Treatment of pilonidal disease by minimal surgical excision under local anesthesia with healing by secondary intention: Results in over 500 patients

Abstract Introduction The accepted treatment of pilonidal disease still consists of surgical excision with primary wound closure. This treatment has complications such as excessive pain, delayed wound healing, and recurrence. We introduced this technique using a radial laser probe (SiLaCTM, Biolitec, Germany). Previous studies have shown encouraging results with respect to safety, patient satisfaction, and minimal recurrence rates. Method The pilot project was planned with the objectives to assess postoperative complications and reoperation rates. All operations were performed as day case procedures under general anaesthesia. We studied the data of our first 25patients operated with this technique between January 2019 and December 2019 using a prospective database and outpatient clinic follow up. Results The median follow up duration was 13 months. The initial success rate was 64%(16/25), reoperation was required in 32%(8/25) and one patient was lost to follow up. one patient returned with abscess formation in the postoperative period. Conclusions SiLaC is a safe and minimally invasive technique for the destruction of the pilonidal cyst and sinus. The success rate is modest, making this new therapy a minimally invasive option for the majority of the patients with pilonidal disease but it should be offered with caution.

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Pilonidal disease

10.1093/med/9780199682874.003.0107 ◽

2021 ◽

pp. 1213-1222

Author(s):

Kezia Echlin ◽

Andrew Fleming

Keyword(s):

Primary Closure ◽

Recurrent Disease ◽

Pilonidal Disease ◽

Signs And Symptoms ◽

Natal Cleft ◽

Secondary Intention ◽

Pain Disability ◽

Sacrococcygeal Region ◽

Pilonidal Abscess ◽

Flap Closure

Pilonidal disease presents with a range of signs and symptoms: asymptomatic pits in the natal cleft, acute abscesses, chronic disease with persistent, discharging sinuses, or recurrent disease following previous attempts at treatment. It primarily affects the sacrococcygeal region and is a disease of young adults, generally male, and leads to pain, disability, and time lost from work. The treatment for an acute pilonidal abscess is widely accepted to be incision and drainage with the incision placed out of the natal cleft. The treatment of chronic and recurrent disease is contentious with excision and then either healing by secondary intention, primary closure, or flap closure all being suggested alongside other less aggressive approaches aimed at conserving tissue. Currently none of these treatments is ideal, although primary closure in the midline has been shown to be inferior and should not be performed.

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Large Rhinophyma Treated by Surgical Excision and Electrocautery

Case Reports in Surgery ◽

10.1155/2019/2395619 ◽

2019 ◽

Vol 2019 ◽

pp. 1-3

Author(s):

Nabeel K. Al Hamzawi ◽

Salih M. Al Baaj

Keyword(s):

Treatment Options ◽

Psychological Impact ◽

Treatment Protocol ◽

Surgical Excision ◽

Surgical Removal ◽

Benign Condition ◽

Secondary Intention ◽

Short Recovery Time ◽

Good Treatment Option ◽

Abnormal Tissue

Rhinophyma is a benign condition characterized by a large, bulbous nose with prominent pores. It is commonly associated with untreated cases of rosacea. The disease can carry a substantial psychological impact that causes patients to seek advice about how to improve their physical appearance. Many treatment options are available for rhinophyma, but there is no standard treatment protocol. Here, we describe the case of a 65-year-old man with a large rhinophyma that caused him cosmetic and psychosocial embarrassment. The condition was treated by surgical excision and bipolar electrocautery. No complications occurred after the procedures, and healing was completed 2 weeks later by secondary intention and reepithelialization. A simple surgical removal using a scalpel to shave off the abnormal tissue with electrocauterization of the bleeding points can be considered as a good treatment option for rhinophyma, as it results in an excellent cosmetic outcome and has short recovery time.

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Treatment of Pilonidal Disease with Laser Epilation

The American Surgeon ◽

10.1177/000313480607200615 ◽

2006 ◽

Vol 72 (6) ◽

pp. 534-537 ◽

Cited By ~ 12

Author(s):

S.M. Schulze ◽

N. Patel ◽

D. Hertzog ◽

L.G. Fares

Keyword(s):

Adjunctive Therapy ◽

Wound Care ◽

Pilonidal Disease ◽

Treatment Options ◽

Wound Dehiscence ◽

Surgical Excision ◽

Etiologic Agent ◽

Laser Treatments ◽

Superficial Wound ◽

Laser Epilation

Pilonidal disease is a debilitating, chronic disease of the natal cleft. It mainly involves the sacrococcygeal region and the presentation varies from asymptomatic pits to painful draining abscesses. Treatment options vary from observation to wide excision. Unfortunately, surgical treatment often results in recurrence. The etiologic agent remains in question, as does the optimal treatment. Our objective was to assess the efficacy of laser epilation as an adjunctive therapy to surgical excision of the pilonidal sinus. Eighteen men and five women were treated with laser epilation in our office from 2001 to 2004. All patients had experienced recurrent folliculitis and had undergone some form of drainage procedure or prior excision. After surgical excision of the affected area, a Vasculite™ Plus laser was used for the epilation treatments. Each session involved 9 to 12 treatments and the patients underwent an average of two sessions. All 19 of the patients that remain in follow-up report no recurrence of their folliculitis or need for further surgical procedures. During treatment, six of the men and one of the women experienced a superficial wound dehiscence. All healed with local wound care and continued laser treatments. Laser epilation is an effective adjunctive therapy for the treatment of pilonidal disease. Although not curative in and of itself, the removal of hair allows better healing and decreases the chance of recurrence by removal of a significant etiology of pilonidal disease.

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Fibro-Epithelial Hyperplasia Mimicking Mucocele

Kathmandu University Medical Journal ◽

10.3126/kumj.v12i2.13663 ◽

2015 ◽

Vol 12 (2) ◽

pp. 146-148

Author(s):

K Jain ◽

BD Singh ◽

A Dubey ◽

A Avinash

Keyword(s):

Medical Journal ◽

Local Anesthesia ◽

Surgical Excision ◽

Chief Complaint ◽

Epithelial Hyperplasia ◽

Local Irritation

The effects of chronic local irritation have been seen commonly in the form of fibroma or mucocele in children. We report a ten year old girl with the chief complaint of swelling in the lower right region of labial mucosa which was diagnosed clinically as mucocele and histologically as fibro-epithelial hyperplasia. Surgical excision was done under local anesthesia with no post-operative complication.Kathmandu University Medical Journal Vol.12(2) 2014: 146-148

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Management of Squamous Cell Carcinoma in a Chronic Sacrococcygeal Pilonidal Cyst: A Case Report

Surgical Case Reports ◽

10.31487/j.scr.2020.06.18 ◽

2020 ◽

pp. 1-4

Author(s):

Ziad El Rassi ◽

Charbel Aoun ◽

Hani Maalouf ◽

Saleem Abdel Backi ◽

Toufic Saber ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Malignant Transformation ◽

Squamous Cell ◽

Pilonidal Disease ◽

Surgical Excision ◽

High Rate ◽

Pilonidal Cyst ◽

Subcutaneous Tissues

Introduction: Pilonidal disease is a chronic inflammatory process resulting from impaction of natal cleft hair into the subcutaneous tissues creating an abscess or a draining sinus over the sacrococcygeal area. Malignant transformation occurs in around 0.1%, mainly into squamous cell carcinoma (SCC) type. Wide excision with tumor-free margins remains the treatment of choice. Multiple closure techniques were settled and the best one ought to be chosen in a context malignancy and future radiological treatment. Case Presentation: We describe the management of a case of a 69-year-old male with chronic pilonidal disease, recurrent after 25 years found on final pathology to undergo malignant transformation into SCC. Wide and aggressive excision were performed with new margins and with periosteal excision of the sacrum and coccyx. rotational myocutaneous gluteal flap was done for closure of the wound in order to ensure better satisfactory esthetic results without a delay in future treatment. Conclusion: The progression of a chronic pilonidal disease into SCC is a rare but serious complication. The diagnosis is confirmed by biopsies. Workup for metastasis should be made before aggressive surgical excision. Oncoplastic surgeries is recommended for satisfactory results. Routine follow-up postoperatively should be considered due to high rate of recurrence by physical examination and imaging.

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Secondary Intention Healing After Mohs Surgical Excision as an Alternative to Surgical Repair

Annals of Plastic Surgery ◽

10.1097/sap.0000000000002330 ◽

2020 ◽

Vol 85 (S1) ◽

pp. S28-S32

Author(s):

Katherine Y. Liu ◽

Brittni Silvestri ◽

Jocellie Marquez ◽

Tara L. Huston

Keyword(s):

Surgical Repair ◽

Surgical Excision ◽

Secondary Intention

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Pilonidal abscess of the breast

BMJ Case Reports ◽

10.1136/bcr-2018-227381 ◽

2019 ◽

Vol 12 (3) ◽

pp. e227381 ◽

Cited By ~ 1

Author(s):

Joseph Keighley ◽

Aishah Nadim ◽

David Howlett

Keyword(s):

Antibiotic Therapy ◽

Pilonidal Disease ◽

Surgical Excision ◽

Needle Aspiration ◽

Breast Abscess ◽

Adult Males ◽

Common Condition ◽

Breast Clinic ◽

Natal Cleft ◽

Pilonidal Abscess

Pilonidal disease is a common condition, typically occurring in the natal cleft of adult males. Other sites of pilonidal sinus are rarely reported. We report a case of periareolar pilonidal abscess in the breast of a 52-year-old woman who presented via the breast clinic complaining of nipple inversion and pain. Clinical examination and imaging revealed an underlying abscess which recurred despite antibiotic therapy and needle aspiration; the patient therefore underwent surgical excision of the abscess cavity. Subsequent histology diagnosed pilonidal abscess, an important differential to consider in the case of breast abscess, particularly in cases that are slow to resolve or recur post-treatment.

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