Sacrococcygeal Pilonidal Sinus Research Articles

Long-term results of limberg flap procedure for treatment of pilonidal sinus: a report of 200 cases.

In the past, various methods of surgical or nonsurgical treatment of sacrococcygeal pilonidal sinus have been used. The most common problem in the treatment of this disease is recurrence. In the present study, our aim was to determine the long-term results of the Limberg flap procedure. We present 200 consecutive patients with pilonidal sinus who underwent the Limberg flap procedure between 1992 and 2001. Twenty-six (13 percent) of the 200 patients were operated on because of recurrent pilonidal sinus. Under general or local anesthesia, all sinus tracts were resected en bloc, and the Limberg flap was prepared from the gluteal region. We used a suction drain. We met all patients and recorded their complaints and complications of treatment. Five sinuses recurred (2.5 percent). Minimal flap necrosis occurred in only six patients (3 percent). In three patients (1.5 percent), seroma developed. Wound infection occurred in three patients (1.5 percent). The mean hospital stay was 3.1 days, whereas the mean time to return to work was 12.8 days. The Limberg flap procedure is a good treatment choice for pilonidal sinus because of its low complication rate, the short time to return to normal activity, and good long-term results. This procedure has good postoperative results and is a comfortable surgical method for the patient.

Sacrococcygeal pilonidal sinus: historical review, pathological insight and surgical options.

Sacrococcygeal pilonidal disease is a common and well recognized entity. For many years the cause of sacrococcygeal pilonidal sinus has been matter of debate. When the treatment is considered, there was a frequent lack of success of the surgical methods of excision regarding morbidity, healing, recurrence and cure. All these factors rendered the acquired thesis of pilonidal sinus disease to be more accepted. In dealing with the pathogenesis of pilonidal sinus disease, Karydakis attributed the hair insertion process to three main factors: the invader, i.e. the loose hair; the force, which causes the insertion; and the vulnerability of the skin to the insertion of hair at the depth of the natal cleft. The sinus is initiated from a small midline opening lined by stratified squamous epithelium. Additional sinuses are frequent and have lateral openings. Malignant transformation is rare but cases of squamous cell carcinoma and verrucous carcinoma have been reported. Pilonidal sinus disease consists in a symptoms complex with presentations ranging from asymptomatic pits to painful draining lesions that are predominantly located in the sacrococcygeal region. Asymptomatic pits do not require treatment. Options for treatment of acute abscess include aspiration, drainage without curettage, and drainage with curettage. The choice of a particular surgical approach depends on the surgeon's familiarity with the procedure and perceived result in terms of low recurrence of sinus and a quick healing of resulting cavity or surgical wound. Conservative nonoperative management, closed methods, laying of track, wide excision and open drainage, wide excision and primary closure, and limited excision are the methods currently used. From the profusion of studies, it is apparent that various methods are being tried and no one method is universally acceptable. Recurrence rates vary with the technique, operator and length of follow-up. Primary closure with a lateral approach appears to give the best results.

Sacrococcygeal pilonidal sinus disease with Limberg flap repair.

Sacrococcygeal pilonidal sinus disease affects younger persons, resulting in long-term loss of productive power. It also has a high rate of morbidity because there is no standard treatment approved by all surgeons. In this study, early and late results of 85 cases treated with excision and Limberg flap in our clinic were investigated. The patients were followed for 9-120 months. The complication rate was 4.7% and the long-term relapse rate was 3.5: Insufficient personal hygiene and inadequate excision were the main causes for recurrence. On the basis of the literature and our previous experiences, we conclude that the Limberg flap is the ideal treatment for sacrococcygeal pilonidal sinus disease with low morbidity, mortality and recurrence rates.

Gluteal V-Y advancement fasciocutaneous flap for treatment of chronic pilonidal sinus disease.

Although pilonidal disease is quite common, controversy still exists about the treatment. The procedure should cure the patient, and allow speedy resumption of normal activities by reducing pain and disability. This retrospective study was conducted to evaluate our experience with the V-Y fasciocutaneous advancement flap and to review current publications about flap surgery for the treatment of sacrococcygeal pilonidal sinus. We describe the application of the fasciocutaneous V-Y advancement flap for reconstruction of defects after radical excision of recurrent pilonidal sinus in 11 cases. Primary and uneventful wound healing was achieved in all patients but two who developed minor wound breakdown. Large defects after excision can easily be closed using the V-Y advancement flap. This type of flap closure in selected cases offers tension-free, recurrence-free, and reliable skin coverage while flattening the natal cleft that predisposes to recurrences. Reliable flap closure reduces hospital stay, costs, as well as disability and time spent off work.

MR Imaging of Sacrococcygeal Pilonidal Sinus

Purpose: The purpose of this study is to evaluate the characteristic MR findings of sacrococcygeal pilonidal sinus. Materials and Methods: Eight MR images of pathologically proven sacrococcygeal pilonidal sinus were retro-spectively reviewed [M: F = 7: 1; age range 9-41 (median, 17) years]. In all cases, a sacrococcygeal mass was present. Five of the eight patients experienced pain, and in three was discharge. MR findings were evaluated with regard to the location and extent of the lesion, and the presence of sinus or cyst, and the results were com-pared with the pathologic findings. Results: According to the clinical manifestations, each case was assigned to one of four groups: the first type (n= 3) showed dermal thickening with subcutaneous fatty infiltration of the ipsilateral natal cleft while patholog-ically, a follicular cyst with dermal fibrosis and multiple fatty lobules with fibrous septa were found to be pre-sent. In the second type (n = 3), fluid was observed in the sinus tract, while the pathologic findings demon-strated the presence of an abscess in this area. In the third type (n = 1), a cystic lesion with air-fluid level was present; pathologically, an abscess was revealed. The fourth type (n = 1) showed only a low signal intensity sinus tract on both T1 and T2-weighted images, while the pathologic findings indicated the presence of hairs and follicles within the tract. Conclusion: The MR findings of sacrococcygeal pilonidal sinus depend on the clinical manifestation and include subcutaneous fatty infiltration, a sinus tract with or without fluid retention, and a cystic lesion with air fluid level. These findings could be helpful for differentiating between this and other sacrococcygeal lesions.

Human wound contraction: collagen organization, fibroblasts, and myofibroblasts.

The closure of ungrafted sacrococcygeal pilonidal sinus excisional wounds was studied in 15 patients. Wound punch biopsies were taken on a regular basis, and histologic sections were made. To document changes, computer-assisted morphometric image analysis was employed. Initial average wound depth was 37.8 +/- 4.6 mm, and complete closure (0 wound depth) was reached by 68 days. Wound contraction contributed 88 percent to wound closure, whereas the deposition of scar only contributed 12 percent. Maximum cells density within granulation tissue was reached by day 18. Myofibroblasts, identified by alpha-smooth muscle actin immunostaining, first appeared on day 11. Unlike those observed in laboratory animals, myofibroblasts were a minor cell population of granulation tissue, never exceeding 10 percent of the cells. The pattern of collagen fiber organization was documented by polarized light microscopy of Sirius red-stained sections. Early granulation tissue collagen fibers demonstrated a fine greenish birefringence, whereas more mature granulation tissue collagen fibers were thicker, displaying orange-yellowish birefringence. Myofibroblasts were associated exclusively with thicker collagen fibers, whereas fibroblasts were associated with both fine and thick collagen fibers. It is proposed that human wound contraction involves a volume change whereby normal dermal and adipose tissues are pulled into the defect by forces generated within fibroblasts.

Reverse transcription‐polymerase chain reaction detection of collagen transcripts in healing human wounds

The aim of this study was to analyse the expression of COl1A1, COl1A2 and COl3A1 in 6 mm diameter punch biopsies obtained from human wounds. Total RNA was isolated from biopsies taken from Sacrococcygeal pilonidal sinus excision cavities at weekly intervals between surgery and clinical closure. cDNAs were generated from the RNA using reverse transcriptase and polymerase chain reaction (PCR) amplifications performed with oligonucleotide primer pairs specific for regions of the COl1A1, COl1A2 and COl3A1 genes. The expression of these three genes was demonstrated throughout the course of healing on 36 biopsies taken from nine patients between surgery and clinical closure. Amplification bands demonstrated on cDNAs generated from 6 mm diameter biopsies were comparable in intensity and specificity with those generated from 50 mg excised scar tissue and cultured fibroblasts. The RT-PCR technique described here allows the rapid 'routine' detection of specific gene expression in 6 mm biopsies obtained from healing wounds.

Management of recurrent pilonidal sinus by simple V-Y fasciocutaneous flap.

Several methods of managing the sacrococcygeal pilonidal sinus have been described, and fervent arguments for each form of therapy can be found in the literature. Recurrence unfortunately plagues all forms of therapy, though it is evident that the lowest rates have been reported for procedures involving local flap reconstruction. We conducted this case review to evaluate the validity of a simple reconstructive procedure for recurrent pilonidal disease. We describe the application of the V-Y fasciocutaneous advancement flap to reconstruct the defect following radical excision of recurrent pilonidal sinus in five consecutive patients. Tension-free closure offers the benefits of a reduction in postoperative pain, less restriction in activity, and a shorter hospital stay. Preliminary results offer evidence of the efficacy of the simple reconstructive procedure in the management of difficult cases.

Radical cure of pilonidal sinus by Z-plasty

Summary o.1.The factors responsible for sacrococcygeal pilonidal sinus are discussed. 2.The technic of Z-plasty is described and a series of twenty patients treated by this method is reviewed. 3.Arguments are presented supporting the logic of the Z-plasty procedure as a method for eliminating the causal factors of pilonidal sinus. Summary o.1.The factors responsible for sacrococcygeal pilonidal sinus are discussed. 2.The technic of Z-plasty is described and a series of twenty patients treated by this method is reviewed. 3.Arguments are presented supporting the logic of the Z-plasty procedure as a method for eliminating the causal factors of pilonidal sinus.

Pilonidal sinus treated by Z-plasty.

The rationale and technique of Z-plasty treatment for sacro-coccygeal pilonidal sinus are presented. Z-plasty achieves healing by primary intention, and by modification of the local environment prevents recurrence.

Sacrococcygeal pilonidal cyst

1. 1. “Hair-nest” sinus occurring at the base of the spine is more properly designated sacrococcygeal pilonidal sinus. 2. 2. The first reference in the literature to the condition is a letter by Dr. A. W. Anderson, Gray, Maine, written to the Editor of The Boston Medical and Surgical Journal on February 8, 1847. 3. 3. The term “pilo-nidal sinus” was used for the first time by Dr. R. M. Hodges in a paper read before the Boston Society for Medical Improvement on November 8, 1880. 4. 4. The theory of nerve origin is based on the assumption that remnants of the embryonic neural canal persist as epithelial rests. 5. 5. The theory of ectodermal invagination predicates a special downgrowth of epithelium from the true skin as in the formation of the breast and external ear. 6. 6. The theory of vestigial sex-gland origin assumes the presence of a vestigial secondary sex gland in the sacrococcygeal region which becomes active at adolescence. 7. 7. Sacrococcygeal pilonidal cyst disease is found primarily in hairy, obese, white, male adults twenty to thirty years of age. The predominant complaints are pain and drainage in the coccygeal region. 8. 8. Diagnostic signs are abscess formation and one or more midline sinus openings over the sacrococcygeal joint. 9. 9. Various methods of treatment are discussed. Best results have been obtained by excision and open packing.