Simple primary closure for sacrococcygeal pilonidal disease

Abstract

A simple method of excision and primary closure for sacrococcygeal disease is described. It is applicable for all cases, except the unusual ones which penetrate the presacral fascia or extend more than 3 4 of an inch to either side of the midline. The importance of certain details is emphasized: (1) diligent pre- and postoperative removal of all hair by shaving, depilatory, and plucking; (2) the creation of a beveled symmetrical wound for accurate coaptation; (3) complete hemostasis without any suture material left in the wound, if possible; (4) obliteration of dead space by encircling wire sutures tied over a gauze bolster; (5) meticulous approximation of the skin, edge to edge. No suture material is in contact with the opposed surfaces throughout the entire depth of the wound below the dermis. No flap formation or tissue undermining is performed.