Inverse ‘D’ incision technique in treatment of pilonidal sinus disease; excision with minimal tissue loss, closure without tension and lateral location of the suture line

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.

Download Full-text

Outcome of Surgical Management of Sacrococcygeal Pilonidal Sinus Disease with Rotation Flap in 52 Patients—A Retrospective Study

Indian Journal of Plastic Surgery ◽

10.1055/s-0041-1729506 ◽

2021 ◽

Vol 54 (02) ◽

pp. 163-167

Author(s):

Abbas Mistry ◽

Parvez Shaikh ◽

Aizaz Mohammed ◽

Samir Bagasrawala ◽

Ankit Chauhan ◽

...

Keyword(s):

Pilonidal Sinus ◽

Suture Line ◽

Pilonidal Sinus Disease ◽

Radical Excision ◽

Natal Cleft ◽

Sinus Disease ◽

Rotation Flap ◽

Post Surgery ◽

Flap Closure

Abstract Background Surgical treatment of sacrococcygeal pilonidal sinus disease (SPSD) consists of radical excision of the entire tract and treatment of the resultant raw area. Here, the authors have reviewed the results of the rotation flap for closure of the SPSD. Aim This study aims to evaluate the outcomes following SPSD excision and rotation flap closure. Materials and Methods All patients were treated for SPSD with excision and closure using a rotation flap from January 2010 to September 2018. Cases having a follow-up of at least 6 months post surgery were evaluated. Result A total of 52 patients were included in the study; 42 cases were of primary disease while 10 were of recurrent disease. The patients’ follow-up records on the 3rd day, 10th day, 1 month, and 6 months were evaluated.None of the patients showed any signs of recurrence on follow-ups. One patient developed a hematoma on the third day post surgery which was treated conservatively. One patient developed a seroma in the perianal region on the fifth postoperative day which required aspiration. Both these patients healed well subsequently. Conclusion Rotation flap is a (simple and reliable) treatment option for closure of postexcision SPSD defect. It not only takes the tension away from suture line, but also pushes the gluteal fat from the sides into the midline, obliterating the deep crevice of the natal cleft which is believed to be one of the important factors in the causation of SPSD, thus minimizing recurrence.

Download Full-text

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.

Download Full-text

Pilonidal sinus disease on the rise: a one-third incidence increase in inpatients in 13 years with substantial regional variation in Germany

International Journal of Colorectal Disease ◽

10.1007/s00384-021-03944-4 ◽

2021 ◽

Author(s):

Christina Oetzmann von Sochaczewski ◽

Jan Gödeke

Keyword(s):

Pilonidal Sinus ◽

Regional Variation ◽

Disease Incidence ◽

Age Groups ◽

Pilonidal Sinus Disease ◽

National Guidelines ◽

Reconstructive Procedures ◽

Sinus Disease ◽

The Mean ◽

Almost All

Abstract Purpose Collective evidence from single-centre studies suggests an increasing incidence of pilonidal sinus disease in the last decades, but population-based data is scarce. Methods We analysed administrative case–based principal diagnoses of pilonidal sinus disease and its surgical therapy between 2005 and 2017 in inpatients. Changes were addressed via linear regression. Results The mean rate of inpatient episodes of pilonidal sinus disease per 100,000 men increased from 43 in 2005 to 56 in 2017. In females, the mean rate of inpatient episodes per 100,000 women rose from 14 in 2005 to 18 in 2017. In the whole population, for every case per 100,000 females, there were 3.1 cases per 100,000 males, but the numbers were highly variable between the age groups. There was considerable regional variation within Germany. Rates of inpatient episodes of pilonidal sinus disease were increasing in almost all age groups and both sexes by almost a third. Surgery was dominated by excision of pilonidal sinus without reconstructive procedures, such as flaps, whose share was around 13% of all procedures, despite recommendations of the national guidelines to prefer flap procedures. Conclusion Rates of inpatient episodes of pilonidal sinus disease in Germany rose across almost all age groups and both sexes with relevant regional variation. The underlying causative factors are unknown. Thus, patient-centred research is necessary to explore them. This should also take cases into account that are solely treated office-based in order to obtain a full-spectrum view of pilonidal sinus disease incidence rates.

Download Full-text

Intermammary Hidradenitis Suppurativa: Considerations on a Unique Presentation

Skin Appendage Disorders ◽

10.1159/000514363 ◽

2021 ◽

pp. 1-4

Author(s):

Ana Luísa João ◽

Nélia Cunha ◽

Joana Cabete

Keyword(s):

Surgical Approach ◽

Inflammatory Disease ◽

Pilonidal Sinus ◽

Hidradenitis Suppurativa ◽

Chronic Inflammatory Disease ◽

Pilonidal Sinus Disease ◽

Sinus Disease ◽

Case Presentation ◽

Overweight Women

Introduction: Hidradenitis suppurativa (HS) is a potentially disabling chronic inflammatory disease. The intermammary location, not clearly specified in the usual phenotypic classifications, entails significant functional and cosmetic compromise. Case Presentation: Eleven cases of predominantly intermammary disease with multiple fistulization and disfiguring scarring were observed at our Department between January 2016 and March 2020. They were young (mean age = 22 years) obese or overweight women, in which the medical-surgical approach has led to variable results. Discussion/Conclusion: Intermammary HS possibly represents a unique phenotypic presentation, likely to be fistulizing and severe. We believe that anatomo-functional considerations, which can be paralleled to pilonidal sinus disease, contribute to its pathophysiology and striking appearance, and further emphasize the importance of multidisciplinary endeavor to reduce the morbidity associated with this seemingly overlooked location.

Download Full-text

The current status of surgical pilonidal sinus disease therapy in Germany

European Surgery ◽

10.1007/s10353-021-00715-x ◽

2021 ◽

Author(s):

Ralph Schneider ◽

Marius Dettmer ◽

Nora Peters ◽

Tenzin Lamdark ◽

Markus M. Luedi ◽

...

Keyword(s):

Pilonidal Sinus ◽

Current Status ◽

Pilonidal Sinus Disease ◽

Sinus Disease ◽

Disease Therapy

Download Full-text

Intra-anal pilonidal sinus disease: a unique diagnosis possibly pointing to the occiput

ANZ Journal of Surgery ◽

10.1111/ans.13473 ◽

2016 ◽

Vol 86 (7-8) ◽

pp. 622-622 ◽

Cited By ~ 7

Author(s):

Dietrich Doll ◽

Verena K. Stauffer ◽

Markus M. Luedi

Keyword(s):

Pilonidal Sinus ◽

Pilonidal Sinus Disease ◽

Sinus Disease

Download Full-text

Pilonidal Sinus Disease: Risk Factors for Postoperative Complications and Recurrence

International Surgery ◽

10.9738/cc86.1 ◽

2012 ◽

Vol 97 (3) ◽

pp. 224-229 ◽

Cited By ~ 29

Author(s):

Akin Onder ◽

Sadullah Girgin ◽

Murat Kapan ◽

Mehmet Toker ◽

Zulfu Arikanoglu ◽

...

Keyword(s):

Risk Factors ◽

Postoperative Complications ◽

Pilonidal Sinus ◽

Primary Closure ◽

Disease Risk ◽

Pilonidal Sinus Disease ◽

Limberg Flap ◽

Sinus Disease ◽

Faculty Department ◽

Closure Method

Abstract The aim of this study is to analyze the risk factors for complications and recurrence in pilonidal sinus disease. The prospective study consisted of 144 patients with pilonidal sinus disease who were operated on at Dicle University Medical Faculty, Department of General Surgery, between February 2008 and December 2010. Patients receiving the Limberg flap totaled 106 (73.6%), while 38 (26.4%) had primary closure. Postoperative complications developed in 42 subjects (29.2%), and recurrence occurred in 19 (13.2%). The Limberg flap method was statistically considered as a risk factor for postoperative complications (P = 0.039). Regarding recurrence, family tendency (P = 0.011), sinus number (P = 0.005), cavity diameter (P = 0.002), and primary closure (P = 0.001) were found to be risk factors. Postoperative complication rate is higher in the Limberg flap method than primary closure method. The risk of recurrence is related to family tendency, sinus number, cavity diameter and anesthesia type and is also higher in primary closure.

Download Full-text