Pilonidal sinus of the penis.
A pilonidal sinus is a subcutaneous sinus containing hair. It is most commonly found in the natal cleft of hirsute men. Here we describe the unusual finding of a pilonidal sinus arising on the male foreskin.
Humans↗
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Use of fibrin glue in the treatment of pilonidal sinus disease: a pilot study.
BACKGROUND: Pilonidal sinus (PS) disease of the sacrococcigeal region is an acquired condition resulting from penetration of shed hair shafts through the skin. Different types of operations have been described in the letterature. More recently fibrin glue has been used with succesfull. Aim of this study was to assess the effectiveness of fibrin glue for the treatment of pilonidal sinus. PATIENTS AND METHODS: Eight patients age ranged 21,8 +/- 6,5 affected by PS disease of sacrococcigeal region were included in this study. All patients undergoing surgical operation under local anaesthesia. Following administration of 1% methylene blue through the main opening, a small vertical elliptical incision is maked including the entire sinus opening and an excision of PS was performed without entering the sinus cavity, removing a minimal amount of subcutaneous tissue. Afterwards the highly concentrated fibrin glue, containing 1,000 U/ml of thrombin was applied to cover the wound. Post-operative pain, analgesic consumption, duration of hospital stay, failure healing, the rate and time of recurrence, time to healing, time to return to work and post-operative complications were recordered. RESULTS: All patients expressed satisfaction with the procedure. Mean hospital stay was 5.4 +/- 2.1 hours. Healing was achieved after 25.8 +/- 13.2 days. The post-operative pain mean score was 3.8 +/- 2.1 in first day, 2,9 +/- 1,8 in third day and 1,3 +/- 0,8 in the seventh day. The mean analgesic consumption per week was 5,6 +/- 3,2 medications. Mean time to return to work was 5,3 +/- 2,1 days. CONCLUSION: The minimal excision of PS and application of fibrin glue is a non-invasive effective treatment, easy and simple to performe and not associated to recurrences. For these reasons this procedure in our opinion as the first line treatment for pilonidal sinus disease.
Adult↗
Interdigital pilonidal sinus in a dog groomer.
Pilonidal sinus is an acquired condition that usually develops in the sacrococcygeal area or other hair-bearing areas. It has also been described as an occupational disease, especially when present interdigitally. We describe the case of a 47-year-old dog groomer with interdigital pilonidal sinus and briefly review the postulated pathogenesis, clinical characteristics, differential diagnosis, and treatment.
Animals↗
Pilonidal sinus in Japan maritime self-defense force at Yokosuka.
Pilonidal sinus is known to be common among soldiers but not among Asian individuals. Few reports have discussed the occurrence of pilonidal sinus in the navy. We analyzed the incidence and etiological factors of 12 cases (11 patients, with 1 recurrence) of pilonidal sinus diagnosed between 1998 and 2004 in Japan Self-Defense Force Hospital Yokosuka. All patients were male, and all lesions were in the sacral area. The patients' average age and body mass index were 29.1 years and 27.4, respectively. The surgical procedures used were primary closures (10 cases, 83.3%) and flaps (two cases, 16.7%), and the number of postoperative hospital days averaged 11.8. Pilonidal sinus was not found to be significantly common among Japan Self-Defense Force personnel in general (7 of 11 patients with pilonidal sinus; not significant); however, it was significantly more common among the crew members of Japan Self-Defense Force ships (seven of seven patients; p < 0.05), which suggests that the on-board lifestyle contributes to the occurrence of pilonidal sinus.
Adult↗
Interdigital pilonidal sinus in a hairdresser.
Pilonidal sinus of the interdigital web space of the hand is a rare occupational disease which occurs in hairdressers and professionals working with animals. This paper reports such a sinus in the hand of a male hairdresser and reviews the treatment of this condition.
Beauty Culture↗
Multiple Z-plasty in pilonidal sinus--a new technique under local anesthesia.
BACKGROUND: Pilonidal sinus is a common surgical condition. Though benign, it causes a lot of distress with its associated morbidity and financial loss to the patient. Many procedures have been tried, ranging from nonsurgical to surgical methods (both conservative and radical ones). It is well known that recurrences are low when the scar is away from the midline. MATERIALS AND METHODS: The author has described a new technique of multiple Z-plasty for the treatment of pilonidal sinus that has been effective in the cure of this problem. This article reports a prospective, nonrandomized noncomparative preliminary clinical study of 115 cases of pilonidal sinus operated on by the author over 14 years. RESULTS: The results were compared with the results of other methods mentioned in the literature. There were only two recurrences. CONCLUSIONS: The author proposes that multiple Z-plasty can be considered as an option in the surgical treatment of pilonidal sinus.
Adolescent↗
Comparison between Eusol and Silastic foam dressing in the postoperative management of pilonidal sinus.
Seventy-five consecutive patients with pilonidal sinus disease were randomized to receive either Eusol dressings or Silastic foam dressings. Patients were divided into those with pilonidal sinus and pilonidal abscess. There was no significant difference between time to hospital discharge or time to full healing in either group. The cost benefits and simplicity of Silastic foam dressing are discussed.
Abscess↗
High body mass index as a possible risk factor for pilonidal sinus disease in adolescents.
Pilonidal sinus disease (PSD) is common in adults, but it may also develop in adolescents. The intergluteal groove is a deep moist area in which broken hairs and foreign bodies can collect, often leading to infection. Only a few papers have been published considering PSD in children. For the present study, we retrospectively examined the data of operated patients with PSD. From that review, it appears that high body mass index (BMI) might be a risk factor for the development of PSD and its complications in older children. Fourteen young patients (12 males, 2 females, 12-18 years of age) underwent surgery for PSD. According to the BMI-for-age, eight of these patients (57, 1%) were overweight or obese. Five of them (35.8%) developed mild to moderate postoperative complications. Symptoms recurred in one patient (7.1%) whose BMI was considered as overweight. In patients with normal weight no early or late complications developed. Our findings suggest that high BMI in adolescents is a significant risk factor in the development of both symptoms and complications of PSD after surgical treatment.
Adolescent↗
Effectiveness of collagenase in the treatment of sacrococcygeal pilonidal sinus disease.
PURPOSE: Sacrococcygeal pilonidal sinus disease (SPSD) is a disease affecting young patients, which results in a long-term loss of productive power, and also tends to have high rates of morbidity since it has no ideal treatment. The main purpose of this study was to investigate the effectiveness of topical collagenase in the treatment of SPSD. METHODS: In the present study, 40 patients admitted to our department were separated into two groups. Excision and marsupialization with dressing by bacterial collagenase was performed in the first group, while the treatment was excision and marsupialization without dressing by bacterial collagenase in the second group. RESULTS: We determined that the healing in terms of the width and depth of the wound in the first week and in depth of wound in the second week was better in group 1 than in group 2 ( P = 0.040, P = 0.020, P = 0.048, respectively). The duration of wound healing was 21.9 +/- 1.3 days in group 1, and 28.1 +/- 1.3 days in group 2 ( P = 0.0001). The recurrence rate in the intergluteal area, which heals by granulation and has no hair follicles, tends to decrease when a partial closure is obtained. CONCLUSION: We therefore recommend an excision, marsupialization, and dressing with bacterial collagenase, in cases with noncomplicated SPSD.
Adult↗
Z-plasty for treatment of disease of the pilonidal sinus.
The theory of acquired origin of pilonidal sinus disease has been emphasized. Advantages of Z-plasty over the other surgical methods for treatment of this disease have been elaborated. The extremely low recurrence rate following Z-plasty for pilonidal sinus results from the fact that the operation was planned with the true physiopathology of the disease in mind. It is the deep intergluteal fold which predisposes to pilonidal sinuses, and this architecture is materially altered with the Z-plasty. In a series of 120 patients, there were only two recurrences and only five hematomas and wound abscesses. There were no necrosis of flaps and no wound disruptions. This represents an improvement over the results of other modalities of treatment of this disease.
Abscess↗
[THE DIFFERENT ASPECTS OF PILONIDAL DISEASE (SACROCOCCYGEAL CYSTS AND FISTULAS. PILONIDAL SINUSES)].
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Cysts↗
Sacrococcygeal pilonidal sinus: historical review, pathological insight and surgical options.
Sacrococcygeal pilonidal disease is a common and well recognized entity. For many years the cause of sacrococcygeal pilonidal sinus has been matter of debate. When the treatment is considered, there was a frequent lack of success of the surgical methods of excision regarding morbidity, healing, recurrence and cure. All these factors rendered the acquired thesis of pilonidal sinus disease to be more accepted. In dealing with the pathogenesis of pilonidal sinus disease, Karydakis attributed the hair insertion process to three main factors: the invader, i.e. the loose hair; the force, which causes the insertion; and the vulnerability of the skin to the insertion of hair at the depth of the natal cleft. The sinus is initiated from a small midline opening lined by stratified squamous epithelium. Additional sinuses are frequent and have lateral openings. Malignant transformation is rare but cases of squamous cell carcinoma and verrucous carcinoma have been reported. Pilonidal sinus disease consists in a symptoms complex with presentations ranging from asymptomatic pits to painful draining lesions that are predominantly located in the sacrococcygeal region. Asymptomatic pits do not require treatment. Options for treatment of acute abscess include aspiration, drainage without curettage, and drainage with curettage. The choice of a particular surgical approach depends on the surgeon's familiarity with the procedure and perceived result in terms of low recurrence of sinus and a quick healing of resulting cavity or surgical wound. Conservative nonoperative management, closed methods, laying of track, wide excision and open drainage, wide excision and primary closure, and limited excision are the methods currently used. From the profusion of studies, it is apparent that various methods are being tried and no one method is universally acceptable. Recurrence rates vary with the technique, operator and length of follow-up. Primary closure with a lateral approach appears to give the best results.
Drainage↗
Surgical treatment of sacrococcygeal pilonidal sinus with the Limberg transposition flap.
BACKGROUND: Pilonidal sinus is a common chronic disease of the sacrococcygeal region. Although many surgical methods have been suggested, an ideal method is still lacking because of high recurrence rates. METHODS: This prospective study was conducted in 63 patients who were treated with the use of a rhomboid excision and Limberg flap closure for sacrococcygeal pilonidal sinus. The follow-up period ranged from 4 to 52 months (mean, 25 months). RESULTS: The mean hospital stay was 3 days (range, 2-7 days) and the mean time to return to work was 15 days (range, 12-26 days). Early wound complications and recurrence were encountered in 6% and 3%, respectively. Nineteen percent had numbness at the operation site and 63% were not pleased with cosmetic appearance of the scars. CONCLUSIONS: The results favor rhomboid excision and Limberg flap closure in the treatment of sacrococcygeal pilonidal sinus, especially in recurrent cases and in patients with extensive involvement. Low recurrence rates, shorter hospital stay, and time off from work may outweigh the disadvantages related to unfavorable cosmetic appearance.
Adolescent↗
Histology of chronic pilonidal sinus.
Many theories concerning the development of chronic pilonidal sinus have been proposed. A histologic study of primary pilonidal sinus in 53 patients is presented. Subcutaneous tissue contained sinuses surrounded by chronic inflammation. Hair in sinuses was found in three quarters of the specimens examined. Examination showed that hair entered via one of the sinus openings created. Pits (defined as darker spots of varying width in the midline of the internatal cleft) were found to be indentations of the skin containing keratin plugs and debris. They may be isolated or connected with hair follicles. Pilonidal sinuses are chronic inflammatory processes of the skin caused by keratin plugs and debris clinically observed as pits, having penetrated the dermis.
Adolescent↗
Outcome of treatment of primary and recurrent pilonidal sinuses with the Limberg flap.
BACKGROUND: Surgical treatment of pilonidal sinus disease has a significant morbidity and recurrence rate. The rhomboid flap of Limberg is a transposition flap that has been advocated for treatment of this condition. We present our experience with the Limberg technique for both primary and recurrent pilonidal sinuses. PATIENTS AND METHODS: In a three-year period, 25 patients with chronic pilonidal sinus disease were treated with this method. Twelve patients had recurrent disease and were previously treated with other types of surgery. The sinuses were excised in a rhomboid fashion and the defect closed using a transposition flap designed to obliterate the midline cleft. Patients were treated with prophylactic antibiotics and the wound drained with a vacuum drain. RESULTS: Median post-operative hospital stay was four days. There were four (16%) wound complications. The mean follow-up period was 20 months. There was a single recurrence (4%) of a pilonidal sinus, which required further surgical excision. CONCLUSIONS: Despite the risk of wound complications, this method is particularly useful for complex sinuses with extended tracts where radical excision leaves a large defect. It is also suitable for cases where simpler operations have failed and carries a low risk for recurrence.
Adult↗
Which technique for treatment of pilonidal sinus--open or closed?
PURPOSE: After excision of the pilonidal sinus, some surgeons leave the wound open, and others close the wound primarily. The aim of this study is to compare length of hospital stay, length of time to return to work, wound infection rate, and recurrence rate in chronic pilonidal sinus patients, after modification of both closed and open techniques. METHODS: One hundred ten patients who had chronic-stage pilonidal sinus were randomly assigned to receive one of two excisional surgical procedures. One-half were treated by surgical excision and primary closure (closed technique, Group A). The other one-half were treated with Obeid's surgical excision (open technique, Group B). RESULTS: Ninety-one (46 in Group A and 45 in Group B) of 110 patients were followed for a period four months to three years. Although patients with primary closure had significantly longer hospital stays (P < 0.05) than patients in the open group, they returned to work significantly earlier (P < 0.05). In Group A and Group B, infection rates were 3.6 percent and 1.8 percent (P > 0.01), and recurrence rates were 4.4 percent and 0 percent (P > 0.01), respectively. CONCLUSION: Because both techniques have very low complication rates, treatment of chronic pilonidal sinus should be based on patient preference and characteristics, especially employment status.
Absenteeism↗
Are postoperative drains necessary with the Limberg flap for treatment of pilonidal sinus?
PURPOSE: Different methods for managing pilonidal sinus have been described in the literature. Our purpose was to evaluate the influence of postoperative drainage in Limberg flaps. METHODS: Forty patients with pilonidal sinus undergoing radical excision and reconstruction with Limberg flap between 1994 and 1996 were evaluated prospectively. After patients were assigned randomly to the two groups, the effects of drains were studied statistically in terms of wound complications, hospital stay, and recurrence rate. RESULTS: Except for two minor transient wound dehiscences, in all cases primary healing was achieved. Early wound complication rate was 7.5 percent and recurrence rate was 2.5 percent for both groups. There was no significant difference between the groups in early wound complications (P > 0.05). The length of hospital stay was significantly longer in the drainage group (P < 0.001). CONCLUSION: We conclude that Limberg flaps with no drains in place will result in shorter hospital stays without deleteriously affecting the surgical results of wide excision and primary closure with well-vascularized tissue.
Adolescent↗
Microbiology of infected pilonidal sinuses.
Aspirates of pus from infected pilonidal sinuses in 75 patients showed bacterial growth. Anaerobic bacteria only were recovered in 58 (77%) specimens, aerobic bacteria only in three (4%), and mixed aerobic and anaerobic bacteria in 14 (19%). Two hundred and nine isolates were recovered: 147 anaerobes (2.0 isolates a specimen) and 62 aerobes (0.8 a specimen). The predominant anaerobes were Bacteroides sp (81 isolates, including 29 Bacteroides fragilis group) and 51 anaerobic cocci. The predominant aerobes were Escherichia coli (n = 15), Proteus sp (n = 9), group D streptococcus (n = 7), and Pseudomonas sp (n = 7). This study highlights the polymicrobial nature and predominance of anaerobic bacteria in infected pilonidal sinuses.
Adolescent↗