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[Pilonidal cysts. Excision and intracutaneous absorbable primary suture].

A retrospective survey revealed a shorter stay in hospital for 22 patients with primarily closed wounds than for 38 patients whose wounds were left open to granulate. There were few complications, and the wounds took no longer to heal than those subjected to primary open treatment. A prospective study of closure of wounds where primary conventional suture (n = 10) was compared with intracutaneous absorbable suture (n = 10) showed no difference in the length of stay in hospital or in the rate of complications. Intracutaneous absorbable suture enhances the patient's comfort. No bandage is needed and the patient can take a shower from the first day after operation. Nor are there any stitches to be removed. We recommend intracutaneous absorbable suture for primary closure of wounds.

Humans↗

Radical treatment of acute pilonidal abscess by marsupialization.

Simple drainage is the most common treatment of pilonidal abscess, but later definitive surgery is often necessary. However, radical treatment can also be performed in a single step by several procedures and even better results. The Authors describe the technique of marsupialization and analyse its long-term outcomes in a retrospective study. Between 1992 and 2001, 43 consecutive patients underwent drainage, curettage and marsupialization for acute pilonidal abscess. The procedure was carried out in outpatient setting (day surgery) after local or spinal anaesthesia. Management of the wound was left to the patient and was periodically checked at our out service. The average operating time was 20 minutes. Complete healing required 4-10 weeks in 95.3% of the patients; a persistent chronic fistula was observed in 4.7%. During the follow-up, 6 recurrences (14.6%) were observed in the healed patients. The treatment was then successful in 81.3% of the cases. Our experience shows that it is possible to carry out a radical management of pilonidal abscess in a single step with a high complete healing rate. Marsupialization proved to be a fast procedure and mainly feasible in the outpatient setting.

Abscess↗

Urgosorb dressing: management of acute and chronic wounds.

This article illustrates the outcomes of a 10-patient prospective case study series. The aim of the study was to evaluate the use of Urgosorb in the management of acute and chronic wounds. (Urgosorb is a dressing comprising calcium alginate fibres and hydrocolloid, and is recommended for sloughy and granulating wounds with moderate to high levels of exudate.) Parameters assessed were the effectiveness of exudate management and integrity of surrounding tissue, ease of removal, patient comfort, effectiveness of odour control and observation for any adverse reactions. Data were collected over a period of 6 weeks with weekly evaluations. Healing was not included in the study objectives as it was recognized this would be difficult on a range of highly variable wounds. Although healing was not assessed, 50% of the wounds did heal during the study period. Dressing removal was considered easy in the majority of cases, and patients experienced none, or only mild discomfort. Levels if exudate were well managed and there were no reports of any adverse events.

Acute Disease↗

Laser and light treatments for pilonidal cysts.

Pilonidal (nest of hair) cysts are foreign body reactions accompanied by chronic inflammation. Current accepted treatments include the traditional conservative treatments or aggressive surgery. However, these modalities exhibit a high rate of disease recurrence, especially in patients with hirsutism; therefore, affected patients often are subjected to repeated surgical interventions. This report describes 5 patients treated with either a diode laser or intense pulsed light (IPL), which produced results leaving the patients recurrence free. Four of 5 patients remained recurrence free for 7 months to more than 36 months; one patient experienced a recurrence after 36 months, which was longer than his previous remission. These results suggest laser and IPL technologies are alternatives to traditional surgical intervention, providing potentially longer disease-free intervals and fewer recurrences.

Adult↗

[Sacrococcygeal cysts. Is Lord Millar's procedure an alternative to exeresis?].

The benignancy of sacrococcygeal cysts stands in contrast to their morbidity and rate of recurrence. Due to the differences in the results found in the literature and to the lack of recommendations as to the optimal surgical procedure, the authors have reviewed a series of 69 patients with a chronic inflammatory state. The procedure was either exeresis up to the sacrum (37 patients) or Lord Millar's procedure (32 patients). The latter consisted in a limited exeresis of the portals and in the extraction of the hairs with a brush, followed in principle by a weekly depilatory treatment until the wound was closed. The results in the 2 groups have been compared. Sixty-six patients (87%) were controlled after an average of 3.7 years. The shorter stay in hospital of the patients operated with Lord Millar's procedure (4.9 vs. 7.6 days) and the shorter period of inability to work (14 vs. 26 days) demonstrate the socioeconomical advantage of this procedure. Recurrence occurred in 5 of the 31 patients controlled after exeresis (16%) and in 7 of the 29 patients controlled after a Lord Millar's operation (24%), including one in the subgroup of 16 patients who submitted themselves to a regular postoperative epilatory treatment (6%) and 6 in the group of 13 who were not followed up in our clinic (46%). Thus Lord Millar's procedure represents an alternative to exeresis, provided the patient is motivated enough to submit himself to regular postoperative controls.

Adolescent↗

Surgical treatment of pilonidal disease: comparison of three different methods in fifty-nine cases.

The surgical treatment of pilonidal disease at the Robert Packer Hospital from 1983 to 1989 was reviewed. During that period, 59 patients were operated on for definitive treatment of the disease. The different methods of treatment, namely excision and packing (28 cases), marsupialization (11 cases), and excision and primary closure (20 cases) were compared in terms of age and sex distribution, length of hospital stay, number of post-operative visits, time required for complete healing, complications, and recurrence rate. The operations were performed by surgical residents under the supervision of board-certified surgeons. The average time for complete healing was 21 weeks, 8 weeks, and 3 weeks, respectively, for the different methods. Recurrence rates were essentially nil for all methods. It was concluded that excision and primary closure is the superior method in the treatment of pilonidal disease. The relevant literature was reviewed and the surgical technique discussed.

Adolescent↗