Cleft closure for the treatment of pilonidal sinus disease

Aim Treatments for pilonidal sinus disease are numerous and prone to failure. In complex disease, the morbidity is high. In contrast with complex operations, the cleft closure procedure can be done simply and successfully with better cosmetic results. We present the results of a single‐centre experience of this procedure. Method One hundred and fifty patients had the operation; most were treated as a day case and many were operated under local anaesthetic. Results Primary healing occurred in 83 (60%) of 139 patients. Recurrences requiring surgery have been seen in 5.3%. The long‐term cosmetic appearance has been noted to approach normality. Conclusion Cleft closure is a simple and highly effective operation to treat recurrent or extensive pilonidal sinus disease.     

Endoscopic pilonidal sinus treatment versus total excision with primary closure for sacrococcygeal pilonidal sinus disease in the pediatric population

Purpose

To evaluate the effectiveness and safety of Endoscopic Pilonidal Sinus Treatment (EPSiT) in the pediatric population and compare it with excision followed by primary closure (EPC) regarding intra- and postoperative outcomes.

Umbilical pilonidal sinus: Ambulatory surgical technique

Hypothesis: Umbilical pilonidal sinus, although uncommon, can become complicated by inflammation, cellulitis and suppuration. Usually it tends to recur after conservative treatment. Various surgical procedures have been suggested for its treatment, but most of them were based on experience with few cases.

Our aim is to describe a modified surgical technique at the day-hospital for the treatment and prevention of recurrent disease.

Design: Retrospective case series.

Settings: Unit of ambulatory surgery, regional day-hospital.

Patients and surgical technique: Twelve consecutive cases of umbilical pilonidal sinus were treated at our hospital by subcutaneous excision of the involved tissue and the deep portion of the umbilicus. The operation was performed under general anesthesia. All the patients were discharged at 5–6 h after surgery.

Results: Minor complications were encountered in two cases: seroma and hyperaemia of the skin treated conservatively at out patient clinic. No recurrent disease was found in two years of follow up. All the patients were satisfied with the cosmetic results of the procedure. This technique was cost effective since it was carried out as an ambulatory procedure.

Conclusions: A simple surgical technique for the treatment of umbilical pilonidal sinus is proposed. Besides its satisfactory results in eradicating the disease it is cost effective.     

Simple excision and primary closure of pilonidal sinus: a simple modification of conventional technique with excellent results

OBJECTIVE: Pilonidal sinus (PNS) is a common condition, which warrants surgical intervention. A number of surgical options have been suggested with variable recurrence rate. This study proposes a modification of a standard method. METHODS: A total of 51 patients with sacrococcygeal PNS were sequentially treated by the standard method devised by one Consultant Colorectal Surgeon (IA). The principle is based on: 1, after excising the PNS ensure obliteration of the natal cleft by releasing the fat pad from the gluteal fascia; 2, avoid tension and 3, encourage patients to lie on their back immediately after the operation. RESULTS: Follow-up was available from 51 patients ranging from 14 to 49 months. All patients were discharged within 48 h. There was only one recurrence, which was successfully treated. CONCLUSION: Our results suggest that PNS can be successfully treated by our hitherto undescribed method, patients can be discharged early and there is very low recurrence rate.     

Excision and primary closure of pilonidal sinus using a drain for antiseptic wound flushing

BACKGROUND: In the case of pilonidus sinus treated with primary intention surgery the uneventful healing is still difficult to obtain, as indirectly proven by the number of different procedures that have been suggested, such as cyst excision with or without primary closure, excision followed by marsupialisation, and excision followed by skin flap transposition. The procedure described here involves excision and primary closure, with a drain being used to flush the operative cavity with an antiseptic solution. METHODS: Two hundred and forty-three patients (173 men and 70 women) were treated by excising the pilonidal sinus and placing a 12F suction drain at the base of the wound, with its tip being brought out in the left gluteal region at least 5 cm laterally to the lower end of the suture. Suction was stopped on the first postoperative day and the drain was cut just above the skin. On day 2, a 5F catheter was inserted through the drain and the cavity was flushed with an antiseptic solution followed by sterile saline solution; the same treatment was repeated on days 4 and 6. The drain was removed on day 8 or 9, some of the stitches on day 8 or 9 and the rest on day 9 or 10. The surgery was performed on a day hospital basis in 207 cases; the remaining 36 were hospitalized overnight and discharged on the following day. RESULTS: Healing was always by first intention, with none of the 243 patients experiencing any complications. The postoperative follow-up now ranges from 5 to 15 years, and there have not been any recurrences. CONCLUSIONS: The drainage of blood from the bottom of the wound and the use of antiseptic/saline flushing are essential for primary intention healing and the avoidance of recurrences.     

Elliptical rotation flap for pilonidal sinus

Background

The treatment of the symptomatic pilonidal sinus is surgical with one of the most extensive being excision of the diseased tissue down to the sacral fascia. The closure of the defect is the matter of debate. An elliptical rotation flap has been used for pilonidal sinus treatment with no recurrence rate.

Methods

From April 1996 to June 2001, 20 patients were treated with this technique. The surgical procedure is a vertical elliptical excision of the diseased tissue and an elliptical cutaneous rotation flap to close the defect.

Results

Twenty patients underwent with this technique, mean age 23.4 years (range 18 to 34). Mean follow-up was 42 months. All patients were discharged on the first postoperative day. Primary healing was achieved in all of the patients in 2 weeks. No recurrence was observed.

Conclusions

Elliptical rotation flap is recommended for patients selected for defect closure. It offers improved patient comfort, shorter hospital stay, and no recurrence rate.     

Intermammary pilonidal sinus: The first case series

IntroductionPilonidal sinus (PNS) is an inflammatory condition caused by hair penetration into the epidermis. It occurs usually in sacro-coccygeal area. Intermammary pilonidal sinus is a very rare variant with a few case reports in literature. The aim of this study is to highlight the presentation and management of intermammary pilonidal sinus.MethodA retrospective multicenter case series. Including all cases of intermammary PNS admitted to either of 5 major tertiary hospitals in Kurdistan region of Iraq. Inclusion criteria were any case of intermammary PNS diagnosed by histopathological examination. The data were taken from the medical records and direct interview with the patients.ResultsThe case series included 12 patients, all case were female. The age range was from 13 to 29. All of cases were obese with body mass index (BMI) ranged between 30.1–32.2 kg/m². All of them presented with discharge for a long time ranging between four weeks to two years. Nine cases (75) were diagnosed preoperatively as cases of infected sebaceous cysts. Resection and direct closure without flap were done for nine (75%) of them and in other three cases (25%), the PNS were resected and left for secondary healing. Three of the patients (25%) developed recurrence.ConclusionIntermammary PNS occurs in young, obese ladies with large breasts which are kept in tight brassieres. Resection and primary closure is the main method of management.     

潜毛囊肿和潜毛窦的诊断治疗

目的分析潜毛囊肿和潜毛窦的诊断和治疗。方法回顾性分析8例少见病例——潜毛囊肿和潜毛窦的临床经过,结合国内外的相关报道进行分析。结果 8例潜毛囊肿和潜毛窦患者中,4例诊断明确,进行手术切除治疗,疗效满意。3例曾误诊为肛旁脓肿切开引流、1例以穿刺引流误治,均形成窦道经久不愈。后经CT明确为潜毛囊肿或潜毛窦,进行肿瘤切除一期缝合痊愈。结论潜毛囊肿和潜毛窦在临床上是少见病,手术彻底切除肿瘤是唯一治疗方法。     

骶尾部藏毛窦诊断与治疗

目的 探讨骶尾部藏毛窦的临床特点、诊断与治疗.方法 2010年10月至2013年1月收治骶尾部藏毛窦5例,5例均骶尾部感染反复发作,待炎症消退后均行藏毛窦一期切除缝合术.结果 5例病理检查结果诊断为藏毛窦,3例术后I期愈合,2例术后切口轻度裂开,经换药后治愈.随访6～12个月均无复发.结论 藏毛窦疾病容易误诊,术前应仔细检查,明确手术范围,彻底手术切除是预防复发的关键.     

Penis: An unusual site for pilonidal sinus

Pilonidal Sinus affects different regions of the body, gluteal cleft being the most common. This condition affecting the penis is extremely rare with only a few case reports around the world. It is prone for complications like infection, actinomycosis, abscess formation, erectile dysfunction and phimosis amongst others. We present a case of Pilonidal sinus of the penis where a pre-operative diagnosis was made and appropriate treatment in the form of circumcision prevented complications.     

Oblique excision with primary closure for the treatment of pilonidal sinus

Although pilonidal disease of the sacrococcygeal region is common, controversy still exists regarding its treatment. The goal of treatment should be to prevent recurrence while minimizing the patient's postoperative pain and disability. During a two-year period, 32 consecutive patients (Group A) were treated for chronic pilonidal disease by oblique excision and primary closure. The results were compared with 45 patients (Group B) who had been treated by vertical excision and primary closure. Patients with acute pilonidal abscess or recurrent pilonidal disease were excluded from the study. The mean follow-up was 15.9 months for Group A and 19.6 months for Group B. The average length of hospital stay and time for return to daily activities were 3.18±1.31 vs. 5.53±4.11 days and 10.4±14.37 vs. 12.91±39.17 days in Groups A and B, respectively (p<0.001 and p<0.01). The overall recurrence rate was 35.5% in Group B whereas there were no recurrences in Group A. On the basis of our current experience, oblique excision with primary closure achieves the most promising treatment of this condition.     

Effect of sinus resection combined with vacuum-assisted closure on sacrococcygeal pilonidal sinus

This study was aimed at investigating the effect of sinus removal combined with vacuum-assisted closure in the treatment of sacrococcygeal pilonidal sinus. From January 2019 to May 2022, 62 patients with sacrococcygeal pilonidal sinus were treated and their information was collected at our hospital. These patients were randomly divided into two groups: an observation group (n = 32) and a control group (n = 30). The control group underwent a simple sinus resection and suture, while the observation group received a sinus resection combined with closed negative pressure drainage of the wound. A retrospective analysis of the data obtained was conducted. Perioperative indicators, clinical efficacy, postoperative pain, complications, aesthetic effects, and satisfaction scores at six months after the operation were compared between the two groups, and the recurrence rate at six months after the operation was recorded. Through this study, we found that the observation group had significantly shorter surgery time, hospital stay, and return time compared with the control group (P < 0.05). Additionally, the observation group had a higher overall recurrence rate (ORR) of 100.00%, which was significantly better than the control group's ORR of 86.67% (P < 0.05). The visual analog scale (VAS) score at 6, 12, and 24 h after the operation was significantly lower in the observation group compared with the control group (P < 0.05). Although the differences were not significant (P > 0.05), the observation group had decreased white blood cell, neutrophil, and C-reactive protein levels after the operation. Moreover, the total occurrence rate of postoperative complications in the observation group was significantly lower (6.25%) than that of the control group (26.67%; P < 0.05). The observation group also had significantly lower scores on the postoperative scar scale and higher satisfaction scores than the control group (P < 0.05). However, there was no significant difference in the postoperative recurrence rate between the two groups (P > 0.05). Our study demonstrated that sinus resection combined with vacuum-assisted closure was more effective in treating sacrococcygeal pilonidal sinus compared with simple sinus resection and suture. This approach significantly reduced surgery time, hospital stay, and return time. It also effectively relieved postoperative pain, reduced the occurrence of postoperative complications, resulted in smaller postoperative scars, and yielded better aesthetic outcomes and higher patient satisfaction.     

The adipofascial turn-over flap for coverage of the dorsum of the finger: a modified surgical technique

PURPOSE: The exact distances from the cutaneous dorsal branches of the digital artery to the proximal interphalangeal joint have been established in a previous anatomic study. The aim of this report is to incorporate these anatomic data into the current way of designing the homodigital adipofascial turn-over flap for cutaneous coverage of the dorsum of the finger. Our clinical experience with this modified surgical technique to this flap is reported. METHODS: The clinical series presented here consists of 40 patients with loss of cutaneous coverage at the dorsal aspect of the middle and distal phalanges. Based on our anatomic findings the flap was designed to include at least 1 dorsal branch in its pedicle. RESULTS: The flap survival was excellent and no donor site complications were observed. CONCLUSIONS: The adipofascial turn-over arterial flap has appeared as an excellent alternative for achieving early coverage of cutaneous wounds at the dorsal aspect of middle and distal phalanges of the long fingers. This flap can be designed as an arterial flap in a predictable and reliable way based on new anatomic data on the vascularization of the dorsum of the finger.     

Limberg flap procedure for pilonidal sinus disease: results of 353 patients

Purpose Pilonidal sinus disease is common especially in young adult males. Many surgical and nonsurgical methods have been described. Some surgical techniques for the treatment still have high recurrence rate. The aim of this study was to evaluate advantages and long term results of Limberg flap surgical technique. Methods From November 2001 to December 2004, 353 patients [335 male, 18 female; average age = 24.65 ± 4.2 (range, 15–53) years] with primary or recurrent pilonidal sinus disease were operated on under spinal anesthesia by rhomboid excision and Limberg flap. Follow-up examinations were made at the end of the 4 weeks and 3, 6, 12, 18, and 24 months after surgery. Results The mean duration of symptoms was 23.28 ± 16.09 (range, 2–140) months. The mean duration of hospital stay was 4.51 ± 2.85 (range, 2–19) days. Thirty nine patients (11%) had recurrent disease. Total wound dehiscence and flap necrosis did not occur in any patient. Recurrences were observed in 11 patients (3.1%) at the end of the follow up period. Conclusion Quick healing time, short hospital stay, early return to daily life, low complication and recurrence rate are the important advantages of the Limberg flap procedure. We think using closed suction drain in Limberg flap operation is not necessary. In the light of this study results, Limberg flap surgical technique may be an ideal operation for pilonidal sinus disease.     

Management of pilonidal sinus using fibrin glue: a new concept and preliminary experience

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.