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PubMed2003

[Reconstructive surgical therapy of infected pilonidal sinus].

INTRODUCTION: Infected sinus pilonidalis is common in young patients, causing much discomfort. Up to now, many different therapy options have been described. The aim of this study was to evaluate the longterm results for infected pilonidal sinus disease after primary drainage of the abscess, secondary rhomboid excision, and Limberg flap procedure. METHODS: 38 patients (5 female, 33 male, mean age 27,mean BMI 26.7 kg/m(2)) suffering from infected pilonidal sinus were first treated by incision of the abscess. After control of the inflammation (8-14 days), radical excision of the pilonidal sinus and defect closure by the Limberg flap procedure were performed. RESULTS: Two patients (5.2%) developed seroma and two (5.2%) developed infected hematoma. During follow-up, one patient (2.6%) showed recurrence. In 33 (87%), postoperative course and follow-up were uneventful (mean 23 months, range 1-36). The mean length of hospital stay was 3.2 days (range 1-4). CONCLUSIONS: In infected sinus pilonidalis disease, primary drainage of the abscess by incision, secondary radical rhomboid excision, and the Limberg flap procedure to close the defect can be recommended as a good therapeutic option due to its low complication rate, acceptable long-term results, and simple operative technique.

Abscess↗
PubMed2001

A fatal case of carcinoma arising from a pilonidal sinus tract.

We report a male patient with carcinoma arising on the basis of neglected sacrococcygeal pilonidal sinus disease. Following initial operation, performed without suspicion of malignancy, histology demonstrated cellular atypia and an increased mitotic rate. A second, wider tissue excision was recommended but the patient declined further surgery. Two years later, he presented with fungating carcinoma involving the rectum but again declined surgery. This rare case demonstrates that the presence of carcinoma should be suspected in long-standing, although innocent-looking, pilonidal sinus disease. In the circumstance of uncertain histologic diagnosis, more generous surgical sampling is required. Every effort must be made to overcome patient's reluctance to accept a second, possibly life-saving procedure.

Carcinoma, Squamous Cell↗
PubMed1994

Pilonidal sinus of the axilla: report of five patients and review of the literature.

Five patients with a pilonidal sinus of the axilla--thought to be the 9th to 13th described in the literature--are reported. All patients were nonhirsute, healthy women aged 17 to 30 years. One or two hairs were seen macroscopically and histologically in 3 of 5 patients, and 1 hair was seen macroscopically in the remaining 2 patients. Friction (abduction-adduction) or suction, as well as assorted factors such as shaving, minor infection, and maceration, seemed to be the most probable cause of pilonidal sinus of the axilla. Complete resection, including the openings of 1 or 2 sinuses, is the only suitable treatment for axillary suppuration.

Adolescent↗
PubMed1999

[Necrotizing fasciitis in sacrococcygeal pilonidal sinus in a patient with bone marrow aplasia. Treatment by large excision and closing by local flaps].

Pilonidal sinus is a frequent, benign disease with either an acute or a chronic course. The treatment of this common disease is essentially surgical. Necrotizing fasciitis is a rare complication of this disease that can be life-threatening, especially in immunocompromised subjects. The authors report the case of a 35-year-old woman with bone marrow aplasia following chemotherapy for type 2 acute myeloblastic leukaemia, who developed necrotizing fasciitis of a pre-existing sacrococcygeal pilonidal sinus and present a review of the literature.

Adult↗
PubMed1981

Pilonidal sinus caused by cutting trauma.

The implantation of hair in the deep corium is responsible for the production of pilonidal sinus. The mechanism responsible may be the drilling of hair, suction, implantation, or sequestration. Cutting trauma can be responsible for the production of pilonidal sinus, if the hair fragments are implanted in the deep corium of the skin.

Adult↗
PubMed1999

Surgical treatment of sacrococcygeal pilonidal sinus disease by excision and skin flaps: the Toulouse experience.

OBJECTIVE: To compare various techniques for the treatment of pilonidal sinus. DESIGN: Retrospective study SETTING: University Hospital of Toulouse, France. SUBJECTS: 246 consecutive patients who presented between 1979 and 1996. The male:female ratio was 2:1, and the mean age 26 years (range 18-69). INTERVENTIONS: 218 one or two stage excision and rotation skin flaps, and 28 simple incisions. RESULTS: 16 sinuses recurred, and no flaps necrosed. CONCLUSION: Excision and rotation skin flaps offers an effective and elegant alternative to the more classic operations for pilonidal sinus as it causes less postoperative pain and shortens convalescence.

Adolescent↗
PubMed2002

Single-dose metronidazole versus 5-day multi-drug antibiotic regimen in excision of pilonidal sinuses with primary closure: a prospective randomised controlled double-blinded study.

BACKGROUND AND AIMS: This pilot study examines whether single-dose intravenous metronidazole preoperatively is at least as effective as a broad-spectrum multi-drug regimen in preventing infection-related wound complications following excision of pilonidal sinuses with primary closure. PATIENTS AND METHODS: A double-blinded study with 50 patients randomised to receiving either a single drug (intravenous metronidazole 500 mg) prophylaxis preoperatively or multi-drug cover (intravenous cefuroxime 1.5 g and metronidazole 0.5 g preoperatively, and oral co-amoxiclav 375 mg 8-hourly postoperatively). They will be reviewed 1, 2 and 4 weeks postoperatively. The wound will be graded as: I, healthy; II, redness and swelling of edges; III, abscess related to a suture; IV, spreading wound infection; V, wound breakdown. Other factors considered are the distance from the lowest wound margin to the anal verge, and previous pilonidal sinus surgery. RESULTS: Results awaited. CONCLUSION: Single-dose metronidazole seems an appropriate and low-cost antibiotic to consider for prophylaxis in pilonidal sinus surgery. This study will form the base for a trial to be conducted in larger numbers as a randomised controlled trial in order to have statistical power.

Amoxicillin-Potassium Clavulanate Combination↗
PubMed1979

Treatment of pilonidal sinus by radical excision and reconstruction by rotation flap surgery of Z-plasty technique.

Defects after excision of large pilonidal sinuses were reconstructed by either rotation skin flaps or a Z-plasty technique. Altogether, 16 patients were operated on, 10 with a rotation flap and 6 with a Z-plasty technique. All the patients except one underwent a radical operation. The patient not having a radical operation had a recurrence. Two cases in the Z-plasty groups acquired an infection in the distal part of the wound necessitating reoperation on the resultant sinus. The disability after this more extensive surgery was not more pronounced than after ordinary surgical procedures. For large recurrent pilonidal sinuses, radical excision and primary suturing of the wound using a rotation flap is recommended as the method of choice.

Adult↗
PubMed1986

Treatment of pilonidal sinus disease with the Z-plasty procedure (modified).

This article points out the significance of the internatal cleft for the formation of pilonidal sinus. Elimination of the internatal cleft by means of Z-plasty carries the smallest recurrence rate. The author, in an attempt to eliminate this small recurrence rate, applied a modified Z-plasty which is described in the present communication, and which was successfully applied in a series of cases of pilonidal sinus.

Female↗
PubMedDate not supplied

Electrocauterization in the treatment of pilonidal sinus.

In view of the morbidity and recurrence rates associated with the various current techniques adopted for the treatment of pilonidal sinus, sinus electrocauterization (EC) was practiced in 18 patients. The results were compared with those obtained after excision operation in another 18 patients. The 2 groups were matched for age, gender and follow-up. Entry criteria comprised non-recurrent quiescent pilonidal sinus. In the EC group, the sinus tracks were laid-open, the debris removed and sinus walls cauterized. In the excision group, the sinus tracks were excised and the wound was left open. Patients were followed up for a mean of 29.6 months. Of the EC group, healing was achieved in 16 patients after the 1st cauterization and in 2 after recauterization. 15 cases of excision group were cured; sinus re-excision was performed in 3 patients in 2 of whom healing was accomplished. The technique of EC compared favourably with the other conventional techniques in terms of recurrence rate. In addition, it is simple, easy, has no complications and is performed as an outpatient procedure.

Adult↗
PubMed2002

[Therapy of the pilonidal sinus--Primary wound closure or open wound after excision].

The postoperative follow up of 177 operations in 162 patients with pilonidal sinus was investigated. After excision of the sinus a primary wound closure was performed in 80 cases; in 83 cases the wound was left open. After primary wound closure 40 % of the patients showed a primary healing of the wound. Although the remaining 60 % of the wounds healed secondarily the patients were not disabled longer and did not demonstrate more frequently recurrences than those with open wound management. As a consequence we recommend a primary wound closure after excision of a pilonidal sinus.

Adolescent↗
PubMed1987

'D' excision for sacrococcygeal pilonidal sinus disease.

A new procedure is described for treating pilonidal sinus by an excision and primary suture technique, and the results reported in 30 consecutive patients so treated--28 with chronic sinuses and 2 with an acute abscess. Seventeen patients (Group 1) had had no previous surgery, while 13 (Group 2) had had multiple previous operations. A total of 24 patients (80%) healed after the operation, their mean hospital stay being 16 days. In Group 1 the success rate was 88% with a mean hospital stay of 15 days; in Group 2 the comparable figures were 69% and 17 days. After additional procedures (usually curettage) all patients healed.

Adult↗
PubMed1994

Conservative surgical treatment of 27 cases of umbilical pilonidal sinus.

A retrospective study of 27 cases of umbilical pilonidal sinus (UPNS) was conducted at the Central Military Hospital of Beirut between 1987 and 1991. In this study a simple conservative surgical technique is described by removing the dead hair and the cotton like dirt as an outpatient procedure without need for anaesthesia or hospitalization. There were 26 male and one female, a mean age of 26 years, patients were followed for a period of 2 years (1987-1991). The cure rate was 98% with only four cases which needed more than one session of treatment.

Adolescent↗
PubMedDate not supplied

Do we need to use subcutaneous suture for pilonidal sinus treated with excision and simple primary closure?

OBJECTIVE: Pilonidal sinus (PS) is a chronic intermittent disease. There are numerous surgical treatment procedures that have been previously reported, yet none have been proved to be ideal. The main issues concerning the surgical treatment of PS are simplicity and cost-effectiveness. This study is designed to research the possibility of decreasing operation costs in the excision and simple primary closure technique of PS by omitting subcutaneous suture usage. MATERIALS AND METHODS: 152 male patients with chronic PS were included in the study. All patients were treated with excision and simple primary closure technique and randomized into two groups. Group-I (n = 74) received subcutaneous closure with 2/0 polyglactin sutures, but Group-II (n = 78) did not. Wound edges were re-approximated by using deep interrupted matress 0 no polypropylene sutures in both groups. RESULTS: In Group-I; overall 7 (9.5%) early complications were noted; 2(2.7%) wounds broke down and 5 (6.7%) experienced superficial wound infections. Any late wound complications were noted. A total of 98 polypropylene and 104 polyglactin sutures were used. In Group-II; overall 5 (6.4%) early wound complications were noted; 3 (3.8%) had wound dehiscence and 2 (2.6%) developed superficial wound infections. Also, 1 (1.3%) late wound complication (wound dehiscence) occurred. Overall 104 polypropylene sutures were used. CONCLUSION: Excision and simple primary closure is a simple and cost effective surgical procedure in the treatment of PS. Omitting the use of subcutaneous sutures makes the procedure simpler and decreases the operation costs.

Adolescent↗
PubMed1997

[Excision and open wound treatment of pilonidal sinus. Rate of recurrence and duration of work incapacity].

BACKGROUND AND OBJECTIVE: There is controversy whether open or closed operative treatment of pilonidal sinuses is better, especially with regard to postoperative recurrence rate and duration of work incapacity in these mostly young patients. Having performed radical excision with subsequent open wound healing, we have analysed recurrence rate, duration of sickness certification, amount of pain and general impairment in our group of patients. PATIENTS AND METHODS: All 103 patients operated on for pilonidal sinus between January 1992 and December 1994 (84 men, 19 women, mean age 28.1 [16-68] years) were sent a questionnaire to record any recurrence, duration of certified incapacity to work, amount of pain and general satisfaction of the operation, using visual analogue scales. Complete answers were obtained from 86 patients (83.5%). RESULTS: The follow-up period ranged from 12 to 47 months postoperatively. The recurrence rate was 12.8%, median duration of work incapacity was 4 weeks, longer for the employed and manual workers than for self-employed. Postoperative pain (scale of 0-6) averaged 3.3 and 2.3, respectively, for the in-hospital and post-hospital periods. CONCLUSION: Taking into account duration of incapacity, general patient satisfaction and recurrence rate, the radical excision method with subsequent open wound granulation provides a reasonable alternative to closed methods. But a definitive assessment of the advantages of the open method with respect to these criteria must await the results of prospective randomized series.

Adolescent↗