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

INTRODUCTION The ideal treatment for pilonidal sinus disease has yet to be defined. There are many approaches described in the literature. METHODS 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. RESULTS 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. CONCLUSIONS 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.

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Z Plasty Single Center Results in The Treatment of Pilonidal Sinus Disease in Children

Tropical Health and Medical Research ◽

10.35916/thmr.v0i0.11 ◽

2020 ◽

Vol 2 (1) ◽

pp. 39-43

Author(s):

Yusuf Atakan Baltrak ◽

Seniha Esin Sogut ◽

Onursal Varlikli

Keyword(s):

Pilonidal Sinus ◽

Pilonidal Disease ◽

Pilonidal Sinus Disease ◽

Recurrence Rates ◽

Sinus Disease ◽

Common Chronic Disease ◽

Sacrococcygeal Region ◽

Surgical Methods

Pilonidal sinus is a common chronic disease of the sacrococcygeal region. Treatment varies according to the clinical presentation of the disease. Although many surgical methods have proposed, the ideal approach is still lacking due to high recurrence rates. This study aimed to evaluate the role of Z-plasty in achieving primary recovery in pilonidal disease and morbidity and recurrence. Twenty-four patients (15 males and nine females) who underwent sinus excision and Z-plasty closure for the sacrococcygeal pilonidal sinus included in this study. Follow-up ranged from 6 to 12 months. There were 15 males and nine females with a median age of 16 years. The mean hospital stay was two days. There was no recurrence, and all patients were satisfied with the cosmetics. Two patients (5%) had numbness on the flap. No flap necrosis observed in any patient. Only three patients had a wound infection (7.5%). Wound seroma developed in five patients (12.5%). Although some technical expertise is required, excision of sinus and Z-plasty provides superior results in terms of recurrence and hospitalization of pilonidal sinus patients during hospitalization.

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Long-term Results of Pilonidal Sinus Disease with Modified Primary Closure: New Technique on 450 Patients

The American Surgeon ◽

10.1177/000313481408000520 ◽

2014 ◽

Vol 80 (5) ◽

pp. 484-488 ◽

Cited By ~ 3

Author(s):

Marco Gallinella Muzi ◽

Riccardo Maglio ◽

Giovanni Milito ◽

Casimiro Nigro ◽

Ilaria Ciangola ◽

...

Keyword(s):

Postoperative Pain ◽

Return To Work ◽

Pilonidal Sinus ◽

Primary Closure ◽

Pilonidal Disease ◽

Pilonidal Sinus Disease ◽

Sinus Disease ◽

Long Term Follow Up

Chronic pilonidal disease is a debilitating condition that typically affects young adults. 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 our modified primary closure. This retrospective study involving consecutive patients with pilonidal disease was conducted over a 6-year period. From January 2004 to January 2010, 450 consecutive patients with primary pilonidal sinus disease received this new surgical treatment. Times for complete healing and return to work, the duration of operation and of hospitalization, postoperative pain, time to first mobilization, and postoperative complications were recorded. To evaluate patient comfort, all patients were asked to complete a questionnaire including visual analog scale. The median long-term follow-up was 54 months (range, 24 to 84 months). Four hundred fifty consecutive patients (96 female, 354 male) underwent excision. The median age was 25 years (range, 17 to 43 years). The median follow-up period was 54 months (range, 24 to 84 months). Four hundred twenty completed questionnaires were returned (87% response rate). The median duration of hospital stay was eight hours (range, 7 to 10 hours) No patient reported severe postoperative pain. Primary operative success (complete wound healing without recurrence) was achieved in 98.2 per cent. Two (0.5%) patients had a recurrence. The mean time lost to work/school after modified primary closure was eight days. Excision and primary closure with this new technique is an effective treatment for chronic pilonidal disease. It is associated with low morbidity, early return to work, and excellent cosmetic result and a high degree of patient satisfaction in the long-term follow-up.

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Pilonidal sinus disease: Karydakis flap procedure in our patients

Perspectives in Surgery ◽

10.33699/pis.2020.99.8.350-355 ◽

2020 ◽

Vol 99 (8) ◽

Keyword(s):

Wound Healing ◽

Pilonidal Sinus ◽

Healing Process ◽

Pilonidal Sinus Disease ◽

Wound Complications ◽

Limberg Flap ◽

New Disease ◽

Sinus Disease ◽

Flap Procedure

Introduction: Despite the available guidelines, opinions of many surgeons are quite ambiguous when it comes to the therapy of pilonidal sinus disease. The treatment can be a frustrating problem both for the surgeon and the patient because it is associated with wound complications and high recurrence rate. The objective of this study was to analyze the results of patients with pilonidal sinus disease undergoing the Karydakis flap procedure. Methods: A total of 27 patients treated for primary and recurrent pilonidal disease using the Karydakis flap procedure at our department between October 23, 2018 and November 22, 2019 were analyzed prospectively. We evaluated postoperative wound healing, complications and recurrence of the disease in a short-term follow-up period. Disease recurrence was defined as prolonged healing or as a new disease requiring repeated surgery. Results: In December 2019 all 27 patients came for a follow-up visit. The result was a fully lateralized wound without any signs of a new disease in all patients. In May 2020 a follow-up visit by phone was performed. The median follow-up was 12 months. The healing process was free of any serious complications in 25 patients. Seroma formation cases were managed by puncture in the outpatient setting. Conclusion: According to the available evidence and guidelines, off-midline procedures – the Karydakis flap, Bascom cleft lift, and Limberg flap procedures – are associated with lower recurrence rates and better wound healing. An important goal is to achieve complete wound lateralization and to change the configuration of the gluteal cleft by reshaping it, which results in a nicely flattened gluteal crease.

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Comparison of Common Surgical Procedures in Non-complicated Pilonidal Sinus Disease, a 7-Year Follow-Up Trial

World Journal of Surgery ◽

10.1007/s00268-019-05331-1 ◽

2019 ◽

Vol 44 (4) ◽

pp. 1091-1098 ◽

Cited By ~ 2

Author(s):

Mujgan Caliskan ◽

Koray Kosmaz ◽

Ismail Ege Subasi ◽

Aylin Acar ◽

Ismail Evren ◽

...

Keyword(s):

Surgical Procedures ◽

Pilonidal Sinus ◽

Pilonidal Sinus Disease ◽

Sinus Disease

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A useful alternative surgical technique to reconstructing large defects following excision of recurrent pilonidal sinus disease in the intergluteal region: An operative approach for the transverse lumbar artery perforator flap

International Wound Journal ◽

10.1111/iwj.12894 ◽

2018 ◽

Vol 15 (4) ◽

pp. 534-537 ◽

Cited By ~ 2

Author(s):

Alethea MY Tan ◽

Zeeshan Ahmad ◽

Charles YY Loh ◽

Sonya Gardiner ◽

Bhagwat Mathur

Keyword(s):

Surgical Technique ◽

Pilonidal Sinus ◽

Perforator Flap ◽

Operative Approach ◽

Pilonidal Sinus Disease ◽

Lumbar Artery ◽

Sinus Disease ◽

Artery Perforator

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Management of pilonidal sinus disease with Limberg flap: our experience

International Surgery Journal ◽

10.18203/2349-2902.isj20201872 ◽

2020 ◽

Vol 7 (5) ◽

pp. 1575

Author(s):

Mahavir Singh ◽

Saish Dalal ◽

Baleshwar . ◽

Sethu Raman

Keyword(s):

Pilonidal Sinus ◽

Pilonidal Disease ◽

Tertiary Care ◽

Pilonidal Sinus Disease ◽

Common Disease ◽

Main Concern ◽

Limberg Flap ◽

Sinus Disease ◽

Minimal Scarring ◽

Early Return

Background: Pilonidal sinus disease is a common disease of young adults. The management of the sacrococcygeal pilonidal sinus varies from conservative measures to various surgical procedures. The main concern for the treatment to the patient is the recurrence. Although several methods have been described all have been associated with high recurrence rates. This study was carried out to evaluate the advantages, results of rhomboid excision and limberg flap reconstruction in the management of pilonidal sinus disease.Methods: This prospective study was conducted in General Surgery department of a tertiary care centre of Haryana. It includes 29 patients who were treated for pilonidal sinus disease by Limberg flap surgery from January 2015 to January 2019. Results: All patients were successfully treated with minimal postoperative discomfort. Only two patients developed seroma which was managed conservatively and in two patients there was slight flap tip necrosis which was also managed conservatively. Rest all other patients wound healed nicely with minimal scarring, with very less postoperative pain, with no recurrence so far.Conclusions:Limberg flap is very effective treatment for pilonidal disease. It has many advantages as it is easy to perform and design, and it flattens the natal cleft with large vascularized pedicle, sutured without tension. This in turn maintains good hygiene, reducing the friction, preventing maceration, and avoiding scar in the midline. The technique is easy to perform in quick time, useful in both primary and recurrent diseases, with very low complication and recurrence rate. Other advantages are quick healing time, short hospital stay, and early return to daily life.

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Non surgical management of pilonidal sinus disease

Acta chirurgica iugoslavica ◽

10.2298/aci1601095p ◽

2016 ◽

Vol 63 (1) ◽

pp. 95-100

Author(s):

Gupta Pravin

Keyword(s):

Pilonidal Sinus ◽

Pilonidal Disease ◽

Low Cost ◽

Secondary Infection ◽

Treatment Options ◽

Outpatient Setting ◽

Tissue Loss ◽

Pilonidal Sinus Disease ◽

Sinus Disease ◽

The One

When cosiidering how to treat pilonidal sinus, physicians should keep in mind that this condition is more than merely a particular form of foreign body granuloma. The ideal method of treatment for pilonidal sinus should be the one having minimal postoperative morbidity, excellent cosmetic results, minimal tissue loss, rapid resumption of daily activities, low cost, and a low recurrence rate. However, although numerous operative and non-operative treatment methods have been described, no approach comprises all of these features. Numerous treatment options have been proposed for the pilonidal disease, including shaving, removal with open packing, incision and drainage, excision with primary closure, phenol application, cryosurgery, excision with marsupialization, and recently, flaps surgery. The management of pilonidal sinus disease will depend on patient assessment, examination and history of the condition. A disease-specific history and physical examination should be performed, emphasizing symptoms, risk factors, and the presence of secondary infection. Conservative therapy can fairly control pilonidal sinus disease in the office outpatient setting while assuring a near-normal work status and should be pre ferred over excisional operations at the outset.

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Endoscopic Treatment of Pilonidal Sinus Disease: State of Art and Review of the Literature

Frontiers in Surgery ◽

10.3389/fsurg.2021.812128 ◽

2022 ◽

Vol 8 ◽

Author(s):

Michele Manigrasso ◽

Pietro Anoldo ◽

Grazia Cantore ◽

Alessia Chini ◽

Anna D'Amore ◽

...

Keyword(s):

Pilonidal Sinus ◽

Endoscopic Treatment ◽

Endoscopic Approach ◽

Pilonidal Sinus Disease ◽

Short Term ◽

Sinus Disease ◽

Video Assisted ◽

Long Term Follow Up

Background: Pilonidal sinus disease (PSD) is a chronic troublesome pathology of the natal cleft of the sacrococcygeal region, with an estimated incidence of 26 cases in every 100,000 inhabitants. The aim of this review is to give a snapshot of the current literature on the endoscopic approach to PSD.Methods: A search on endoscopic treatment of pilonidal disease was performed according to PRISMA guidelines, adopting the following search terms: (pilonidal OR sacrococcygeal) and (endoscopic OR VAAPS OR EPSiT OR minimally invasive OR video-assisted OR video assisted).Results: Thirty-four articles were included in the final analysis, among which 23 were on adults and 11 were on pediatric population. The endoscopic approach is associated with painless postoperative pain, good aesthetic results, short time off work, and high patient satisfaction.Despite these advantages in short-term outcomes, results on recurrence rate in a long-term follow up are needed to definitively confirm the importance of this technique.Conclusions: The endoscopic approach is associated with significant postoperative advantages over other standard surgical approaches, and it should be included in the surgical portfolio for the treatment of PSD. According to the Italian guidelines, this technique could be considered as the gold standard for limited PSD. However, the favorable short-term-outcomes and lack of reliable data on long-term follow-up must be a stimulus to perform further high-quality studies to give definitive conclusions on this technique.

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