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[Contribution to the study of the pilonidal sinus].
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Single-dose metronidazole vs 5-day multi-drug antibiotic regimen in excision of pilonidal sinuses with primary closure: a prospective, randomized, double-blinded pilot study.
AIM: To compare infection-related wound complications following excision of pilonidal sinuses with primary closure using either single-dose intravenous (i.v.) administration of metronidazole preoperatively or a broad-spectrum multi-drug regimen. PATIENTS AND METHODS: This is a double-blinded study wherein 50 patients were randomized into receiving either single-drug (metronidazole 500 mg i.v.) prophylaxis preoperatively or multi-drug cover (cefuroxime 1.5 g i.v. and metronidazole 0.5 g i.v. preoperatively, and co-amoxiclav 375 mg orally 8-hourly postoperatively for 5 days). They were reviewed at 1, 2 and 4 weeks postoperatively. Wounds were graded as follows: I, healthy; II, redness and swelling of edges; III, abscess in relation to a suture; IV, spreading wound infection; and V, wound breakdown. Other factors considered were the distance from the lowest wound margin to the anal verge and previous local surgery. RESULTS: Fifty patients (38 men and 12 women, mean age 27 years) underwent pilonidal sinus surgery. At week 1, there was no difference in wound infection rates (p=0.9). However, there were significantly more wound infections in the single-drug group at week 2 (p<0.0001) and week 4 (p=0.03). Seventy-two per cent of all patients had complete wound healing at week 4. Distance from the anal verge and previous surgery did not affect wound infection rates (p> or =0.2). Treating such complications costs 73,219.20 dollars per 100 patients. CONCLUSION: A broad-spectrum 5-day regimen is superior to 'single-shot' antibiotic prophylaxis in preventing infection-related wound complications. However, this study needs to be conducted in a larger number of patients to have statistical power.
Barber's interdigital pilonidal sinus of the hand: a foreign body hair granuloma.
Interdigital pilonidal sinus of the hand is an occupational disease of male barbers. Customers' hairs penetrate the supple interdigital skin, cause a sinus, and later a cyst. Through the sinus, the hairs get entrapped and may occasionally be expressed. Excision of the sinus or the cyst is curative.
Squamous-cell carcinoma in a pilonidal sinus. Case report.
Squamous-cell carcinoma arising in a pilonidal sinus is a rare occasion. The present case stresses the importance of recognizing the condition. Malignancies of this location often has a more aggressive clinical course than squamous-cell carcinoma of other skin locations.
Interdigital pilonidal sinus in the hand.
We report three cases of interdigital pilonidal sinus including a case of a woman with this condition. Previous reports that surgical excision is curative in all cases are not supported by our experience.
The natural history of the post anal (pilonidal) sinus.
Forty-two military hospital patients with post anal (pilonidal) sinus disease who had returned a questionnaire were studied retrospectively. Overall recurrence rate after various treatments was high, and it is suggested this be considered a chronic disease with a natural regression. Seldom this point seems to be after the 30th birthday. However, there appears to be a small group that develop the condition for the first time in their fourth decade. Sitting down at work appears to be a significant (p = less than 0.05) factor in aetiology.
Treatment of pilonidal sinus by phenol injection.
This report reviews the treatment of pilonidal sinus by phenol injection in 54 patients. Forty-four patients were treated initially by phenol injection and this was successful in 70%. The median number of injections per patient was one (range 1-5) with a median hospital stay per injection of two days (range 1-17 days). The median time to complete healing for patients treated by injection alone was two months (range 1-32 months). These results compare very favourably with more radical methods of treatment.
Radical cure of pilonidal sinus by a transposition rhomboid flap.
A new operation for pilonidal sinus is described. This utilizes a rhomboid transposition flap to cover the defect left after radical excision. The results show healing by first intention in 29 out of 30 patients. No patient remained in hospital for more than ten days. Minor infection took place in five cases and major infection in one case. Patients have been followed for up to three years. No recurrence has yet been encountered. The reasons for the success of this operation are discussed.
[Surgical revision of the pilonidal sinus with single shot antibiosis].
For a therapy of the pilonidal sinus there are different surgical and non-surgical methods to be found in literature. In our surgical wing 140 male patients have been operated on this disease from September 1990 to July 1992. 16 cases out of these 140 were re-operations. Using a special surgical technique we applied the excision with a primary closure under single-shot antibiosis in 139 cases. By modifying this antibiosis prophylaxis we could reach a primary success healing rate of up to 96%. A retrospective study among our patients showed a recurrence rate of 5%.
Excision with primary closure and suction drainage for pilonidal sinus in adolescent patients.
Controversy persists regarding the treatment of pilonidal sinus (PS). To evaluate the efficacy of excision with primary closure and closed-suction drainage in adolescent patients, between 1990 and 1999, 34 consecutive patients aged 13-18 years (mean 16.4) underwent PS excision with primary closure and suction drainage. Anesthesia was general in 16 (47%) and spinal in 18 (53%) with a statistical age difference ( P< 0.001) (15.5 vs 17.2 years, respectively). No complications due to the anesthetic were observed. Twenty-one patients (61.8%) had day-case surgery while the others were hospitalized for 2 to 4 days (average 2.3 days). The drain was removed on postoperative day 2 to 6 (average 2.2). Primary healing with no postoperative complications occurred in 30 patients (88.2%); 1 underwent partial opening of the wound because of rupture of the drainage tube during its removal. Postoperative infections requiring incision, drainage, and lay-open occurred in 3 cases (9.1%). No recurrence was found at 12-month follow-up. One recurrence (2.9%) was noted 3 years after surgery. Excision with primary closure and closed-suction drainage as an ambulatory procedure is thus a simple and effective method of treatment of uncomplicated PS in adolescents.
Toxic shock syndrome and necrotizing fasciitis complicating neglected sacrococcygeal pilonidal sinus disease: report of a case.
PURPOSE: This study was conducted to report the rare combination of necrotizing fasciitis and toxic shock syndrome, which both complicated neglected sacrococcygeal pilonidal sinus disease. METHODS: A case report is presented. RESULTS: We describe the rare case of a previously healthy adult male patient who developed necrotizing fasciitis and toxic shock syndrome associated with Streptococcus pyogenes and Bacteroides fragilis. Patient's response to emergency surgery followed by repeated debridements of necrotic tissue, together with aggressive fluid resuscitation, broad-spectrum antibiotic coverage, and hyperbaric oxygenation was good. CONCLUSION: This case serves again as a clear reminder that neglected pilonidal sinus disease can lead to unusual and life-threatening consequences.
Bacteriology and complications of chronic pilonidal sinus treated with excision and primary suture.
Two prospective studies were undertaken to examine the role of bacteria in the outcome after excision and primary suture for chronic pilonidal sinus disease. In the first study 52 consecutive patients were given cloxacillin as prophylaxis. In a second randomised study 51 patients were given 2 g cefoxitin intravenously (n = 25) or no prophylaxis (n = 26). From 49 out of 98 patients (50%) no microorganisms were isolated from sinuses preoperatively. Wound complications were observed postoperatively in 61% of the patients (63/103). A postoperative bacteriology sample was positive in 47 of 49 samples (96%). Preoperative presence of bacteria was not significantly associated with wound complications. Anaerobe isolates were present in 40% of patients preoperatively whereas aerobes were cultured in 43% postoperatively. After an observation period of 30-42 months, recurrences were 13% among the patients (7/52) who had been given cloxacillin. No recurrences were seen in the last study after an observation period of 18-30 months, for an overall 7% in both studies. We conclude that preoperative bacterial isolates, usually anaerobes, in chronic pilonidal sinuses do not influence the complication rate since bacterial isolates from infected wounds are mostly aerobes.
Pilonidal sinus on the neck.
A recurrent nuchal abscess was treated in a 21-year-old obese young man with a total excision of the lesion. In the histopathological findings, many similarities were found between this lesion and pilonidal sinus. We discuss the pathogenesis of this lesion, as well as our belief that this case was a rare example of pilonidal sinus on the neck.
Treatment of chronic pilonidal sinus with local anaesthesia: a randomized trial of closed compared with open technique.
OBJECTIVE: To compare open with closed treatment of chronic pilonidal sinus. PATIENTS AND METHODS: From 1993 to 1996, 100 patients were submitted to excision of chronic pilonidal sinus, with local anaesthesia and were randomized in two groups: group A in which open treatment and group B in which direct suture were performed. The follow-up, ranging from 37 to 89 months, was performed by outpatient visits or by phone. RESULTS: Short-term results showed 6 (12.0%) post-operative complications in group A vs 10 (20.0%) in group B. Long-term results showed 9 (18.0%) complications in group A vs 7 (14.0%) in group B. Mean wound healing was 58 days (range: 29-93) in group A vs 12 (range: 9-61) in group B. The return to normal activity was 25.7 (range: 11-77) vs 10.4 (range: 5-32). Wound healing and the return to normal activity were the only statistically significant differences. CONCLUSIONS: Regarding morbidity neither technique has particular advantages over the other. The closed technique produced quicker wound healing and a quicker return to normal activity.
Pilonidal sinus of the nose.
We report an unusual case of a pilonidal sinus appearing on the nose. From the clinical and pathological findings, we find it difficult to believe that it is an acquired condition. En bloc excision by an external rhinoplasty approach was performed with no evidence of any recurrence.
Squamous carcinoma arising in a pilonidal sinus.
A patient with squamous cell carcinoma arising from an extensive pilonidal sinus was treated with wide local excision, resulting in an apparent cure over a 1-year follow-up period. Review of the literature revealed 32 previously reported cases of this entity. Forty-four percent of these patients developed recurrences or metastases, and 22% died of their disease. The largest historical treatment group with at least 1-year follow-up (19 patients with localized disease) underwent wide excision. Forty-two percent of these patients recurred or developed metastases. Ultimately, 89.5% of these patients were reported cured, but only five survivors were followed for as long as 5 years. Historical experience appears to identify pilonidal tract squamous carcinoma as an aggressive tumor. The reported success of wide local excision is based on a small number of patients followed for short periods of time. Continued experience with this disease should be reported to verify the adequacy of local excision or identify the need for adjunctive therapy.