a longer hospital stay of 6.5 days on average. We conclude that the application of antibiotic carriers does not raise the rate of primary wound healing. Better results can be achieved by secondary wound healing appropriate treatment with hydrocolloidal moist wound dressings.

Adolescent↗

Simple excision and primary closure of pilonidal sinus: a simple modification of conventional technique with excellent results.

OBJECTIVE: Pilonidal sinus (PNS) is a common condition, which warrants surgical intervention. A number of surgical options have been suggested with variable recurrence rate. This study proposes a modification of a standard method. METHODS: A total of 51 patients with sacrococcygeal PNS were sequentially treated by the standard method devised by one Consultant Colorectal Surgeon (IA). The principle is based on: 1, after excising the PNS ensure obliteration of the natal cleft by releasing the fat pad from the gluteal fascia; 2, avoid tension and 3, encourage patients to lie on their back immediately after the operation. RESULTS: Follow-up was available from 51 patients ranging from 14 to 49 months. All patients were discharged within 48 h. There was only one recurrence, which was successfully treated. CONCLUSION: Our results suggest that PNS can be successfully treated by our hitherto undescribed method, patients can be discharged early and there is very low recurrence rate.

Adolescent↗

Pilonidal sinus. Excision--marsupialization--phenolization?

Too often still this disease is called sacrococcygeal cyst, pointing into the direction of congenital etiology. With this paper (and a review of the literature) we try to proof that the theory of acquired origin of pilonidal sinus is the only one logically to be accepted. We indicate that extensive surgical procedures such as Z-plasty rotated flap or broad excision--are really unnecessary and that a simple and accurate technique--marsupialization--gives excellent results with a minimum of recurrences. The last few years phenolization of the pilonidal sinus has become a popular, and eventually a worthwhile alternative.

Adult↗

Bascom's operation for pilonidal sinus.

During 1985 in England and Wales, 7000 patients were treated for pilonidal disease with an average hospital stay of 5 days. The aim of this paper is to report our early experience with Bascom's operation for pilonidal sinus--a procedure relatively untried in the UK.

Acute Disease↗

What is the role of mechanical bowel preparation in patients with pilonidal sinus undergoing surgery? Prospective, randomized, surgeon-blinded trial.

The aim of this study was to determine the effect of a mechanical bowel preparation on postoperative surgical wound infections in patients treated with identical antimicrobial prophylaxis undergoing wide excision and primary closure for chronic pilonidal sinus disease. Patients more than 18 years old were included in the study. All patients had intravenous antimicrobial prophylaxis at the time of anesthesia induction. In a prospective, randomized setting, patients were allocated to either the bowel preparation group or the no-bowel-preparation group. Mechanical bowel preparation was performed using an oral sodium phosphate solution. On the morning of the procedure a rectal enema was performed with the phosphate solution. The primary outcome measure was the rate of wound infection, but all postoperative complications and recurrences were recorded. All patients were actively observed for 1 year after discharge. The overall infection rate for the entire study population was 12.8% (13/101) including 14.3% (7/49) of those who had had the bowel preparation and 11.5% (6/52) of those with no bowel preparation. There was no statistically significant difference between groups (P = 0.680). The mean rate of recurrence for all 101 patients was 4.9% (5/101) at 19.2 months (range 12-32 months) of follow-up. The recurrence rate was 6.1% (3/49) in the bowel preparation group and 3.8% (2/52) in the no-bowel-preparation group (P = 1.000). Although the number of patients is small in this study, our results showed that the mechanical bowel preparation does not cause a decrease in the rate of surgical wound infections after excision and primary closure in patients with chronic pilonidal sinus disease.

Adult↗

Karydakis operation for sacrococcygeal pilonidal sinus disease: experience in a district general hospital.

Asymmetrical excision of sacrococcygeal pilonidal sinus has been shown to be associated with low recurrence rates. We report our experience with an asymmetric technique--the Karydakis operation. Of 28 patients who had the operation over a 4-year period, no recurrences were observed in 27 patients available for follow-up (median follow-up 3 years). Three patients had complications requiring surgical intervention. The operation is easy to teach and learn and is worth considering by both specialist and non-specialist surgeons.

Adolescent↗

Vacuum-assisted closure therapy: a new treatment option for recurrent pilonidal sinus disease. Report of three cases.

No single treatment option available for symptomatic pilonidal disease is entirely satisfactory. In our department, we have treated successfully three cases of pilonidal disease with vacuum-assisted closure therapy. We describe our initial experience with this technique. In two cases, the pilonidal sinus was primarily excised, a split skin graft applied to cover the defect, and the vacuum-assisted closure pump applied over the skin graft for a period of four days on a continuous negative pressure of 50 mmHg. The third case was treated and completely healed with vacuum-assisted closure therapy alone. To our knowledge, this is the first report in the literature describing the use of vacuum-assisted closure therapy for this condition. We propose this therapy as an alternative adjunctive treatment for pilonidal disease.

Adult↗

A simple surgical method of treating pilonidal sinus.

A simple surgical method of treatment was used in 63 patients with pilonidal sinus. Adequate block excision with primary closure is the basis of this technique. The problem of closure and obliteration of the dead space was solved by using absorbable sutures to unite fascia and subcutis in the midline, after mobilization of the skin and subcutaneous layers of the wound edges. In 59 (93.6%) of 63 patients treated, primary healing was obtained; in 4 (6.4%) disturbances of wound healing occured; and in 3 (4..8%) recurrences developed. The average stay in hospital was 10.4 days and the average healing time 10 days. The follow-up period was between 1 year and 6 years. The scars were sound, supple and painless. Our results include 6 patients, treated several days before the definitive procedure by incision and drainage for a pilonidal abscess. Antibiotic or chemotherapeutic agents were not used.

Adult↗

Pilonidal sinus.

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Humans↗

Pilonidal sinus.

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Humans↗