Technic of excision and primary closure of pilonidal sinus.
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Humans↗
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Pilonidal sinus excision--healing by open granulation.
A prospective study is reported of 100 pilonidal sinus excisions healing by open granulation. Delays in healing appeared to be due to infection, particularly by anaerobic bacteria. Comparisons are made between three groups studied consecutively - 30 wounds not treated with antibiotics, 20 given a fixed two-week course of metronidazole and 50 managed flexibly. In this last group, wound management was determined by clinical appearance; 24 wounds were clinically healthy throughout and received no antibiotic while 26 looked unhealthy initially or after an interval and were treated with metronidazole, supplemented in some cases with erythromycin. The best results were obtained in the group managed flexibly. It is considered that the problems of delayed healing are due to excisions which leave a wound of a shape ill-designed to maintain good drainage. Unhealthy wounds should be re-shaped if possible and treated early with a combination of metronidazole and erythromycin.
Bacteria, Anaerobic↗
Limberg flap repair for pilonidal sinus disease.
PURPOSE: There are many methods described for the treatment of sacrococcygeal pilonidal sinus disease, and none of them has been accepted as an optimal modality. Plastic procedures have some advantages, such as short duration of hospitalization, quick healing time, low risk of wound infection, and lower recurrence rates. Our choice is Limberg flap repair; we present here our experience with this procedure. METHODS: From August 1998 to July 2000, 147 male patients were treated with Limberg flap repair under regional anesthesia in a soldier's hospital. RESULTS: No major anesthetic complication or wound infection developed. Three patients (2 percent) had a seroma (with negative culture) and six patients (4.1 percent) had partial wound detachment. Patients returned to full activity on the 10th to 25th postoperative day (mean, 18.8). Patients were followed from 1 to 40 (mean; 13.1) months. Seven patients (4.8 percent) had a recurrence. CONCLUSION: The Limberg flap procedure is an easy and effective technique. Patient comfort, quick healing time, early return to full activity, and low complication and recurrence rates are the important advantages of this procedure.
Adult↗
Pilonidal sinus: a claim for simple track incision.
Ninety-six patients treated surgically for pilonidal sinus were examined in a two-part study. In the first part, 36 patients were randomly allocated according to the surgical techniques employed: marsupialization, incision, and excision without primary closure. Healing times and recurrences a year after operation were studied. The healing times of patients treated by excision were longer in comparison with those treated by incision or marsupialization. The recurrence rates were similar for all techniques used. In the second part of the study 60 patients were randomly allocated according to times of returning to work. Twenty-nine of these patients returned to work before their wound healed; 31 resumed work a week after epithelization of the wound. The wounds healed more quickly in patients who started working before they were closed. Incision of the sinus track, carried out using local anesthesia in the outpatient clinic, allowed the patient to return to work without pain sooner.
Anesthesia, Local↗
Actinomycosis associated with pilonidal sinus of the penis.
We report a case of actinomycosis associated with a penile pilonidal sinus. This association does not appear to have been described previously. We recommend the submission of biopsies of unusual lumps in the genital region (fresh biopsies for bacteriological examination and fixed biopsies for histomorphological assessment).
Actinomycosis↗
Successful treatment of recurrent pilonidal sinus with laser epilation.
BACKGROUND: Pilonidal disease is a chronic disease of the natal cleft. Recurrent follicular infection is the causative factor. Surgical treatment has a significant failure rate, and recurrence is common. Laser removal of hair in the natal cleft could be an alternative to surgery. OBJECTIVE: To determine the effectiveness of laser hair removal in the natal cleft on pilonidal disease. METHODS: Six young men with recurrent pilonidal disease were treated with laser epilation in our clinic from 2000 to 2003. Most patients had a history of one or more surgical treatments in the area, and all patients had suffered recurrent folliculitis for years. An alexandrite laser was mostly used, although, occasionally, an intense pulsed light device was used. The number of epilation treatments ranged from 3 to 11, performed at 6- to 8-week intervals. RESULTS: All patients experienced progressive resolution of the folliculitis with the laser epilation treatments. No more surgical treatments have been needed. The treatments were simple and quick, and there were no complications. CONCLUSION: Laser epilation of the natal cleft should be considered a first choice treatment for recurrent pilonidal disease. Preventive laser epilation of the natal cleft in patients with recurrent folliculitis could avoid future surgery.
Adolescent↗
[Day-surgery treatment of pilonidal sinus].
Authors discuss ethiopathogenus of pilonidal disease after a historical background and support acquired-congenital theory. Open and closed treatment are reported on the acute and chronic phases, highlighting economical advantages of closed method. Carbon-dioxide laser on Authors experience was very useful to prevent complications and to shorten healing time in open method.
Adolescent↗
Pilonidal sinus: experience with the Karydakis flap.
A personal series of 141 patients with postanal pilonidal sinus was treated by the Karydakis operation. Each sinus was totally excised with a vertical eccentric elliptical excision. A thick flap was created by undercutting the medial edge and advancing it across the midline so that the whole suture line was lateralized to reduce the risk of recurrence. Follow-up was achieved in 114 patients for 1-108 months; 79 (69 per cent) were followed for more than 18 months. Overall there were five recurrences (4 per cent) which required further surgery. Thirty-three patients (23 per cent) were referred following recurrence or failure of healing after previous surgery elsewhere; all were cured by this method. The Karydakis operation has a low recurrence rate because it produces a shallow midline furrow free from scar or suture holes which is less vulnerable to hair penetration than a midline wound.
Adolescent↗
Life-threatening streptococcal myonecrosis complicating primary wound closure after pilonidal sinus excision.
We describe a case of anaerobic streptococcal myonecrosis as a rare complication after pilonidal sinus excision with primary closure. The recognition of the disease in any patient who has early septic deterioration after a surgical procedure requires aggressive management for survival.
Adult↗
Pilonidal sinus treated by phenol injection.
The method of using phenol injections for the treatment of pilonidal sinus is described in detail. This is a simple, safe and painless method which may be used as a day case procedure. The results are discussed and compare very favourably with the more radical forms of treatment.
Adolescent↗
Treatment of pilonidal sinuses by phenol injections.
Six female and 39 male outpatients, who suffered from acutely inflamed pilonidal sinus were treated by sclerotherapy between January 1985 and December 1988. Under local anaesthesia, 1-2 ml 80% phenol was injected into the sinus. The phenol, which was allowed to act for a minute, was washed out by irrigating the sinus with physiological common-salt solution. Of the questionnaire sent to all 45 patients, 37 proved suitable for evaluation. Complete healing occurred in 22 cases (59.8%). The healing time was 6.2 weeks on average. Besides a rather frequently observed transient reddening as a result of the local inflammation caused by the phenol, 5 patients developed an abcess which needed operative treatment. This study does not support the encouraging results of previous series.
Abscess↗
[Morbidity of Z-plasty in the treatment of pilonidal sinus].
21 patients were followed up on an average of 28 months following excision of pilonidal sinus and Z-plasty. There were 2 recurrences (10%), 3 hypertrophic scars (14%) and hypaesthesia of the skin flaps in almost every patient. 2 out of 3 patients (67%) were satisfied with the results. 5 suffer from the cosmetic appearance, 5 from pruritus, 3 (14%) have problems with clothing. About 1/3 experience discomfort when sitting and sporting. This morbidity causes us to recommend Z-plasty only in cases of a recurrence with strong discomfort or frequent recurrences.
Adolescent↗
Excision and delayed closure of pilonidal sinuses.
An alternative drainage procedure, a technique of excision and delayed closure for the treatment of pilonidal sinuses, was used upon 78 patients. The procedure compared favorably with marsupialization as well as the excision and semiprimary closure technique with regard to healing time and low recurrence rates.
Adolescent↗
[Interdigital pilonidal sinus ("barber's disease")--a rare occupational disease].
Barber's disease is produced by short hairs that penetrate the interdigital spaces of the hands. The following chronic inflammatory reaction causes fistulas or sinuses and cysts. We present the case of a patient with interdigital pilonidal sinuses of all web spaces in both hands. Such an extensive case of this occupational disease has so far not been reported.
Barbering↗
A case of sacro-coccygeal chordoma masquerading as pilonidal sinus.
Chordoma is a rare, slow-growing, but locally aggressive malignant tumour derived from the primitive notochord. Pilonidal sinus disease, characterised by communicating granulating natal cleft tracts and abscesses, is a common condition. We report a case of a sacro-coccygeal chordoma diagnosed incidentally on surgical exploration of a case of presumed pilonidal disease.
Adult↗
Pilonidal sinus carcinoma.
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Carcinoma, Squamous Cell↗
Prospective follow-up after ambulatory plain midline excision of pilonidal sinus and primary suture under local anaesthesia--efficient, sufficient, and persistent.
OBJECTIVE: Optimal surgical treatment for chronic pilonidal sinus (PS) disease should be easy and efficient. The purpose of this study was to establish the feasibility of and results after ambulatory simple midline excision and primary wound closure under local anaesthesia. PATIENTS AND METHODS: The prospective nonrandomised single institution study included 131 consecutive PS patients admitted for surgery. After standardized surgery, all patients were prospectively followed until fully healed. Complications were registered. Results after 41 months (mean, range 36-59) were evaluated by questionnaire. RESULTS: 95% were primary closed. All were ambulatory treated and 98% under local anaesthesia. 88% healed in two weeks. 5.6% exhibited minor wound healing defects and 6.4% demanded full debridement of the wound. Mean delayed healing time was 7.5 weeks (range 3-12). 8% developed a recurrence. 10% of the remainders reported a slight tenderness in the scar area. 90% were symptom-free. CONCLUSION: PS treatment as of above is readily achieved. Wound related complications were reasonably few and in the same magnitude as after more complex excision techniques and induced no significant long-term sequels. Recurrences could, however, be more common. Prospective randomised studies are warranted to determine if there are any significant differences between excision techniques in and out of the midline.
Ambulatory Surgical Procedures↗