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A pilonidal sinus developed in the superio-medial aspect of the thigh of an above-knee amputee. This is an unusual site for the condition to develop. We suggest that the same aetiological factors that were responsible for the "Jeep Bottom" of World War II were also responsible for this problem in the amputation stump of a Falklands campaign casualty.
OBJECTIVE: To evaluate the outcome of asymmetrical complete excision of pilonidal sinus with simple primary closure without using drains or tension sutures. DESIGN: Prospective study. SETTING: Teaching hospital, Jordan. SUBJECTS: 46 patients with chronic pilonidal sinus treated between November 1994 and October 1998 by excision of the sinus down to the sacrococcygeal fascia and simple primary closure of the wound without tension sutures or drains. RESULTS: Patients stayed in hospital for 48 hours and postoperative pain was minimal. Complete healing was achieved in 41 patients (89%) after a mean follow up period of 36 months (range 12-60). Two patients (4%) developed recurrent sinuses and in three (7%) the wound broke down. All the patients who healed completely were back to work within three weeks of the operation. CONCLUSION: Excision and simple primary closure is a cost-effective way of treating chronic pilonidal sinus.
OBJECTIVE: To study the comparison between the primary closure and open technique after excision of chronic sacrococcygeal pilonidal sinus. METHODS: A randomized study was designed and 77 patients with chronic sacrococcygeal pilonidal sinus were included in this study. This study took place in Rizgary Teaching Hospital, Erbil, Kurdistan, Iraq, from January 1997 to August 2003. The patients were separated into 2 groups; Group A (37 patients) were treated by open method (excision and healing by secondary intention) and Group B (40 patients) for whom primary midline suturing was performed after excision of the pilonidal sinus. The follow up ranged from 1.5-5.5 years (mean 4.16) was through outpatient visits. RESULTS: The Student t test was applied for statistical analysis for the operating time, hospital-stay, time off from work and wound healing time; and the results show extremely significant differences between the 2 groups (p < 0.0001). The statistical analysis of the total number of postoperative complications of both techniques showed a significant difference (p = 0.0401), while the differences were insignificant for each complication when analyzed separately. CONCLUSION: Excision and primary closure for chronic sacrococcygeal pilonidal sinus is superior to excision and healing by secondary intention. We believe that primary midline suturing is a useful method for management of chronic sacrococcygeal pilonidal sinus.
This article reports on the results of conservative treatment of 48 patients with complicated pilonidal sinus disease. The treatment consisted of an injection of phenol 80% into the sinus tract after the patients had undergone depilation and excavation while under local anesthesia. The number of phenol injections in each patient varied from one to nine (mean: two injections). Patients were considered cured if no signs of recurrent pilonidal sinus disease occurred within 1 year after treatment. The mean follow-up period after cure was 3 years (range: 1 to 6 years). The recurrence rate was 6.3% (a 95% confidence interval of 1.3% to 17.2%), which was one of the lowest reported for different methods of treatment for pilonidal sinus disease. The good results in this study justify continuation of conservative treatment of pilonidal sinus disease, especially in view of the low costs and the high degree of patient comfort. Sclerosing therapy with phenol is thus recommended as a successful treatment for complicated pilonidal sinus disease.
OBJECTIVE: To evaluate our short term results of simple V-Y advancement flap for complicated pilonidal sinus. DESIGN: Prospective study. SETTING: Yüzüncü Yýl University hospital, Van, Turkey. SUBJECTS: 23 patients aged 19-47 (mean 31) years with complicated pilonidal sinus treated between October 1994 and December 1996, of whom 9 had had previous operations for pilonidal sinus. INTERVENTIONS: Bilateral V-Y-plasty to close the defect after wide excision (n = 7), and unilateral V-Y-plasty (n = 16) were performed under spinal anaesthesia. RESULTS: There were no complications during the operation. There were 4 minor complications (17%) consisted of seroma (n = 2) and severe wound pain, and wound infection (n = 1 each). All patients were discharged within 10 days of operation and returned to work within 3 weeks. The mean follow up was 18 months (range 10-25) and no recurrences have occurred so far. CONCLUSIONS: Simple V-Y advancement flap may prove to be useful in patients with recurrent and complicated pilonidal sinuses.
Management of pilonidal sinus is frequently unsatisfactory. No method satisfies all requirements for the ideal treatment--quick healing, no hospital admission, minimal patient inconvenience, and low recurrence--but greater awareness of the strengths and weaknesses of existing methods would lead to improved management. Early excision of the pilonidal pit at the time of treatment of pilonidal abscess reduces the high (40 per cent) risk of subsequent sinus. Treatments for pilonidal sinus that flatten the natal cleft halve the risk of recurrence. En block excision of pilonidal sinus with secondary healing should be abandoned and emphasis given to development of treatments, such as primary asymmetric closure, which have more potential. Some treatments are operator-dependent and, to achieve the best results, junior surgeons must be correctly trained and supervised. Future treatment studies must be prospective and randomized, and should compare healing time, recurrence rates beyond 3 years, nurse and hospital visits, patient inconvenience and loss of income.
BACKGROUND: Treatment of chronic pilonidal sinus with excision and primary suture is followed by a relatively high proportion of wound infections. The role of preoperative antibiotic prophylaxis in improving results is not clear. STUDY DESIGN: One hundred fifty-three patients with chronic pilonidal sinus were operated on with radical excision and primary suture and randomized to receive a single dose antibiotic prophylaxis of 2 g cefoxitin intravenously (n = 78) or no prophylaxis (n = 75). RESULTS: The most common complications consisted of partial, slight separation of wound edges with slight discharge. In the group with cefoxitin, 34 patients (44 percent) had complications compared with 32 patients (43 percent) in the group without prophylaxis. Fifty-four patients (69 percent) healed within four weeks in the group with cefoxitin, whereas 48 (64 percent) healed within four weeks in the group without prophylaxis. After a follow-up period of six to 30 months, two patients in each group had not healed. Including these, two patients (3 percent) had recurrences in the group with cefoxitin and five patients (7 percent) in the group without prophylaxis (p = 0.41). CONCLUSIONS: The immediate and short-term results after excision and primary suture for chronic pilonidal sinus are not influenced significantly by a single dose prophylaxis of 2 g cefoxitin.
Pilonidal sinus is a common disorder of the sacrococcygeal region and several surgical treatments have been described. However, rates of recurrences and complications vary, so there is no consensus on one specific approach. In this prospective study from 1 August 2000 to 1 August 2003, 60 patients with pilonidal sinus were treated by our new surgical technique. All patients were operated on by the first author or under his supervision. A vertical elliptical excision was made, and the defect repaired by a fasciocutaneous rotation flap based on the inferior pedicle under general anaesthesia. All patients were discharged from hospital on the first postoperative day. By the 12th day, the wound had healed completely. There were no recurrences during one years' follow-up. Postoperative pain was negligible and the scar was cosmetically acceptable. The inferiorly-based rotation flap is an ideal technique for treatment of pilonidal sinus, cures the disease, has low recurrence rates, little postoperative pain, and few complications. Stay in hospital was short and patients returned to their regular activities in a short time.
Only 15 cases of pilonidal sinus of the umbilicus have so far been reported. A 16th case is described; it supports the theory of acquired origin of the disease. The case fulfilled the criterion for pilonidal sinus--the 36-year-old man had a hair in the infected umbilical cyst. The cyst and umbilicus were excised. The umbilicus was not reconstructed because of the danger of recurrence. It is recommended that a careful search be carried out for hair in all patients with an infected umbilicus.
Primary closure after excision of postanal pilonidal sinus disease frequently has been complicated by wound break-downs. Healing by second intention takes many weeks and requires supervised wound care. A simple technique has been developed which has resulted in primary healing in 28 of 31 patients treated in a 5-year period. Sepsis and haematoma formation, the causes of wound breakdown after pilonidal sinus excision, have been prevented by preoperative preparation, prophylactic antibiotic administration, wound irrigation with povidone-iodine and simple skin closure over a Redivac suction drain for at least 4 days. This series suggests that primary closure can be successful using the technique described.
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OBJECTIVE: To retrospectively analyse the results of pilonidal sinus managed using wide excision with primary eccentric closure with various adipo-fascio-cutaneous flaps. METHODS: Data from 50 consecutive patients who had elective surgery for chronic pilonidal sinus with wide excision of all the sinuses and primary eccentric closure with various adipo-fascio-cutaneous flaps (40 lateral advancements, 4 Z-plasties, four rotations, 1 rhomboid and 1 V-Y advancement) were retrospectively analysed. Special emphasis was placed on partial obliteration of the natal cleft, duration of wound healing, postoperative morbidity and hospital stay, loss of work days, cosmetic outcome and recurrence. RESULTS: In all patients, partial obliteration of the natal cleft was achieved by eccentric primary wound closure, with good cosmesis. Superficial necrosis of the flaps occurred in five patients (3 Z-plasties, 2 rotation flaps). None had collection, haematoma, infection or recurrence. CONCLUSION: Complete eccentric excision and partial obliteration of the natal cleft using various adipo-fascio-cutaneous flaps ensured reliable wound healing with fewer dressings and morbidity, shortened hospital stay and early resumption of work, good cosmesis and prevention of early and late recurrence. The lateral advancement flap is a viable option in the treatment of chronic pilonidal sinus.
PURPOSE: Pilonidal sinus is a common disease, mostly among young males. Although the conventional surgery, secondary repair of the wound after wide excision with or without curettage, is not technically difficult, it takes a long time, weeks or months, for a wound to heal. In this study, we compared outcomes and complications of Z-plasty repair with outcomes and complications of delayed healing by secondary intention (conventional surgery). METHODS: In a randomized, clinical trial, we recruited 72 patients in each arm. All of the patients were operated on by a general surgeon and were followed up for variable periods. Patients in the Z-plasty arm were followed for a mean period of 22.01 months. Patients conventional surgery arm were followed for a mean period of 22.23 months. The main studied outcomes were healing of the wound and disease recurrence during the follow-up period. The main complications that were taken into account were bleeding, hematoma, infection, and recurrence. RESULTS: The two arms were comparable in the age and gender distributions, duration of disease, and history of any types of operations. The duration of hospitalization after the operation was shorter in the conventional surgery group (1.76+/-0.75 days vs. 2.86+/-0.73 days, P<0.001). However, wounds healed much faster in the Z-plasty group (15.4 vs. 41 days, P<0.001). Moreover, it took longer for patients in the conventional surgery group to return to normal activity (17.5 vs. 11.9 days, P<0.001). There was no difference in postoperative complications regarding bleeding, hematoma, infection, or recurrence during the follow-up period in two arms. CONCLUSIONS: Healing was considerably faster in patients who were treated with Z-plasty technique of wound closure. This procedure can be used as a desirable treatment for pilonidal sinus, which is a noncomplex method without increased rate of complications. Nonetheless, it might slightly increase the duration of hospitalization.
PURPOSE: In the past, various methods of surgical or nonsurgical treatment of sacrococcygeal pilonidal sinus have been used. The most common problem in the treatment of this disease is recurrence. In the present study, our aim was to determine the long-term results of the Limberg flap procedure. METHODS: We present 200 consecutive patients with pilonidal sinus who underwent the Limberg flap procedure between 1992 and 2001. Twenty-six (13 percent) of the 200 patients were operated on because of recurrent pilonidal sinus. Under general or local anesthesia, all sinus tracts were resected en bloc, and the Limberg flap was prepared from the gluteal region. We used a suction drain. We met all patients and recorded their complaints and complications of treatment. RESULTS: Five sinuses recurred (2.5 percent). Minimal flap necrosis occurred in only six patients (3 percent). In three patients (1.5 percent), seroma developed. Wound infection occurred in three patients (1.5 percent). The mean hospital stay was 3.1 days, whereas the mean time to return to work was 12.8 days. CONCLUSION: The Limberg flap procedure is a good treatment choice for pilonidal sinus because of its low complication rate, the short time to return to normal activity, and good long-term results. This procedure has good postoperative results and is a comfortable surgical method for the patient.
Interdigital pilonidal sinus of the hand is an occupational hazard in barbers, sheep shearers and cow milkers. We present a case of a subungual pilonidal sinus of the thumb of a dog groomer, complicated by the development of osteomyelitis in the distal phalanx.
BACKGROUND: There is a multiplicity of treatment techniques described for pilonidal sinus. However none of the methods has emerged as being superior to the others. A ideal treatment should be simple, lead to minimal disability and a rapid return to normal activity. We present the preliminary finding an operative technique using fibrin glue in patents with pilonidal sinus. PATIENTS AND METHODS: The study was carried out in the surgical unit of the Armed Forces Hospital, Khamis Mushayt, Kingdom of Saudi Arabia. From September 2001 to February 2004, 25 consecutive patients with primary pilonidal sinus, were prospectively submitted to tension free excision and fibrin glue injection under local anaesthesia as day surgery cases. There were 23 males and 2 females with a mean age of 26.4 years (range 17-50 years). The data recorded included the duration of the disease symptoms, operative time, duration of hospital stay, postoperative analgesia, and return to work. All excised specimens were sent to histopathology. The postoperative disability and the social disruption were evaluated by indirect questions about the ability to drive a car and the position assumed while at home in the outpatient follow-up. RESULTS: The mean duration of the symptoms was 15.4 months (range 4-36 months). Mean operative time including local anaesthetic time was 19.3 min (range 15-50 min). The mean hospital stay was 7.5 h (range 6-10 h). All patients were discharged home on the day of surgery. Mean follow-up was 10.8 months (range 4-36 months). Primary healing was achieved in 24 (96%) patients within two weeks. One (4%) patient had a breakdown of the fibrin glue and the open wound managed with daily betadine dressings. CONCLUSION: The management of pilonidal sinus with excision under local anesthesia and application of a fibrin glue is simple and reduces postoperative disability and disruption of patient social life.
With the uncertainty as to the etiology and the complexities often encountered in its treatment, a pilonidal sinus has been considered as a tricky disease. Wide varieties of approaches are employed in dealing with this ailment ranging from a conservative treatment to an extensive surgical excision or repair. However, a method of simple lying open of pilonidal sinus is still considered as the favored one. We describe a modified approach to the procedure of incision and lying open the sinus tracts. This retrospective study describes 18 patients of chronic pilonidal sinus treated with a technique of radiofrequency surgery under local anesthesia. There were 12 males and 6 females within an age group ranging from 16 to 30. The patients were subjected to a follow-up for a period of 18 months. The patients were discharged on the same day of the procedure. Mean period off work was 7 days. The average healing time recorded was 67 days. Two wound complications in the form of premature closure of the skin edges were noted, requiring trimming of the edges. One of these two remained unhealed. At the last follow-up, no recurrence was found in the remaining 17 patients. In the era when the emphasis is on the criteria like minimum hospital stay, less postoperative pain, early resumption to work and a reduced recurrence rate, there is a future to the procedure of incision and lying open of the pilonidal sinuses by using the radiofrequency wave.
OBJECTIVE: To assess the efficacy of hydrocolloid dressings in wound management after excision of pilonidal sinus. DESIGN: Prospective randomised trial. SETTING: District hospital, Spain. PATIENTS: 38 patients with chronic pilonidal sinus. INTERVENTIONS: Open excision with healing by second intention. Divided into three groups: conventional gauze dressing (control, n = 15), Comfeel (n = 12) and Varihesive (n = 11). MAIN OUTCOME MEASURES: Median healing time, infection rate, intolerance, pain, comfort, ease of management, leakage, and recurrence. RESULTS: Median healing time was 68 days (range 33-168) in the control group, compared with 65 days (range 40-137) in the two hydrocolloid groups combined. There were no differences between the hydrocolloid groups. There were no recurrences during the 74 months of follow-up. A third of the postoperative cultures in the control group grew pathogens compared with 1/23 of the patients treated with hydrocolloid dressings (p = 0.03). This was of no clinical relevance. 14/23 in the hydrocolloid group developed leaks. Pain was significantly less in the first four postoperative weeks among the patients in the hydrocolloid group than in the control group (p < 0.05). CONCLUSIONS: Hydrocolloid dressings lessen pain and increase comfort for patients after excision of pilonidal sinus, though time to healing is no shorten than when a conventional gauze dressing is used.