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PubMed2005

Comparison between drainage and curettage in the treatment of acute pilonidal abscess.

OBJECTIVE: Simple incision and drainage of a sacrococcygeal pilonidal abscess is associated with more than 40% recurrence. Definitive treatment of the chronic pilonidal sinus is recommended 4-8 weeks after incision and drainage. The present prospective clinical trial study was designed to compare the curettage and drainage of the acute abscess of the pilonidal sinus. Hospital stay, wound healing, and recurrence were noted. METHODS: This study was performed in Kerman University of Medical Sciences and Health Services, Iran from March 1999 to May 2004. One hundred and fifty patients who had an acute sacrococcygeal pilonidal abscess were randomly assigned to receive one of 2 drainage or curettage surgical procedures. All the surgical wounds were laid open, and daily sitting in a warm tub together with douche was recommended postoperatively. The 2 treatment modalities were compared in terms of the wound healing period, hospital stay, and postoperative complications using Chi-square and Student-t test. Patients with completed wound repair, consisting of 72 subjects in the curettage and 59 subjects in the drainage groups, were followed up to 65 months for the detection of recurrence by means of life table and Gehan s generalized Wilcoxon test. RESULTS: Most patients spent only one day in the hospital, with initial healing occurring in <2 months. Healing process in the curettage cases occurred more quickly than the drainage patients (96% versus 78.7%, p<0.001). In all cases, the treatment relieved symptoms, and all the patients returned to work 7-10 days after the treatment. Three patients in the curettage group (4%) and 16 patients in the drainage group (21.3%) did not complete wound healing within 10 weeks (p<0.001). Recurrence of disease was encountered significantly less in the curettage subjects than the drainage ones (11% versus 42%) (p<0.001). CONCLUSION: Unroofing and curettage, which is associated with higher rates of healing and lower rates of recurrence, may be the treatment of choice in the acute pilonidal abscess.

Acute Disease↗
PubMed1990

[Spinocellular carcinoma as a rare complication in pilonidal cyst].

The authors present two cases where on the basis of the pilonidal sinus spinocellular carcinoma developed. Both patients were successfully operated. The first one has been for three years, the second one for eight months without relapse. From the paper ensues that cancerization of the pilonidal sinus must be considered a very serious complication and must be prevented by early surgery.

Adult↗
PubMedDate not supplied

Treatment of pilonidal disease in short-stay surgery: personal method.

HYPOTHESIS: We state that our personal method constitued by excision and primary closure in the treatment of pilonidal sinus, is able to obtain a low rate of recurrence and a fast return to work. PATIENTS AND METHODS: Our report has been conducted on 315 patients. Excision and primary closure in the treatment of pilonidal sinus by local-regional anesthesia. The patients have been discharged on second day. RESULTS: We have not had intraoperative complication; about morbilità there have been 4% of seromas treated conservatively. CONCLUSIONS: With this personal method we have obtained very good results, in short and long time, with less of recurrences and fast return to work.

Humans↗
PubMed1997

Definite surgical treatment of complicated recurrent pilonidal disease with a modified fasciocutaneous V-Y advancement flap.

BACKGROUND: Different methods for managing pilonidal disease have been described in the literature. Recurrence impairs the success of all forms of therapy, but the lowest rates have been reported for reconstructions involving local flaps. Nevertheless, treatment of pilonidal disease with a fasciocutaneous V-Y flap is not a well-established procedure. We have modified the surgical technique and used it selectively for complicated recurrent cases. Our experience with this method is analyzed, and its validity is evaluated. METHODS: Twenty-four patients with recurrent pilonidal sinus undergoing radical excision and reconstruction with our modified fasciocutaneous V-Y advancement flap between 1986 and 1993 were studied retrospectively. RESULTS: Except for two minor transient wound dehiscences, in all cases primary healing was achieved. Furthermore, an excellent functional result and acceptable scar pattern were obtained in all twenty-four patients, with a mean follow-up of 4.5 years. Neither evidence of recurrence nor impairment of daily life activity was noted. CONCLUSIONS: Treatment of complicated recurrent pilonidal sinus with the described technique offers a safe but demanding method for definite reconstruction, and we support a more common application.

Adolescent↗
PubMed1983

[Is preventive epilation following sacral dermoid operation useful or ineffective?].

Following operation for pilonidal sinus, 79 patients were followed up for 1-10 years. The ratio male/female was 6 to 1. The majority of the patients had overweight. After primary closure of the wound, 62% healed without and 38% with infection. There were 15 recurrencies (19%) noted in this series. Consequent regular epilation was advised following the operation. One half of all patients neglected our recommendation and only 2/3 of the remaining patients practiced this regularly for a shorter or longer period of time. There were more recurrencies among the patients with regular epilation than the others who neglected epilation. In our study the practice of consequent regular epilation was not successful in preventing recurrent pilonidal sinus.

Adolescent↗
PubMed2002

Glomus coccygeum may mimic glomus tumour.

We reviewed all cases of pilonidal sinus excision specimens from our surgical pathology records from 1990 to 2000 to determine the presence of glomus coccygeum. We found only two cases of glomus coccygeum, also known as coccygeal body. We describe the histology and immunohistochemical findings of two glomera coccygea incidentally discovered in pilonidal sinus excision specimens, and review the world's English literature.

Adolescent↗
PubMed2001

[Analysis of a programme of direct referral between primary and specialist care in potential surgery patients].

OBJECTIVE: To describe the results of a programme of direct referral of potential surgery patients between primary and specialist care, designed to lessen waiting-times.Design. Prospective, longitudinal and descriptive study. SETTING: Health Area N. masculine 19 (Valencian Health Service): Surgery Service of Elche Hospital and 6 Health Centres. PARTICIPANTS: Patients with pathologies that do not need special techniques for diagnosis except examination and who have a clear irrefutable indication of surgery without risk factors (ASA I-II).Intervention. The referral protocol consists of: a) diagnosis of pathology and pre-operative study in primary care (PC); b) appointment made by phone for the surgery clinic at the hospital, where diagnosis and pre-operative study are confirmed; c) referral and operation in the unit of non-hospital major surgery (UCMA); d) monitoring post-operation by the home hospitalisation unit (HHU) or preferably by the health centre, and e) check-up at the surgery clinic. Main measurements. The degree of agreement between PC and the specialist, assessment of the pre-operative study, and waiting time. RESULTS: 86 patients were referred (average age, 35; 76% male) by 28 doctors. The most common pathologies were hernia (36%), pilonidal sinus (23.2%) and miscellaneous (32.5%). There was general agreement in diagnosis in 90.7% of cases. 89.5% of patients brought the proper pre-operative study. Mean waiting time between the primary care consultation in the different procedures and the first hospital consultation was 19 days; with 44 more days elapsing till the surgical operation. CONCLUSIONS: This new programme is effective and economic, in that there is < > of patients, waiting time is reduced by over 7 months for pilonidal sinus and by over 2 years for hernia pathology, and the procedure can be used for a large number of patients, as the pathologies involved are very common.

Adolescent↗
PubMed2000

Systematic reviews of wound care management: (3) antimicrobial agents for chronic wounds; (4) diabetic foot ulceration.

BACKGROUND: Chronic wounds, including pressure sores, leg ulcers, diabetic foot ulcers and other kinds of wounds, healing by secondary intention are common in both acute and community settings. The prevention and treatment of chronic wounds includes many strategies, including the use of various wound dressings, bandages, antimicrobial agents, footwear, physical therapies and educational strategies. This review is one of a series of reviews, and focuses on the prevention and treatment of diabetic foot ulcers and the role of antimicrobial agents in chronic wounds in general. OBJECTIVES: To assess the clinical- and cost-effectiveness of (1) prevention and treatment strategies for diabetic foot ulcers and (2) systemic and topical antimicrobial agents in the prevention and healing of chronic wounds. METHODS - DATA SOURCES: Nineteen electronic databases were searched, including MEDLINE, CINAHL, Embase and the Cochrane Library. Relevant journals, conference proceedings and bibliographies of retrieved papers were hand-searched. An expert panel was consulted. METHODS - STUDY SELECTION: Randomised and non-randomised trials with a concurrent control group, which evaluated any intervention for the prevention or treatment of diabetic foot ulcers, or systemic or topical antimicrobials for chronic wounds (diabetic foot ulcers, pressure ulcers, leg ulcers of various aetiologies, pilonidal sinuses, non-healing surgical wounds, and cavity wounds) and used objective measures of outcome such as: (1) development or resolution of callus; (2) incidence of ulceration (for diabetic foot ulcer prevention studies); (3) incidence of pressure sores (pressure sore prevention studies); (4) any objective measure of wound healing (frequency of complete healing, change in wound size, time to healing, rate of healing); (5) ulcer recurrence rates; (6) side-effects; (7) amputation rates (diabetic foot ulcer treatment studies); (8) healing rates and recurrence of disease, among others, for pilonidal sinuses. Studies reporting solely microbiological outcomes were excluded. Decisions on the inclusion of primary studies were made independently by two reviewers. Disagreements were resolved through discussion. Data were extracted by one reviewer into structured summary tables. Data extraction was checked independently by a second reviewer and discrepancies resolved by discussion. All included studies were assessed against a comprehensive checklist for methodological quality. INCLUDED STUDIES - DIABETIC FOOT ULCERS: Thirty-nine trials which evaluated various prevention and treatment modalities for diabetic foot ulcers: footwear (2), hosiery (1), education (5), screening and foot protection programme (1); podiatry (1) for the prevention of diabetic foot ulcers; and footwear (1), skin replacement (2), hyperbaric oxygen (2), ketanserin (3), prostaglandins (3), growth factors (5), dressings and topical applications (9), debridement (2) and antibiotics (2) for the treatment of diabetic foot ulcers. INCLUDED STUDIES - ANTIMICROBIALS: Thirty studies were included, 25 with a randomised design. There were nine evaluations of systemic antimicrobials and 21 of topical agents. QUALITY OF STUDIES: The methodological and reporting quality was generally poor. Commonly encountered problems of reporting included lack of clarity about randomisation and outcome measurement procedures, and lack of baseline descriptive data. Common methodological weaknesses included: lack of blinded outcome assessment and lack of adjustment for baseline differences in important variables such as wound size; large loss to follow-up; and no intention-to-treat analysis. RESULTS - PREVENTION OF DIABETIC FOOT ULCERS: There is some evidence (1 large trial) that a screening and foot protection programme reduces the rate of major amputations. The evidence for special footwear (2 small trials) and educational programmes (5 trials) is equivocal. A single trial of podiatric care reported a significantly greater reduction in callus in patients receiving podiatric care. RESULTS - TREATMENT OF DIABETIC FOOT ULCERS: Total contact casting healed significantly more ulcers than did standard treatment in one study. There is evidence from 5 trials of topical growth factors to suggest that these, particularly platelet-derived growth factor, may increase the healing rate of diabetic foot ulcers. Although these studies were of relatively good quality, the sample sizes were far too small to make any definitive conclusions, and growth factors should be compared with current standard treatments in large, multicentre studies. Topical ketanserin increased ulcer healing rate in 2 studies, while systemic hyperbaric oxygen therapy reduced the rate of major amputations in 1 study. Preliminary research into the effects of iloprost and prostaglandin E1 (PGE1) on diabetic foot ulcer healing suggests possible benefits. However, good quality, large-scale confirmatory research is needed. (ABSTRACT TRUNCATED)

Administration, Topical↗
PubMed2006

Surgical treatment of complicated pilonidal disease: limited separate elliptical excision with primary closure.

OBJECTIVE: We aimed at treating complicated pilonidal sinus (PS) patients by a simple and effective surgical procedure. METHOD: Between 2000 and 2004, 24 selected complicated PS patients were treated with 'limited separate elliptical excision and primary closure'. Patients with extensive or bilateral gluteal involvement, having more lateral, caudal or cephalic sinuses, multiple recurrences and unhealed chronic wounds after pilonidal surgery were included. Asymmetric excision and primary closure was performed to main diseased tissue in the midline. Additionally, small separate elliptical excisions with primary closure were performed in other involved tissues. The fistula tract or granulation tissue were excised subcutaneously if present. All patients were operated under local anaesthesia. The fascial attachments between the skin and coccyx were released at the deep point in the midline and at one side of wound. Suction drains and prophylactic antibiotics were used; subcutaneous tissues were closed with running polyglactin sutures and skin with polypropylene subcutaneously. RESULTS: The mean age of patients was 28.4 years (range 18-38). The mean follow-up time was 2.8 years. One recurrence, one seroma, one wound infection and one wound breakdown were recorded. Healing was always by first intention except in patients with wound infection and breakdown. CONCLUSION: Most of the complicated PS patients can be operated with acceptable rates of recurrences and complications by using 'limited separate elliptical excisions with primary closure'.

Adult↗
PubMed1998

Atypical dermoid sinus in a chow chow dog.

A case of multiple dermoid sinuses in the dorsal cervical and craniothoracic regions in an adult chow chow dog is described. One sinus did not open on the skin surface. This is the first reported case of the condition in this breed and the first time absence of the sinus opening on the skin is described. The use of the term pilonidal sinus to describe this condition is challenged.

Animals↗
PubMed2003

The rhomboid flap for pilonidal disease.

INTRODUCTION: There have been many surgical techniques described for the treatment of pilonidal sinuses. Recurrent disease causes significant morbidity particularly with time from work. AIM: To assess the rhomboid flap's role in promoting one-stage primary healing in pilonidal disease and to evaluate the morbidity and recurrence. METHODS: Fifty-three patients were prospectively recruited of which 27 had previous multiple abscess formation requiring surgical drainage from their pilonidal disease, although none had acute disease at the time of surgery. By using the transposition flap, we were able to obliterate the natal cleft and therefore the rolling action of the buttocks between the cleft in these patients and thereby remove one of the factors involved in pilonidal disease. Hospital stay, healing time, wound infection, wound breakdown and recurrence were noted. RESULTS: There were 47 males and 6 females with a median age of 28 years (range 16-64 years). Median follow-up was 24 months (range 3-36 months). Post-operative morbidity involved superficial wound infection in 7 (13%) which settled with out-patient dressings. There were four recurrences (7%), two occurred between the flap and the anal canal, and the other two in the flap margin needing intervention. All the patients healed their wounds and the median healing time was 14 days. CONCLUSION: As this condition affects a predominantly young population causing significant time off from work, we feel that the Rhomboid Flap is useful for difficult cases in that it allows early return to full activity and does not necessitate prolonged postoperative care.

Adolescent↗
PubMedDate not supplied

[Daily aspects of proctology].

Revue of the commonest anal diseases encountered in the daily practice of general medicine. Hemorrhoids share their symptoms with a whole series of other diseases, and it is this lack of specificity that always calls for a thorough examination to reach a precise diagnosis. The most usual and accessible methods of treatment are described. Anal fissures: their diagnosis and, mostly, their prompt conservative treatment lead to frequent therapeutic success. Anal fistulas: if their description and origins are interesting, it is mostly the prompt incision and drainage of the abscess, by the general practitioner, without use of antibiotics, that will prevent the formation of fistulas. Pilonidal sinuses must be recognized as incurable without the help of surgery. Condylomas can often be treated at the office.

Anus Diseases↗
PubMed1982

Pilonidal fistulas mimicking fistulas-in-ano.

Four pilonidal fistulas which were initially diagnosed as fistulas-in-ano are reported. Only one perianal pilonidal fistula and four perineal pilonidal sinuses have previously been reported. It is suggested that they are more common than the literature suggests and should be excluded when patients present with symptoms of fistula-in-ano.

Adult↗