Excision Of Pilonidal Sinus Research Articles

Direct closure versus local flaps in management of pilonidal sinus

Objectives The aim of this randomized prospective trial was to compare both the results of direct closure and local flaps in management of pilonidal sinus. Background The best surgical technique for sacrococcygeal pilonidal disease is still controversial in terms of minimizing disease recurrence and patient discomfort. The present study analyzes the results of excision with primary closure and excision with flap reconstruction in the surgical treatment of sacrococcygeal pilonidal disease. Materials and methods From February 2012 to February 2013, 30 consecutive patients with chronic pilonidal sinus disease received surgical treatment in the form of either excision and primary closure (group 1, n = 15 patients) or excision and flap reconstruction [group 2, n = 15 patients; classic Limberg flap ( n = 5), modified Limberg flap ( n = 5), and V-Y advancement flap ( n = 5)]. Demographic data, operative time, postoperative pain, hospital stay, duration of incapacity for work, postoperative complications (infection, flap edema, wound dehiscence), patient satisfaction, and postoperative recurrence were recorded. Results The mean follow-up was 12 months. A significant difference was observed between the two groups in terms of operative time (min), postoperative complications, and patient satisfaction (P 0.05) for all comparisons. In the modified Limberg flap, no wound infection or recurrence of the disease occurred. Conclusion Flap reconstructions were superior to primary closure after excision of pilonidal sinus, and modified Limberg flap was superior with respect to wound infection and recurrence.

ProSeal laryngeal mask airway TM insertion in the prone position: Optimal utilization of operation theatre personnel and time?

Background:Positioning an anesthetized patient prone is challenging with regard to manpower requirement, time to surgical readiness and airway management. The ProSeal laryngeal mask airway™ (PLMA) is emerging as a suitable alternative, both as a primary and a rescue airway device to the tracheal tube (TT) for patients undergoing surgery in the prone position.Materials and Methods:In this prospective randomized study, 70 patients scheduled to undergo pilonidal sinus excision in prone position were allocated to two groups of 35 patients each, depending on the position of the patient at induction and device placement: Group S (device placed while supine) and Group P (device placed while prone). We compared the manpower requirement, time to surgical readiness, efficacy and safety of the PLMA for airway management in the two groups.Results:The number of personnel [5 (4-6) vs. 3 (3-3); P < 0.001] required for positioning the patient and surgical readiness time (22.1 ± 3 vs. 5.9 ± 0.9 min; P < 0.001) was higher in group S. There was no difference between the two groups with regard to efficacy and safety of the PLMA. Incidence of blood on the PLMA cuff and sore throat was comparable in the two groups (P = 1.000).Conclusion:We conclude that induction and placing the PLMA in the prone position by experienced users require fewer personnel and reduces surgical readiness time.

Rare Complication After VAC Therapy in the Treatment of Tissue Defect Due to Surgical Excision of Pilonidal Sinus

Pilonidal sinus is frequently managed with surgical incision. If the wound is left open to heal by secondary intention, negative pressure wound therapy (NPWT) is often used to promote healing. We describe the case of a 60-year-old patient referred after excision of a pilonidal sinus, which was managed postoperatively with NPWT. Unfortunately, the patient developed squamous cell carcinoma, which was undetected postoperatively, as the dressing was left in place for 5 days. Guidelines for the use of NPWT should be followed, with dressing intervals at 2 to 3 days. Wounds managed by NPWT should be monitored carefully for malignancy at the time of dressing changes.

A New Technique in Management of Pilonidal Sinus, a University Teaching Hospital Experience

This paper evaluates a new technique that can lead to excision of pilonidal sinus with less healing time and low recurrence rate. A prospective randomized double-blind controlled study on 142 patients with pilonidal sinus conducted during the period from September 2008 to March 2012. The patients were prospectively randomized to be operated with one of four surgical techniques, excision and primary closure, or excision after using hydrogen peroxide (H202) and primary closure, or excision without closure, or excision after injection of H202 without closure. The main outcome measures were the healing time and the recurrence rate. Out of 142 patients, 118 patients were males (83%), and 24 were females (17%). The mean age was 24.5 years. The recurrence rate in patients treated with excision after injection of H202 without closure was the lowest (1.8%) with P-value < 0.005, and the mean duration of healing was 30.7 days with P-value < 0.005. We recommend using excision after injection of H202 without closure in management of PNS. Injection of H202 into the pilonidal tracts can give a precise delineation of the affected tracts, which can be excised with minimal amount of surrounding normal tissues and hence lead to a quicker recovery and low recurrence rate.

The role of drainage after excision and primary closure of pilonidal sinus: a meta-analysis

We carried out a systematic review of the literature to identify the association between the use of drain and the incidence of infections and recurrences after surgery. MEDLINE, SCOPUS and ISI databases were searched up to September 2012. The two outcomes of this meta-analysis were wound infection and recurrence. Postoperative wound infection occurred in 50 of the 604 (8.28 %) patients who underwent drainage and in 68 of the 598 (11.4 %) patients who did not, with a resulting odds ratio (OR) of 0.71 (95 % CI: 0.48-1.03). Recurrence of pilonidal sinus occurred in 41 of the 604 (6.79 %) patients who underwent drainage and in 50 of the 598 (8.36 %) patients who did not, with a resulting OR of 0.80 (95 % CI: 0.52-1.23). The results suggest that, despite a trend toward a reduction in infectious complications and recurrence, drainage was not associated with a better outcome. However, because of the present literature's limitations, further studies are needed to address this issue.

Breakneck Bradycardia Pursuant to Spinal Anesthesia: A Report of Two Cases

Abruptly bradycardia is one of the uncommon but fatal complication of spinal anesthesia and may occur at the any stage. Lethal complications during spinal anesthesia can occur in patients without problem in their respiratory or cardiovascular system. In this article, we present 2 cases with knee arthroscopy and pilonidal sinus excision that complicated with breakneck bradycardia follow to spinal anesthesia. In both two cases there was no problem with ventilation or respiratory system and they have taken 1 lit ringer solution 30 min before procedure. We concluded that must not only take closer care with patients undergoing S.A, at the operation room but also the duration of recovery room.

Is There a Relation Between Natal Cleft Depth and Post-Operative Morbidity After Different Methods of Excision of Sacro-Coccygeal Pilonidal Sinus?

The role of natal cleft depth in postoperative morbidities after pilonidal sinus disease (PSD) surgery is still uncertain. To examine the correlation between natal cleft depth and postoperative morbidities after different methods of excision of PSD. We prospectively examined data of 66 operated patients with PSD at Prince Fahd Ben Sultan hospital, Tabouk, KSA. Of the studied patients, 18 were treated by simple closure (27.3%), 13 patients by Bascom closure (19.7%), 21 patients by the open method (31.8%) and 14 patients by the semiopen method (21.2%). Postoperative morbidities were recorded. The data were analyzed using appropriate statistical tests. Sixty six patients (62 males, 4 females) underwent surgery for PSD. The mean age of the studied patients was 26.7 ± 6.9 (range 15-51). Nine patients (13.7%) showed delayed healing with the highest incidence was among patients treated by the open method (6/21 (28.5%)), and 5 patients (7.5%) showed recurrence. There have been significant positive correlations between natal cleft depth and delayed healing, which was evident among patients treated by the open method (r = +0.78; p < .0001). The findings suggest that natal cleft depth is a significant factor correlated with postoperative morbidities of PSD after surgical treatment.

Outcomes in the repair of pilonidal sinus disease excision wounds using a parasacral perforator flap

The ideal treatment for pilonidal sinus disease has yet to be defined. There are many approaches described in the literature. Thirty-five consecutive patients who underwent wide excision of pilonidal sinus disease had the wound repaired using a parasacral perforator flap. Outcomes were assessed by case notes analysis and follow-up telephone and postal questionnaires. There were ten minor complications including six minor wound edge dehiscences. There were two ischaemic complications, with one flap loss. There were 3 recurrences of pilonidal disease at a mean follow-up of 33 months, giving a 5-year recurrence free rate of 86%. Of the patients questioned, all would recommend the procedure to someone else despite 69% being dissatisfied with the cosmetic outcome. This series indicates that the parasacral perforator flap technique is able to repair pilonidal sinus excision wounds successfully with minimal morbidity and a low recurrence rate at a mean of follow-up of 33 months. The study suggests that it may be a technique best reserved for recurrent cases of pilonidal sinus disease. Patients feel the procedure is successful despite reservations regarding the cosmetic outcome.

Local application of gentamicin-containing collagen implant in the prophylaxis of surgical site infection following gastrointestinal surgery

BackgroundGastrointestinal surgery is associated with one of the highest rates of SSI due to the nature of the surgery and to the added complication of operating on patients with significant co-morbidities. This high rate of SSI may negatively impact wound healing, patient recovery time, length of hospital stay and associated healthcare costs. This article provides an overview of the efficacy and safety of prophylactic application of resorbable gentamicin-containing collagen implants (GCCI) in the prevention of SSI following GI surgical procedures. MethodThirteen publications were identified using the PubMed online database and search terms ‘gentamicin collagen implant’ plus ‘surgical site infection’, ‘wound infection’ and ‘gastrointestinal surgery’. ResultsEleven out of 13 studies have demonstrated that prophylactic use of GCCI can reduce the wound infection rate in high-risk GI surgical procedures (e.g. abdominoperineal resection [APR]) and improve wound healing after pilonidal sinus excision. GCCI may also have a role to play in preventing anastomotic leakage following mesorectal excision for rectal carcinoma. It is recommended that GCCI are used dry in line with the manufacturer's recommendations. ConclusionThis review demonstrates that GCCI can significantly reduce surgical site infection following GI surgery including pilonidal sinus excision and high-risk procedures such as APR.

Effects of a Tissue Sealing-Cutting Device Versus Monopolar Electrocautery on Early Pilonidal Wound Healing: A Prospective Randomized Controlled Trial

Monopolar electrocauterization produces thermal effects on neighboring tissues, causing tissue damage. Recently, tissue sealing-cutting devices, which are easy to use and achieve simultaneous selective sealing and cutting with less production of heat, have been used. The aim of this study was to investigate the effects of a tissue sealing-cutting device vs monopolar electrocautery on wound healing in the early postoperative period after pilonidal sinus surgery. This study was a prospective randomized clinical trial. This study was conducted at Military Hospital, Eskisehir, Turkey. In total, 128 patients with chronic pilonidal disease were randomly assigned into 2 clinically comparable groups between December 2009 and June 2010. Pilonidal sinus excision was performed with monopolar electrocautery in the control group (n = 64) and with a tissue sealing-cutting device in the study group (n = 64). Data regarding wound healing, demographic variables, history, physical examination findings, defect dimensions, and scores for a visual analog scale were recorded. The main outcomes measured were surgical site infection, early wound failure (dehiscence), and unhealed wound rate. : Wound infection and dehiscence rates were significantly lower (P = .01 and .02), but the duration of surgery was significantly longer (P < .01) in the tissue sealing-cutting group. The unhealed wound rate was 12.5% in the electrocautery group and 4.7% in the tissue sealing-cutting group (P = .01). When the distance from the lowest margin to the anus was 5 cm or less, wound infection and dehiscence rates were lower in the tissue sealing-cutting group (P < .01 and .03). We could not obtain data regarding the cost-effectiveness of the instruments. A tissue sealing-cutting device in pilonidal sinus surgery yields better wound healing than monopolar electrocautery.

Local Administration of Antibiotics by Gentamycin–Collagene Sponge does not Improve Wound Healing or Reduce Recurrence Rate after Pilonidal Excision with Primary Suture. A Prospective Randomized Controlled Trial

Poor old sacrococcygeal pilonidal sinus is an orphan disease; it has no society or annual meeting on some distant palm-fringed shores. This is bread-and-butter general surgery, without the flashing lights of robotics or the glamorous reps of stapler manufacturers. Perhaps because of this, there are few well-designed, properly powered, randomized, controlled trials of treatments for pilonidal sinus. Roland Andersson and his colleagues are to be congratulated for completing their multicenter, randomized, controlled trial of the use of Collatemp (gentamicin-impregnated collagen sponge) as an adjunct to excision and primary closure of pilonidal sinus. They found that the use of Collatemp did not reduce wound complications or recurrence rate after pilonidal sinus surgery. They also have demonstrated that surgeons working in cooperation with colleagues in different hospitals can together perform good randomized, controlled trials with rapid patient accrual. This collaborative approach is a model that others would do well to copy. As the authors acknowledge in their discussion, excision and midline closure of pilonidal sinus is unfashionable. Evidence pooled from randomized, controlled trials shows a clear benefit to excision and primary closure with a lateral wound compared with closure in the midline [1]. Despite this, excision of pilonidal sinus with closure in the midline is probably the commonest procedure performed around the world for pilonidal sinus. The linked trial was a pragmatic one—reflecting real-life practice in the community rather than theoretical concerns. Indeed, the risk of recurrent pilonidal sinus in the authors’ hands seems to have been very low (reflected by the small numbers of patients needing reoperation: 10% in the Collatemp group and 4% in the control group). This may be due to the use of tie-over dressings, which are designed to reduce accumulation of fluid in the wound cavity and also spread the tension on the skin closure. Perhaps before midline primary closure is completely dismissed, the use of such bolsters should be further evaluated. Pilonidal sinus exhibits a wide spectrum of disease, which may range from a couple of midline pits to a large cavity or unhealed open wound. The surgical approaches to pilonidal sinus also vary from minimal pit-picking procedures to radical excision with complex flap reconstruction. The ‘‘cure rate’’ seems to be higher for some of the more radical approaches, albeit with a corresponding increase in morbidity. It is a wise surgeon who tailors the surgical approach to the severity of the disease and the patient’s symptoms. For ‘‘early’’ disease a minimal approach, such as those advocated by Bascom [2], often will suffice. More extensive or recurrent disease usually requires a major excision. The Karydakis procedure [3] and Bascom’s cleft closure [4] have a similar concept. Both result in a flattening of the natal cleft and a lateral wound, although the depth of excision is greater with the Karydakis procedure. Patients with difficult recurrent disease or a nonhealing central wound may occasionally benefit from the use of a rhomboid rotational flap for reconstruction; such patients need careful preoperative counseling about the extent of the surgery and the expected cosmetic result. The wise surgeon will familiarize himself with one or more of these procedures for these difficult situations. M. Cheetham (&) Royal Shrewsbury Hospital, Shrewsbury, UK e-mail: mark.cheetham@sath.nhs.uk

Local Administration of Antibiotics by Gentamicin–Collagen Sponge does not Improve Wound Healing or Reduce Recurrence Rate After Pilonidal Excision with Primary Suture: A Prospective Randomized Controlled Trial

Excision and primary suture for pilonidal disease is associated with a high rate of wound infection and recurrences. This randomized, controlled study was designed to analyze the effect of local application of a gentamicin-containing collagen sponge (Collatamp(®)) in reducing the wound infection rate and recurrences after excision of pilonidal sinus and wound closure with primary midline suture. From March 2003 to November 2005, 161 patients with symptomatic pilonidal disease were operated on at 11 hospitals with traditional wide excision of the sinus and all of its tracts. The patients were randomized to filling of the cavity with a gentamicin-containing collagen sponge (Collatamp(®)) before wound closure or to closure with no additional treatment. Information about the treatment allocation was hidden until the end of the study. Information about wound healing was noted at follow-up at the outpatient department after 2-4days, 2weeks, 3months, and 1year. No statistically significant differences were observed between the groups during follow-up. Patients who received prophylaxis with Collatamp(®) had slightly fewer wounds with exudate at 2-4days and 2weeks of follow-up (2% vs. 10%, p=0.051 and 57% vs. 65%, p=0.325, respectively), a slightly larger proportion of healed wounds at 3months follow-up (77% vs. 66%, p=0.138) but not at 1year (85% vs. 90%, p=0.42, respectively), and slightly more reoperations (10% vs. 4%, p=0.213). This randomized, controlled study showed no significant differences in the rates of wound infection, wound healing, and recurrences when a gentamicin-collagen sponge was added to the surgical treatment of pilonidal disease with excision and primary midline suture. This does not support the use of gentamicin-collagen sponge for the surgical treatment of pilonidal disease.

Excision and primary closure of pilonidal sinus disease: worthwhile option with an acceptable recurrence rate

Treatment of pilonidal sinus disease is controversial. Many claim policy of marsupialisation and healing by secondary intention. This is demanding in terms of nursing care and time lost from work. To examine outcome of excision and primary closure of chronic pilonidal disease on recurrence rate and patient's daily activities. One hundred and fourteen consecutive elective patients who had excision and primary closure of pilonidal sinus disease were reviewed. The demographic data and the post-operative outcome were studied. The recurrence of pilonidal sinus was noted in 9% of patients, wound breakdown occasioning delayed healing in 9%, patients able to drive by day 16 on average. The mean time to return to work was 20.5 days; duration of analgesia, 2.4 days; and duration of antibiotic treatment, 4.7 days. Excision and primary closure of chronic pilonidal sinus has low recurrence rate with early return to activities. Primary closure appears to be a cost-effective option for uncomplicated pilonidal sinus disease.

Local application of gentamicin collagen implants in the prophylaxis of surgical site infections following gastrointestinal surgery: a review of clinical experience.

BackgroundSurgical site infection (SSI) is a common type of healthcare-associated infection in gastrointestinal (GI) surgical procedures, which often has major consequences for patient recovery and increased healthcare costs due to prolonged hospital stay. This article provides an overview of the efficacy and safety of prophylactic application of resorbable gentamicin-containing collagen implants (GCI) in the prevention of SSI following high-risk GI surgical procedures.MethodNine publications were identified using the PubMed online database and search terms ‘gentamicin collagen implant’ plus ‘surgical site infection’, ‘wound infection’ and ‘gastrointestinal surgery’.ResultsData from 483 patients treated prophylactically have demonstrated that GCI can reduce the wound infection rate in high-risk GI surgical procedures and improve wound healing after pilonidal sinus excision. In a study of 221 patients who underwent colorectal surgery, the wound infection rate was reduced to 5.6% in the GCI group compared to 18.4% in the control group (P < 0.01). GCI also positively influences the post-operative course for patients undergoing particularly risky procedures e.g. abdominoperineal resection (APR) combined with neoadjuvant radiotherapy. In one such patient series, GCI reduced the wound infection rate by over 70% and the length of hospital stay by 40%. Few side effects of GCI were noted in the 9 clinical studies.ConclusionsThis review demonstrates that GCI can have a positive effect on wound infection rates in high-risk GI surgery and can also improve wound healing after pilonidal sinus excision.

A prospective randomised study comparing two treatment modalities for chronic pilonidal sinus with a 5-year follow-up

The optimal treatment of chronic pilonidal sinus is a matter of debate. Although excision and suture offers faster healing, it is associated with an increased incidence of wound infection. This study compared excision and primary closure of pilonidal sinus using incorporated gentamicin impregnated collagen with conventional laying open. Consecutive patients with pilonidal sinus were randomly assigned to one of two treatment groups: (1) open method-wound left open post-excision and (2) closed method-wound closed in two layers over gentamicin impregnated collagen. The main outcome measures were operating time, hospital stay, linear analogue pain scores (days 1, 2, 4, 7 and 14), healing rates, analgesic use and cost. Rate of recurrence at 5 years was further assessed by means of a telephone survey. Sixty patients were recruited from June 1999 to December 2000. Operating time was significantly longer in the closed method. Pain scores were significantly lower for the closed group. A significantly higher proportion of closed wounds healed at 4 weeks. The overall cost per patient was significantly lower for the closed group. Recurrence rate was similar at 5 years. Excision and primary closure over a gentamicin impregnated collagen is a cost-effective method of treating pilonidal sinuses, as it ensures faster healing, causes less pain and its long-term recurrence rates are similar to other techniques.

Reconstruction following excision of sacrococcygeal pilonidal sinus with a perforator-based fasciocutaneous Limberg flap

Many procedures have been proposed for the management of sacrococcygeal pilonidal sinus disease. The aim of this work is to evaluate the superiorly based flap (used before for reconstruction of pressure sore) for reconstruction after excision of sacrococcygeal pilonidal sinus. Between January 2004 and February 2007, 25 male patients of ages between 14 and 29 years(median age: 23 years), who had recurrent pilonidal sinus, underwent surgical treatment by the Limberg flap technique. The mean duration of symptoms was 5.2 + or - 4.5 years (range 3-6 years). Rhombic-shaped excision of the sinus-bearing skin and subcutaneous tissue up to the presacral fascia guided by electrocautery was performed, followed by reconstruction of the defect by perforator-based Limberg flap (based on the superior gluteal and sacral perforators). Primary healing occurred in 22 patients. Two patients (8%) had seroma with negative bacterial cultures, which healed completely with bedside drainage and conservative treatment. Another patient (4%) had superficial wound infection that were treated by appropriate antimicrobial therapy. Complete healing of all cases occurred without recurrence during the follow-up period. The mean operative time was 40min (ranging between 30 and 45min according to the size of the lesion). There was no ischaemia or necrosis of the flaps, and all flaps remained viable. The mean length of hospital stay was 2 days, ranging between 1 and 6 days. The use of superiorly based Limberg flap in reconstruction after excision of sacrococcygeal pilonidal sinus is reliable, easily performed, associated with complete cure and low postoperative complications.

PILONIDAL SINUS

O b j e c t i v e s : To study the prevalence of pilonidal sinus and compare the outcome of the excision and primary closure withlay open surgical procedures. D e s i g n : Prospective randomized comparative study. Setting: Department of surgery, Bahawal VictoriaHospital Bahawalpur. P e r i o d : From 1s t December 2002 to 30th November 2007.Materials a n d M e t h o d s : A total of 40 patients with pilonidalsinus were randomized into two groups. Group I underwent excision and primary closure while Group II underwent excision and lay openprocedure. Results: Patients of Group I &amp; II had comparable mean operation time of 42.7 minutes. Group I patients had a shorter meanhospital stay of 4.87 days, earlier return to light work after 13.21 days, less treatment expenses and low rate of postoperative complicationsand good patient satisfaction. C o n c l u s i o n : We conclude that primary closure after excision of pilonidal sinus is superior surgical procedurethan excision and laying it open

Pilonidal sinus: healing rates, pain and embarrassment levels

To identify the healing rates, wound hygiene practices, types of primary wound dressings used, antibiotics prescribed, pain intensity and embarrassment levels in patients with pilonidal sinus. A prospective descriptive design was used. We followed 55 patients for three months following excision of pilonidal sinus. Digital photographs were taken and the wound area was calculated using the Alfred and Medseed Wound Imaging System on the first postoperative day, at 2-3 weeks and again at 12 weeks. Data were collected from the nurses and patients using piloted questionnaires. Sixty per cent of the participants had closed wounds within 12 weeks of surgery. Various dressing types were used. There was no significant correlation between dressing type and healing, or wound size and healing. There was no significant association between antibiotic usage and faster healing rates. A mean pain intensity score of 4.8 on a 0-10 scale was reported at the first dressing change for saline gauze dressings, which was the most painful experience with this wound. Average levels of embarrassment were low and decreased over time. Forty per cent of participants who had unhealed wounds at 12 weeks had other factors involved, which were not measured in this study.

Surgical Treatment of the Pilonidal Disease: Primary Closure or Flap Reconstruction After Excision

Controversy still exists regarding the best surgical technique for the treatment of pilonidal disease in terms of minimizing disease recurrence and patient discomfort. The present study analyzes the results of excision with primary closure and excision with flap reconstruction in the surgical treatment of sacrococcygeal pilonidal disease. From January 2003 to January 2006, 60 consecutive patients with primary pilonidal sinus disease received surgical treatment in the form of either excision and primary closure (group I, n = 20 patients) or excision and flap reconstruction (group II, n = 40 patients; modified Limberg flap n = 20, classic Limberg flap n = 10 and adipo-fasciocutaneous flap n = 10). Times for complete healing and return to work were recorded. To evaluate patient comfort, all patients were asked to complete a questionnaire including visual analog scale, time to sitting on toilet without pain, and time to walking without pain 3 months after surgery. Mean follow-up was 21 months. A significant difference was observed between the two groups in terms of length of hospital stay (P < 0.003), time to complete healing (P < 0.001), time off work (P < 0.001), wound infection (P < 0.01), recurrence rates (P < 0.01), times to sitting on toilet without pain (P < 0.002), and walking without pain (P < 0.001). The mean (standard deviation) postoperative visual analog scale scores were 6.1 (1.2) in the primary closure group vs. 7.4 (1.3) in the flaps groups (P < 0.001). In the modified Limberg flap, no wound infection, wound breakdown, or recurrence of the disease occurred. Flap reconstructions were superior to primary closure after excision of pilonidal sinus and that modified Limberg flap was superior with regard to wound infection and recurrence.

Sinus Excision, Release of Coccycutaneous Attachments and Dermal-Subcuticular Closure (XRD Procedure): A Novel Technique in Flattening the Natal Cleft in Pilonidal Sinus Treatment

The objective of this study was to analyse, prospectively, the outcome of a new technique - excision of pilonidal sinus and flattening the natal cleft by division of the coccycutaneous attachments at the lower end of the incision. Sixty-six consecutive patients with chronic pilonidal sinuses were treated between 1995 and 2001. The procedure consisted of an elliptical, wide, local excision, release of the coccycutaneous attachments and primary closure using dermal-subcuticular closure (XRD). Suction drains were used until drainage was minimal. The height of skin level at the lower angle of the wound from the coccyx was measured intra-operatively before and after division of the coccycutaneous attachments. Postoperatively, patients were assessed for hospital stay, return to normal activity, complications and recurrence. Sixty-four patients (97%) were males, median age 27 years. The height of skin level rose from a mean of 1.8 cm (95% CI, 1.78-1.85) to a mean of 3.8 cm (95% CI, 3.77-3.88; P < 0.001). Morbidity affected 12 patients (18%), epidermal separation of the lower wound angles (6 patients), seromas (5 patients) and 1 wound dehiscence at 2 weeks. All other wounds healed primarily without dehiscence. There were no recurrences after a median follow-up of 22.5 months (range, 12-38 months). Release of the coccycutaneous attachments is an easy technique to learn, which seems to be an effective way of flattening the natal cleft and may result in lower recurrence rate. This technique should be tried in uncomplicated pilonidal sinus disease before more complex procedures are attempted.