Pilonidal disease

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.

Excision and Primary Closure May be the Better Option in the Surgical Management of Pilonidal Disease in the Pediatric Population

2016 ◽  
Vol 82 (10) ◽  
pp. 964-967 ◽  
Author(s):  
Jessica A. Zagory ◽  
Jamie Golden ◽  
Kathleen Holoyda ◽  
Natalie Demeter ◽  
Nam X. Nguyen
Keyword(s):  
Length Of Stay ◽  
Surgical Management ◽  
Analysis Of Variance ◽  
Primary Closure ◽  
Average Length ◽  
Pilonidal Disease ◽  
Pediatric Population ◽  
Average Length Of Stay ◽  
Secondary Intention ◽  
Flap Closure

The optimal management of pilonidal disease in the pediatric population is still debated. We conducted a retrospective review of patients 21 years old and younger who underwent surgical management for pilonidal disease between 2009 and 2013 at a single pediatric institution. Sixty patients (41.7% male) were included in the analysis, with a mean age of 15.0 years (range, 13–20). Twelve (20%) had a prior drainage procedure for pilonidal abscess before the definitive operative treatment. After excision to the presacral fascia, 36 (60%) had primary closure, 17 (28.3%) were left to heal by secondary intention, and 7 (11.7%) had flap closure. Overall recurrence rate was 41.7 per cent with 33.3 per cent in the primary, 58.8 per cent in the secondary, and 42.9 per cent in the flap group, respectively. Ten (16.7%) patients developed postoperative complications, which were similar among surgical groups, gender, and body mass index. The average length of stay was 0.67 (median 0, range, 0–5) days. Primary closure had the shortest length of stay (analysis of variance P = 0.04), and flap closure had no reoperations (analysis of variance P < 0.01). Pilonidal disease remains surgically challenging. Our data suggest that excision and primary closure is a better option in the pediatric population.

scholarly journals SURGICAL TREATMENT OF CHRONIC PILONIDAL SINUS

2019 ◽  
Vol 141 (3-4) ◽  
pp. 63-67
Keyword(s):  
Wound Healing ◽  
Hospital Stay ◽  
Pilonidal Sinus ◽  
Primary Closure ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Limberg Flap ◽  
Secondary Intention ◽  
One Year ◽  
Flap Closure

Chronic pilonidal sinus is an acquired skin disease resulting from chronic inflammation of an affected skin area. It creates a cyst with epithelized subcutaneous channels. The disease mostly affects younger men with elevated BMI and sedentary lifestyle being the main risk factors. The aim of this study was to compare wound healing times, seroma, wound infection and wound dehiscence frequency, average length of hospital stay and recurrence rate in patients undergoing first-time operation for chronic pilonidal sinus at the Surgery clinic of University hospital Mostar from June 2015 to June 2017, with recurrence rate monitoring for one one year after the operative procedure. The patients were divided into three groups by the type of operating procedure: excision with primary closure (23.0%), excision with healing by secondary intention (55.2%) and excision with Limberg flap closure (21.8%). Most of the patients included in this study had elevated BMI (72.4%). Patients who were operated using primary closure and Limberg flap closure had on average shorter wound healing times than patients operated with excision and secondary intention healing. Seroma frequency was highest in patients operated using primary closure (70.6%) and lowest in patients operated using Limberg flap closure (29.4%). Average length of hospital stay was 6.4 days (min 3, max 13; SD 1.919). There were no statistically significant differences in hospital stay between different types of operating procedures used. Patients operated using Limberg flap closure had two (10.5%) cases of recurrence in the one year period after the operation. There were seven (35.0%) recurrences of the disease in patients operated using primary closure and six (12.5%) recurrences in patients operated using healing with secondary intention. The difference in the number of recurrences between patients operated using primary closure, healing by secondary intention and Limberg flap closure was borderline statistically significant. We find that Limberg flap closure reduces postoperative complications and wound healing time which improves postoperative recovery.

scholarly journals Pilonidal abscess of the breast

2019 ◽  
Vol 12 (3) ◽  
pp. e227381 ◽  
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.

Excision and Primary Closure Using the Karydakis Flap for the Treatment of Pilonidal Disease: Outcomes from a Single Institution

2011 ◽  
Vol 35 (8) ◽  
pp. 1803-1808 ◽  
Author(s):  
D. C. Moran ◽  
D. O. Kavanagh ◽  
I. Adhmed ◽  
M. C. Regan
Keyword(s):  
Primary Closure ◽  
Pilonidal Disease ◽  
Single Institution ◽  
Disease Outcomes

scholarly journals PILONIDAL SINUS DISEASE: COMPARISON OF EXCISION AND PRIMARY CLOSURE VERSES EXCISION AND HEALING BY SECONDARY INTENTION

1969 ◽  
Vol 2 (1) ◽  
pp. 134-137
Author(s):  
Mohammad Hussain ◽  
Manzoor Ali ◽  
S.M.Naeem ◽  
Nisar Ali ◽  
Muhammad Ismail
Keyword(s):  
Local Excision ◽  
Pilonidal Sinus ◽  
Wide Local Excision ◽  
Primary Closure ◽  
Health Concern ◽  
Pilonidal Sinus Disease ◽  
Sinus Disease ◽  
Secondary Intention ◽  
Group A ◽  
Group B

Introduction: Sacrococcygeal pilonidal disease is a serious health concern because of its associatedcomplications and recurrence. Pilonidal sinus disease is presented with symptoms ranging fromasymptomatic pits to painful draining lesions that are predominantly located in the sacrococcygeal region. Itis characterized by multiple subcutaneous sinuses, containing hairs. The exact etiology of the disease is notknown. Various treatment options are available. The choice of a particular surgical approach depends on thesurgeon's familiarity with the procedure and perceived results. The present study was aimed to compare twotreatment regimens i.e.excision and primary closure verses excision and healing by secondary intention.Patients and methods: The study was conducted in the department of surgery, Saidu Teaching HospitalSaidu Sharif Swat. Forty nine (49) human subjects with informed consent were included in the study.Patients were divided in two groups, depending on their preference and acceptance of the procedure.Patients in group A under went excision of the tract with primary closure of the defect by primary simpleclosure, Rhomboid Limberg flap or by Karydakis procedure. Patients in group B were those in whom sinustracts were excised and wound was left open for healing by secondary intention.Results: Out of the total 49 patients 3 (6.122%) were female. Mean age was 26 years (range 18-40years).Group A comprised of 24 patients in whom wide local excision was performed and wound was closedprimarily while Group B comprised of 25 patients who underwent wide local excision and wound was leftopen for healing by secondary intention. Mean hospital stay of patients in group B was significantly longerthan group A (p=0.002). The mean time for complete healing of the wound after primary closure wasmarkedly shorter.mConclusion: Primary closure of the wound after excision of the sinus tract is preferable over simple excisionand healing by secondary intention.Key words; Pilonidal sinus, primary closure, simple excision.

scholarly journals Extensive Surgical Emphysema in a Child after Primary Closure of Tracheocutaneous Fistula

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
R. Gurung ◽  
B. M. Shakya ◽  
H. Dutta
Keyword(s):  
Primary Closure ◽  
Signs And Symptoms ◽  
Oxygen Supplementation ◽  
X Ray ◽  
Close Observation ◽  
The Face ◽  
Chest X Ray ◽  
Tracheocutaneous Fistula ◽  
Surgical Emphysema ◽  
Upper Abdomen

A 4-year-old child had closure of tracheocutaneous fistula under general anaesthesia. He developed extensive surgical emphysema over the face, chest, and upper abdomen immediately in the recovery room. We gave him oxygen supplementation, removed surgical stitch, and inserted a 4 mm tracheostomy tube to secure airway. Chest X-ray ruled out pneumothorax or pneumomediastinum. After a week, a tight bandage was applied which approximated the tissue and helped in the closure of stoma; no suture was applied. The patient was discharged home on the fourth postoperative day. The patient needs close observation in the postoperative period with likely complication in mind. Recognizing early signs and symptoms of respiratory distress with quick intervention is lifesaving during the complication of tracheocutaneous fistula surgery. In absence of pneumothorax or pneumomediastinum, extensive surgical emphysema occurring during primary closure of tracheocutaneous fistula can be treated without inserting any drainage tube.

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