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

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.

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

2012 ◽  
Vol 94 (1) ◽  
pp. 12-16 ◽  
Author(s):  
MR Venus ◽  
OG Titley
Keyword(s):  
Pilonidal Sinus ◽  
Pilonidal Disease ◽  
Perforator Flap ◽  
Cosmetic Outcome ◽  
Pilonidal Sinus Disease ◽  
Wound Edge ◽  
Sinus Disease ◽  
Free Rate ◽  
The Ideal

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.

scholarly journals Short-term outcomes of endoscopic pilonidal sinus treatment

2020 ◽  
Vol 102 (2) ◽  
pp. 94-97 ◽  
Author(s):  
R Kalaiselvan ◽  
ASD Liyanage ◽  
R Rajaganeshan
Keyword(s):  
Minimally Invasive ◽  
Pilonidal Sinus ◽  
Endoscopic Treatment ◽  
Pilonidal Disease ◽  
Minimally Invasive Technique ◽  
Pilonidal Sinus Disease ◽  
Invasive Technique ◽  
Short Term ◽  
Recurrence Rates

Introduction Endoscopic treatment for pilonidal disease was initially described by Meinero in 2013. This minimally invasive technique has both technical and aesthetic advantages. The diagnostic application helps identify the anatomy of the pilonidal disease and the operative phase ablates and cleans the infected cavity. Our aim was to study the short-term outcomes of endoscopic treatment for pilonidal disease and to evaluate complications and recurrence rates. Materials and methods A prospectively maintained database of all consecutive patients who underwent endoscopic treatment for pilonidal disease by a single surgeon in a district general hospital from 1 November 2014 to 31 March 2018 was analysed. Follow-up was available until 30 September 2018. Results A total of 74 patients (56 men) underwent endoscopic treatment for pilonidal disease. The median age was 21 years (range 16–62 years). All patients underwent the procedure as daycase procedures, seven under local anaesthesia. There were no immediate postoperative complications and no return to theatre or readmission within 90 days. On a median follow-up of 52 weeks (range 2–114 weeks), 57 patients healed completely and 8 lost to follow-up. We achieved primary healing rates of 67% (44/66) and delayed healing rate of 77% (51/66). Conclusions Endoscopic treatment for pilonidal disease is a safe and effective minimally invasive technique that should be considered as first-line treatment in selected cases of pilonidal sinus disease, thereby reducing morbidity related to conventional procedures.

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

2014 ◽  
Vol 80 (5) ◽  
pp. 484-488 ◽  
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.

scholarly journals Impact of geography and surgical approach on recurrence in global pilonidal sinus disease

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Dietrich Doll ◽  
Andriu Orlik ◽  
Katharina Maier ◽  
Peter Kauf ◽  
Marco Schmid ◽  
...  
Keyword(s):  
Pilonidal Sinus ◽  
Meta Analysis ◽  
Geographic Origin ◽  
Pilonidal Sinus Disease ◽  
Surgical Approaches ◽  
Recurrence Rates ◽  
Sinus Disease ◽  
The Usa ◽  
The Impact

Abstract Pilonidal sinus disease (PSD) is increasing globally. A recent meta-analysis and merged-data analysis showed that recurrence rates in PSD depend essentially on follow-up time and specific surgical procedures. However, the global distribution of surgical approaches and respective recurrence rates have never been studied in PSD. We aimed at studying the impact of geographic distribution of surgical approaches to treat PSD and subsequent geography-specific recurrence rates. We searched relevant databases as described previously. Recurrence rates were then associated with reported follow-up times and geographic origin. We simulated individual patients to enable analogy across data. Globally, recurrence rates range from 0.3% for Limberg/Dufourmentel approaches (95% CI 0.2–0.4) and flaps (95% CI 0.1–0.5) and up to 6.3% for incision (95% CI 3.2–9.3) at 12 months. Recurrence rates range from 0.3% for Karydakis/Bascom approaches (95% CI 0.0–0.8) up to 67.2% for incision (95% CI 7.5–100) in the USA, and 0.0% for primary asymmetric closure in Germany (95% CI 0.0–0.0). Our analysis shows that recurrence rates in PSD not only depend on therapeutic approaches and follow-up time but also on geography. Primary asymmetric closure and various flap techniques remain superior regardless of the geographical region. Some approaches have extraordinarily good outcomes in specific countries.

Pilonidal sinus disease: Karydakis flap procedure in our patients

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.

Surgical reconstruction of pilonidal sinus disease with concomitant extracellular matrix graft placement: a case series

2021 ◽  
Vol 30 (Sup7) ◽  
pp. S28-S34
Author(s):  
Abigail E Chaffin ◽  
Shane G Dowling ◽  
Mychajlo S Kosyk ◽  
Brandon A Bosque
Keyword(s):  
Extracellular Matrix ◽  
Postoperative Complications ◽  
Pilonidal Sinus ◽  
Case Series ◽  
Surgical Reconstruction ◽  
Pilonidal Sinus Disease ◽  
Surgical Approaches ◽  
Flap Reconstruction ◽  
Recurrence Rates ◽  
Sinus Disease

Background: Pilonidal sinus disease (PSD) is a chronic inflammatory disease affecting the soft tissue of the sacrococcygeal region and remains a challenging disease for clinicians to treat. The optimal treatment for PSD remains controversial and recent reports describe several different surgical approaches offering different benefits. Approximately 40% of initial incision and drainage cases require subsequent surgery. Due to high recurrence rates and postoperative complications, a more complex revision surgery involving a flap reconstruction may be required. We hypothesised that the combination of an extracellular matrix (ECM) graft with tissue flap reconstruction may decrease the postoperative complications and recurrence rates for PSD. Method: We report a retrospective case series using a surgical flap reconstruction with concomitant implantation of an ovine forestomach ECM graft under a fasciocutaneous flap with an off-midline closure for recurrent PSD, where previously surgical intervention had failed due to wound dehiscence and/or recurrent disease. Results: The case series included six patients. After three weeks, all patients except one were fully healed, and the sixth was fully healed by week 4; all wounds remained fully healed at 12 weeks. All patients achieved good cosmesis and were able to return to normal function without any residual symptoms. Conclusion: This pilot case series explored augmenting a flap reconstruction for complex PSD with advanced ECM graft materials, demonstrating that it may improve outcomes and minimise typical complications seen in flap closure, such as inflammation, infection, haematoma/seroma and hypoperfusion. Although the study had a limited number of participants, long-term outcomes were promising and suggest that further studies are warranted.

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

2019 ◽  
Vol 44 (4) ◽  
pp. 1091-1098 ◽  
Author(s):  
Mujgan Caliskan ◽  
Koray Kosmaz ◽  
Ismail Ege Subasi ◽  
Aylin Acar ◽  
Ismail Evren ◽  
...  
Keyword(s):  
Surgical Procedures ◽  
Pilonidal Sinus ◽  
Pilonidal Sinus Disease ◽  
Sinus Disease

scholarly journals Management of pilonidal sinus disease with Limberg flap: our experience

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.  

scholarly journals Retrospective analysis of 30 cases of pilonidal sinus by various techniques of conservative and surgical management and review of literature

2016 ◽  
Vol 4 (1) ◽  
pp. 291
Author(s):  
Sangram Karandikar ◽  
Narendra G. Naik
Keyword(s):  
Surgical Treatment ◽  
Retrospective Analysis ◽  
Pilonidal Sinus ◽  
Complete Healing ◽  
Pilonidal Sinus Disease ◽  
Local Skin ◽  
Sinus Disease ◽  
Conservative Method ◽  
Surgical Methods ◽  
Choice Of Treatment

Background:The pilonidal sinus disease may present as chronic cutaneous infection, pilonidal abscess, pilonidal sinus or recurrent pilonidal sinuses. There are several conservative non-surgical and surgical methods of treatment of pilonidal sinus. The wound healing of pilonidal sinus depends upon multiple factors such as the stage at which patient presented to the surgeon, co-existing medical conditions, method of medical/surgical treatment chosen and the expertise of the surgeon. Here we are presenting the retrospective analysis of 30 cases of pilonidal disease, in view of different modalities of treatment, challenges faced, post-operative results and hospital stay.Methods: Over a period of 7 years, 30 patients suffering from various stages of pilonidal sinus disease were treated by conservative and surgical methods. The choice of treatment modality offered to each patient was individualized based on the stage and severity at the time of presentation. The patients were followed up to assess recurrence for 1 year after complete healing of the pilonidal sinus.Results:All patients with pilonidal sinus/ ulcer < 5 mm showed complete healing without recurrence with conservative line of management. There was recurrence of sinus in 80 % patients treated with only Incision and Drainage for pilonidal sinus abscess. The patients with large sinus (> 5 mm ulcer or skin involvement), were treated by excision with healing by secondary intension. This group of patients was associated with recurrence in 80% cases. The remaining patients with large pilonidal sinus disease were treated by the newer technique of semi-closed method with drain. In this group, only 20% patients developed recurrent sinus. All patients with recurrences healed after either conservative method or surgical method involving local skin flap.Conclusions:The conservative method of treatment is suitable for early and superficial pilonidal sinuses. For chronic and extensive pilonidal sinus disease, surgical treatment with the newer technique of semi-closed method with drain was found to reduce the rate of recurrence. The cases with superficial recurrent pilonidal sinuses may heal with conservative approach and extensive recurrent lesions require reconstruction with local skin flap. The results of the newer technique of semi-closed method with drain were found to be comparable with that of surgery by excision with primary closer. These results may be further evaluated at high volume centre for practical statistical significance regarding choice of treatment.

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