The Use of Paraspinal Transposition Flap for Recurrent Pilonidal Sinus, a New Histological Basis for Management of Pilonidal Sinus Disease

Abstract

The ability of the pilonidal sinuses to spread laterally into both gluteal regions, governed by the skin vulnerability, raises the theoretical probability of a similar skin characteristic of the donor site from which most of the flaps used for repair of the PNS are taken. The present study aimed at a clinical outcome and histologic study of the use of paraspinal transposition flap for treatment of recurrent pilonidal sinus disease. This was a prospective clinical study that enrolled all patients who presented to our General Surgery Clinic, Kasralainy Hospital, Cairo University, with recurrent pilonidal sinus in the period from July 2007 till August 2017. They underwent excision of their pilonidal sinus and the use of paraspinal transposition flap to cover the defect. Histologic studies were done for the skin from both areas. This study ended up with 84 adult patients with recurrent pilonidal disease. The follow-up period ranged from 9 to 108 months (mean 70.45 months). All the patients reported pain scores from 0 to 3 during the first postoperative week. Incidence of early minor complications including mild wound dehiscence, sloughing at the tip of the flap, wound infection, and edema occurred in 21 patients (25%). Three patients developed recurrence (3.57%). Histological examination revealed deep pits lined by stratified squamous epithelium (SSE) at the macroscopic healthy skin at the edge of resection. Those changes were absent in biopsies from the flap skin. The paraspinal flap has good results in management of recurrent pilonidal disease. Also, histological findings suggest that the skin over both glutei is as vulnerable as the skin of the excised sinus which is different from the skin over the lower back. This explains that use of that skin to cover the defect is more prone to develop recurrence.