Treatment of Chronic Pilonidal Sinus Disease-Comparison between Z-plasty, Primary Closure, and Marsupialization

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Background: Pilonidal sinus disease is a common problem that affects the skin of the natal cleft. Various treatments for pilonidal sinus disease have been described in the literature. The treatment involves eradication of the sinus tract and prevention of recurrence. Determining the optimal treatment remains a challenge for surgeons. Aim and Objectives: This article presents our clinical experience with different surgical options for the treatment of pilonidal sinus disease. Materials and Methods: From December 2002 to September 2009, 12 patients underwent different types of surgical treatment for pilonidal sinus disease at the China Medical University Hospital. The age and gender of the patients, surgical options, length of hospital stay (days), wound healing period (days), rate of surgical site infection, and recurrence rate were analyzed retrospectively. The follow-up period ranged from 6 to 81 months. Results: The patients comprised 9 (75%) males and 3 (25%) females with a mean age of 25.6 years. The primary closure method was applied to 7 (58.3%) patients, Z-plasty to 3 patients (25.0%), and marsupialization to 2 patients (16.7%), and the average length of hospital stay was 1.85, 2.33, and 2.5 days, respectively. The mean wound healing periods were 24.7 days in the Z-plasty group, 34.9 days in the primary closure group, and 48 days in the marsupialization group. The highest rates of complication (2/7, 28.5%) and recurrence (3/7, 42.9%) were observed in the primary closure group. There were no postoperative complications in the marsupialization and Z-plasty groups. The Z-plasty and marsupialization groups both showed satisfactory results, but the marsupialization group required a longer period of wound management. Conclusion: Z-plasty is a simple and easy treatment method. It may be a more preferable treatment option as compared to the primary closure method, due to lower rates of complication and recurrence. Compared to the marsupialization method, post-operative wound care is less complicated after the Z-plasty method.