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PubMedDate not supplied

Efficacy of local adrenalin injection during sacrococcygeal pilonidal sinus excision.

BACKGROUND: The most commonly preferred treatment method for sacrococcygeal pilonidal sinus disease is surgery. Peroperative and postoperative hemorrhages may develop frequently because of the increased vascularity of the region. The aim of this study was to evaluate the effects of adrenalin, a potent vasoconstrictor agent, on pilonidal sinus operations in comparison to a control group. METHODS: A prospective, randomized, double-blind, clinical study was designed and 51 patients with symptomatic, uncomplicated pilonidal disease were included (44 males and 7 females; mean age 24.5, range 16-44 years). Adrenalin 0.1 mg with 10 ml 0.9% NaCl (1/100,000 dilution) was injected through the incision tracts to all layers and the base of the incision area in group 1 (n = 21). The same process was applied to group 2 (n = 21) with 10 ml physiological serum solution. Then, after removal of the sinus and its tracks, a suction-type drain was placed in the pouch in all cases and the incision was primarily closed. Peroperative and postoperative hemorrhage, and operation time were accepted as the evaluation criteria. Cases were followed for 6 months postoperatively. RESULTS: The amount of peroperative hemorrhage was 6.5 +/- 3.5 ml in group 1 and 17.5 +/- 9.5 ml in group 2 (p < 0.001). The postoperative hemorrhage was 11 +/- 7.5 ml in group 1 and 13.5 +/- 6 ml in group 2 (p > 0.05). The operation time was 14 +/- 5 min in group 1 and 22 +/- 8.5 min in group 2 (p < 0.05). No reactionary hemorrhage, hematoma or recurrence was seen during the follow-up period. CONCLUSIONS: Adrenalin injection is quite effective to decrease peroperative bleeding and operation time, but it does not decrease postoperative bleeding and the need for a drain.

Adolescent↗
PubMed2002

Recurrent pilonidal sinus treated with epilation using a ruby laser.

BACKGROUND: Surgical treatment of pilonidal sinus disease of the natal cleft has a significant failure rate. Reported here is the case of a 33-year-old man who first presented at the age of 18 with a pilonidal sinus. METHOD: The patient's scar was treated with a ruby laser using a pulse length of 2 ms and energy densities of 6.0-7.2 J/cm(2). Treatment was performed five times at 6-week intervals. RESULT: The sinus healed and has not recurred to date, 6 months after the last treatment. CONCLUSION: It is felt that there may be a future for this treatment, either as primary treatment or as an adjunct to surgery in refractive cases. It could also be useful in preventing the growth of hairs into wounds that have been left open and allowed to granulate.

Adult↗
PubMed1992

[Light and scanning electron microscopy study of the pathogenesis of pilonidal sinus and anal fistula].

From various theories about the development of the pilonidal sinus Stelzner's opinion as to an acquired disease is generally accepted. Our scanning electron microscopic investigations strengthen this theory that hair splits and drills into the skin. Hooks keep it from retracting. Needlelike sharp ends may contribute to the hair piercing the skin. The anal fistula differs from the pilonidal sinus concerning morphology and pathogenesis. Surgical treatment must consider the localisation of the proctodeal gland.

Adult↗
PubMed1992

[Treatment of pilonidal sinus with excision and primary suture using a local, resorbable antibiotic carrier. Results of a prospective randomized study].

The excision of a pilonidal sinus with wound healing by second intention, often results in a long duration of treatment. On the other hand, primary suture after excision has a high rate of abscess formation. In a randomized study we treated 40 patients with excision of pilonidal sinus, insertion of a collagen sponge containing Gentamicin and primary suture (group 1) to prevent this abscess formation. Another 40 patients were treated in the same way but without applying the Gentamicin-collagen sponge (group 2). There had been no significant differences as to the history and duration of the disease, the wound size, the degree of inflammation, the weight of the patients or the amount of hair near the sinus. In group 1 only 7.5% of the patients had a postoperative abscess formation, in contrast to group 2, with an abscess rate of 52.5% and consecutive surgery (p less than 0.001). One year after the operation the recurrence rate was 0 in both groups. Considering the results mentioned, surgical excision of the pilonidal sinus in combination with insertion of a resorbable antibiotic sponge we recommend this therapy.

Abscess↗
PubMedDate not supplied

[Pilonidal sinus: long term results of excision and closure technic. Review of the literature].

The Authors report their experience in the surgical management of pilonidal sinus with modified Leichtling technique. Long term results of various treatments proposed in the past are analyzed: it is not possible to identify a satisfactory procedure for the treatment of pilonidal sinus. Ideal treatment should avoid hospital admission and general anaesthesia, assure a short time of healing, a reduced number of complications, a low risk of recurrence and a minimal time off from work. Authors' variations to the original technique show good results for non recurrent pilonidal sinus and a lower number of failed primary healing. Recurrences are probably related to the patient anatomical status which may be modified only by flattening natal cleft or surgically changing follicles orientation of presacral skin, together with a meticulous hygiene and shaving of the presacral healing area as well as a dietary regimen for obese patients.

Adolescent↗
PubMed2005

Radio surgery in pilonidal sinus: a new approach for the old problem.

BACKGROUND: A wide variety of approaches are employed in dealing with sacro-coccygeal pilonidal sinus disease. They range from a conservative treatment to an extensive surgical excision. However, a method of lying open sinuses is still practiced in many parts of the world due to its simplicity and favourable outcome. MATERIAL AND METHODS: This study describes a modified approach to the above procedure where a radio surgical device has been used to carry out the complete process. Twenty-one patients with chronic pilonidal sinus were treated with this technique of radio surgery. There were 11 males and 10 females. RESULTS: The mean hospital stay was 8 hrs and mean time to return to work was 7 days. Mean healing time was recorded as 71 days. One patient had a delayed wound healing due to premature approximation of the external wound, needing refashioning of the edges. No recurrence was seen at a 2-year follow-up. CONCLUSION: An ideal surgical procedure for pilonidal sinus should be one, aiming at reducing hospital stay, minimizing tissue assault, promoting early work resumption and preventing recurrence. The technique of lying open of sinus tract using radio surgery technique resulted in achieving less tissue trauma, pain and inflammation. The patients returned to their routine within a short duration of time. The results do compare with the other extensive surgical procedures in vogue.

Adolescent↗
PubMed1996

Recurrent pilonidal sinus after excision with closed or open treatment: final result of a randomised trial.

OBJECTIVE: To find out the recurrence rate of chronic pilonidal sinus after excision and primary suture compared with open excision and healing by second intention. DESIGN: Randomised trial. SETTING: Teaching hospital, Norway. SUBJECTS: 120 Patients treated between 1987 and 1989. INTERVENTIONS: 60 Patients were treated by excision and primary suture and 60 by open excision. The median follow-up period was 4.2 years. RESULTS: Recurrent pilonidal sinus was seen in six patients (10%) after primary suture compared with three patients (5%) after open treatment (p = 0.49); 57 (95%) and 55 (92%), respectively, were satisfied with the outcome of treatment at follow-up (p = 0.72). CONCLUSION: Excision and primary suture compares favourably with open excision and healing by second intention in the treatment of chronic pilonidal sinus.

Adolescent↗
PubMed2005

Modified lay-open (incision, curettage, partial lateral wall excision and marsupialization) versus total excision with primary closure in the treatment of chronic sacrococcygeal pilonidal sinus: a prospective, randomized clinical trial with a complete two-year follow-up.

BACKGROUND AND AIMS: The best surgical technique for treating pilonidal sinus disease is controversial. The aim of this study is to compare the modified lay-open technique with primary closure following excision with respect to operating time, healing time, time before return to work, morbidity rate, and recurrence rate. PATIENTS AND METHODS: After a pre-study power analysis, 142 patients with chronic sacrococcygeal pilonidal sinus were prospectively and randomly allocated, either to the modified lay-open group (Group A, n=73) or the primary closure group (Group B, n=69). In the former, incision, curettage, partial lateral wall excision, and marsupialization were performed. Single doses of cefazoline (1 g) and metronidazole (500 mg) were given intravenously 15 min before surgery to all patients. RESULTS: There were no differences with respect to gender, age, body mass index, and mean operating time between the groups. In Group A, healing failure and early bridging occurred in one patient each. In Group B, wound infection occurred in four patients, wound breakdown in three, one healing failure and hematoma in one patient each. Morbidity and recurrence rates were significantly lower in Group A (2.7 vs. 13%, P=0.028 and 1.4 vs. 17.4%, P<0.001 respectively). The median time before return to work in Group A was significantly shorter than in Group B (3 [range 2--8] vs. 21 [range 14--63] days, P<0.001). The median healing time in Group A was significantly longer than in Group B (7 [range 3--16] weeks vs. 2 [range 2--9] weeks; P<0.001). CONCLUSION: The results of the present study suggest that modified lay-open is superior to excision with primary closure for the surgical treatment of chronic sacrococcygeal pilonidal sinus with regard to morbidity and recurrence rates, and time before return to work, although healing time is longer.

Adolescent↗
PubMed1988

A new technique for treatment of pilonidal sinus.

Twenty-seven patients with chronic pilonidal sinus were treated by a new adopted technique. It was found to be simple, time-saving and to minimize the postoperative morbidity and hospital stay. Results of this new technique were compared with those of other excisional methods in the literature and were found to be superior to them with a shorter hospital stay. The new technique also preserves the internatal cleft, which is valuable in restoring the normal configuration of the breech. Six-year follow-up revealed no recurrences.

Adult↗
PubMed2002

Influence of failure of primary wound healing on subsequent recurrence of pilonidal sinus. combined prospective study and randomised controlled trial.

OBJECTIVE: To find out whether failure of primary wound healing after excision and primary suture for chronic pilonidal sinus predicts recurrence. DESIGN: Follow-up of one prospective study and one subsequent randomised, multicentre study. SETTING: Three teaching hospitals in WesternNorway. SUBJECTS: A total of 197 consecutive patients operated on for chronic pilonidal sinus. INTERVENTIONS: Fifty two patients in the prospective group were given cloxacillin perioperatively. In the randomised study, 145 patients were randomised to have either a single preoperative dose of cefoxitin 2 g intravenously (n = 73) or no prophylaxis (n = 72). Patients were followed up for a median of 7 years. MAIN OUTCOME MEASURES: Recurrence of pilonidal sinus. RESULTS: In the prospective group there were 10 recurrences (19%). In the randomised study 6 patients (8%) who had been given antibiotic prophylaxis had a recurrence compared with 14 patients (19%) who had not been given prophylaxis (p = 0.09). In both groups, failure of primary normal healing was significantly associated with early recurrence (p = 0.0002). Neither the use of antibiotics nor sex had any significant influence on the incidence of recurrences. Most recurrences occurred within the first year. CONCLUSION: Wound complications significantly influenced the recurrence rate whereas antibiotics did not. Most recurrences were seen early.

Adult↗
PubMed1995

[Retrospective study 10 years after plastic surgery for sacrococcygeal pilonidal sinus].

The authors give a brief summary on the etiology and pathomechanism of the sacrococcygeal pilonidal sinus. They have distinguished the congenital, cystic deformation (dermoid cyst) from the pilonidal sinus which is considered to be an adventitious illness. During ten years (1976-1985) 208 patients were operated on with the method the authors applied. Only one early recurrence was registered and 7.2% of the patients recovered from secondary healing. Delayed recurrences were analysed according to questionnaires. From 151 of the questionnaires only three male patients complaints referred to delayed recurrence.

Dermoid Cyst↗
PubMed2002

The effect of obesity on the results of Karydakis technique for the management of chronic pilonidal sinus.

BACKGROUND AND AIMS: Body mass index (BMI) was assessed as an objective indicator of obesity to determine whether it has an effect on the results of the Karydakis technique for managing chronic pilonidal sinus. PATIENTS AND METHODS: The prospective study included 41 consecutive patients with chronic pilonidal sinus categorized according to their BMI as obese (BMI >/=26.5, n=32) or nonobese (BMI <26.5, n=9). Patient data included demographics, symptoms, duration of disease, previous management, postoperative course, morbidity, and recurrence. All patients were treated by the Karydakis flap and were discharged on the 2nd-4th day postoperatively. Patients were followed-up for a mean of 25.7 months (range 3-38). RESULTS: The mean operating time was significantly longer in obese patients, and there was a trend to mean hospital stay being longer in them than in nonobese patients. Minor postoperative complications were encountered in four patients: two in the obese group had a seroma that resolved in 2 weeks with conservative measures, and two others, one in each group, suffered from wound infection that resulted in partial wound dehiscence in the obese patient but healed with secondary intention after 20 days without prolonging hospital stay. In the obese group the mean BMI of patients with complications (excluding recurrence) was significantly higher than that in patients without complications. Recurrence, at 13 months postoperatively, was observed in only one patient (3.1%) who had a BMI of 32.2. CONCLUSION: These findings show that (a) the Karydakis procedure for managing chronic pilonidal sinus in obese patients is easy to perform, has a fast healing time, short hospital stay, rapid return to work, and a low recurrence rate, (b) the results are similar between nonobese and obese patients, with no recurrence seen in these patients, and (c) complications occur in patients with a BMI greater than 30; in such patients a dietary regimen before operation is advisable, and inserting a suction drain during operation is recommended to avoid seroma formation.

Adult↗
PubMed1989

Recurrent squamous-cell carcinoma arising in pilonidal sinus tract--multiple flap reconstructions. Report of a case.

Squamous-cell carcinoma arising from a pilonidal sinus tract is an unusual complication of a common condition. Approximately 36 cases of carcinoma related to pilonidal disease have been reported in the literature. Wide excision with tumor-free margins has yielded five-year disease-free states in 55 percent of patients. Recurrence rates have been 44 percent to 50 percent in several large series. Regional (inguinal) nodal metastasis occurs in 14 percent of patients, heralding a dismal prognosis. Radiation and chemotherapy are of minimal palliative value. Reconstruction of these patients has consisted of split-thickness skin grafts or local cutaneous and myocutaneous flaps. Some authors have allowed healing by secondary intention. A case of squamous-cell carcinoma arising in a chronic pilonidal sinus tract is reported. Local recurrence required an extensive resection resulting in a large sacral/perineal defect. A single-stage reconstruction of this defect with multiple muscle and musculocutaneous flaps is described.

Carcinoma, Squamous Cell↗
PubMed2002

Pilonidal sinus: how to choose between excision and open granulation versus excision and primary closure? Study of a series of 141 patients operated on from 1991 to 1995.

AIMS: The purpose of this study was to evaluate excision and open granulation versus excision and primary closure as treatments for pilonidal sinus. SUBJECTS AND METHODS: We evaluated a group of 141 patients operated on for a pilonidal sinus between 1991 and 1995. Ninety patients were treated by excision and open granulation, 34 patients by excision and primary closure and 17 patients by incision and drainage, as a unique treatment of an infected pilonidal sinus. RESULTS: The first group, receiving treatment of excision and open granulation, experienced the following outcomes: average length of hospital stay, four days; average healing time; 72 days; average number of post-operative ambulatory visits, 40; average off-work delay, 38 days; and average follow-up time, 43 months. There were five recurrences (6%) in this group during the follow-up period. For the second group treated by excision and primary closure, the corresponding outcome measurements were as follows: average length of hospital stay, four days; average healing time, 23 days; primary healing failure rate, 9%; average number of post-operative ambulatory visits, 6; average off-work delay, 21 days. The average follow-up time was 34 months, and two recurrences (6%) were observed during the follow-up period. In the third group, seventeen patients benefited from an incision and drainage as unique treatment. The mean follow-up was 37 months. Five recurrences (29%) were noticed, requiring a new operation in all the cases. DISCUSSION AND CONCLUSION: This series of 141 patients is too limited to permit final conclusions to be drawn concerning significant advantages of one form of treatment compared to the other. Nevertheless, primary closure offers the advantages of quicker healing time, fewer post-operative visits and shorter time off work. When a primary closure can be carried out, it should be routinely considered for socioeconomical and comfort reasons.

Adolescent↗
PubMed1999

Recurrent squamous-cell carcinoma arising in sacrococcygeal pilonidal sinus tract: report of a case and review of the literature.

PURPOSE: Carcinoma arising in a pilonidal sinus is a rare complication. This study reports the case of a patient with recurrent squamous-cell carcinoma arising in a sacrococcygeal pilonidal sinus tract. METHODS: This patient was treated with a wide local excision and mesh grafts. Three months later the patient was treated with adjuvant radiation therapy. RESULTS: The patient died two years later from recurrence in inguinal lymph nodes, liver, and lungs. CONCLUSION: Some authors propose consideration of treatment with adjuvant chemotherapy and radiation therapy in addition to complete local excision as a possible means to decrease the local recurrence rate.

Carcinoma, Squamous Cell↗
PubMed1994

Management of recurrent pilonidal sinus by simple V-Y fasciocutaneous flap.

PURPOSE: Several methods of managing the sacrococcygeal pilonidal sinus have been described, and fervent arguments for each form of therapy can be found in the literature. Recurrence unfortunately plagues all forms of therapy, though it is evident that the lowest rates have been reported for procedures involving local flap reconstruction. We conducted this case review to evaluate the validity of a simple reconstructive procedure for recurrent pilonidal disease. METHODS: We describe the application of the V-Y fasciocutaneous advancement flap to reconstruct the defect following radical excision of recurrent pilonidal sinus in five consecutive patients. RESULTS: Tension-free closure offers the benefits of a reduction in postoperative pain, less restriction in activity, and a shorter hospital stay. CONCLUSIONS: Preliminary results offer evidence of the efficacy of the simple reconstructive procedure in the management of difficult cases.

Adult↗
PubMed2001

Pilonidal sinus of the finger pulp.

A case of pilonidal sinus of the finger-tip pulp in a male barber is reported. The site appears to be previously unreported for this condition.

Adult↗
PubMed1991

[Secondary tuberculous infection of a pilonidal sinus].

The authors report the case of a pilonidal sinus which was the site of active tuberculosis. They stress the rarity of this condition. Particular emphasis is placed upon the need for histopathological examination of all operative specimens resulting from excision of a perianal lesion.

Humans↗