A new surgical method of pilonidal sinus treatment: A bilaterally paralel elliptic fascio-cutaneous advancement flap technique

ArticleinBratislavske lekarske listy 113(12):728-31 · November 2012with5 Reads
Impact Factor: 0.44 · DOI: 10.4149/BLL_2012_165 · Source: PubMed

Pilonidal sinus disease (PSD) is a common chronic disease in young people, It is often associated with considerable discomfort and morbidity Background: We aimed to describe our new bilateral parallel elliptic fascio-cutaneous advancement flap technique in PSD treatment and we assessed the technique's results in 57 patients.Method: This procedure consists of a bilateral parallel elliptical excision, mobilization of the fascio-cutaneous flap from the median line of the wound, fixation of the base of the flap to the sacrococcygeal fascia by method of overlapping, and suturing its edge to the lateral side. Finally, we closed the wound without tension in accord with the anatomical plane.Result: The mean age of the patients was 25.3±4 years. Complications such as infection, wound dehiscence, and seroma were detected in 2 (3.5 %), 2 (3.5 %), and 3 (5.2 %) patients, respectively. The mean durations of hospitalization and absence from work were 2.4±3 and 12.6±3 days, respectively. The mean length of defects after operations was 14.4±1 cm and the mean width was 7.2±1 cm). Follow up period averaged 21.4±1.2 (range, 12 to 72) months. Recurrence occurred in one (1.7 %) patient included in this study. We detected a mild-degree wound dehiscence in patients with wound infection (n=2, 3.5 %). Conclusion: Our novel technique provided the patients with minimum postoperative morbidity, short hospital stay and reduced absence from work. In addition, the technique has a satisfying aesthetic outcome and a decreased recurrence rate. Moreover, the flap could be prepared easily. In the light of our results, we suggest that our novel surgical technique seems to be a reasonable method in treatment of PSD (Fig. 2, Ref. 24). Keywords: fascio-cutaneous advancement flap, pilonidal sinus disease, surgical treatment.

  • [Show abstract] [Hide abstract] ABSTRACT: This study was planned to evaluate prospectively the results of 112 pilonidal sinus cases treated surgically by using asymmetric excision and primary closure with suction drain and subcuticular skin closure. It is aimed at elimination of the causative factors of pilonidal sinus. The patient's age, profession, weight and height, symptoms and signs, duration of symptoms, previous treatments, operation time and cost, hospital stay, return to normal activity, complications, pathologic and microbiologic examinations, and recurrences were noted. All pilonidal sinus cases except pilonidal abscess and extensive gluteal involvement were treated surgically. The procedure consists of an eccentric, elliptical excision of the affected tissue, mobilization of the flap to the sacrococcygeal fascia and the suturing of its edge to the lateral one. Penrose drains were placed in the first eight (7.14 percent) cases, but suction drains were placed in others. The cases were followed up for a mean of 2.4 years. Twenty-eight (25 percent) cases had undergone previous operative procedures. Of 112 patients 106 (94.6 percent) were male. Mean age was 22.1 years. Mean history of disease was 4.2 years. The overall complication rate was 7.14 percent. Two (1.8 percent) wound infections, two wound breakdowns, three (2.7 percent) collections, and one (0.9 percent) recurrence were recorded. The collections were reduced to zero after first eight cases by using a suction drain. Sixty-eight of the patients (60.7 percent) had body weight over 90 kg, and the mean body mass index was 24.8. The mean hospital stay was 2.6 days, and the mean time off work was 12.4 days. The average healing time was 13.2 days. There were no anesthetic or surgical deaths. The natal cleft is flattened and the incision scar and the incision line is transferred from the midline to the lateral side by performing the asymmetric excision and primary closure, and thus the essential cause of pilonidal sinus is eliminated. The procedure is simple, the complications and recurrences are very low, and it is seen to be an excellent procedure in the surgical treatment of uncomplicated pilonidal sinus disease.
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  • [Show abstract] [Hide abstract] ABSTRACT: Many theories concerning the development of chronic pilonidal sinus have been proposed. A histologic study of primary pilonidal sinus in 53 patients is presented. Subcutaneous tissue contained sinuses surrounded by chronic inflammation. Hair in sinuses was found in three quarters of the specimens examined. Examination showed that hair entered via one of the sinus openings created. Pits (defined as darker spots of varying width in the midline of the internatal cleft) were found to be indentations of the skin containing keratin plugs and debris. They may be isolated or connected with hair follicles. Pilonidal sinuses are chronic inflammatory processes of the skin caused by keratin plugs and debris clinically observed as pits, having penetrated the dermis.
    No preview · Article · May 1995 · Apmis
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  • [Show abstract] [Hide abstract] ABSTRACT: Pilonidal sinus disease is common especially in young adult males. Many surgical and nonsurgical methods have been described. Some surgical techniques for the treatment still have high recurrence rate. The aim of this study was to evaluate advantages and long term results of Limberg flap surgical technique. From November 2001 to December 2004, 353 patients [335 male, 18 female; average age = 24.65 +/- 4.2 (range, 15-53) years] with primary or recurrent pilonidal sinus disease were operated on under spinal anesthesia by rhomboid excision and Limberg flap. Follow-up examinations were made at the end of the 4 weeks and 3, 6, 12, 18, and 24 months after surgery. The mean duration of symptoms was 23.28 +/- 16.09 (range, 2-140) months. The mean duration of hospital stay was 4.51 +/- 2.85 (range, 2-19) days. Thirty nine patients (11%) had recurrent disease. Total wound dehiscence and flap necrosis did not occur in any patient. Recurrences were observed in 11 patients (3.1%) at the end of the follow up period. Quick healing time, short hospital stay, early return to daily life, low complication and recurrence rate are the important advantages of the Limberg flap procedure. We think using closed suction drain in Limberg flap operation is not necessary. In the light of this study results, Limberg flap surgical technique may be an ideal operation for pilonidal sinus disease.
    No preview · Article · Apr 2008 · Langenbeck s Archives of Surgery
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