A Method for Primary Reconstruction Following Radical Excision of Sacrococcygeal Pilonidal Disease

Abstract

A great variety of procedures have been proposed for the cure of Sacrococcygeal pilonidal disease. Initial enthusiasm has usually given way to disappointment when it is realized that the treatment is painful, the hospitalization is prolonged, the aftercare is tedious or the original condition appears to have recurred. A technique is described which permits the total extirpation of cyst and sinus tracts while allowing for a tensionless wound closure by advancement of a buttock flap. Hospitalization is brief and the postoperative course is comfortable. Fifty such operations have been performed since November 1968. In the first group of thirty patients operated upon between three and ten years ago, a single bonafide failure occurred. An additional twenty patients have been successfully treated for an overall failure rate of 2%.

Treatment of pilonidal sinus by phenol application and factors affecting the recurrence

“…In our study, follow-up was 24 months, and 10 of 12 recurrences occurred in the first year of treatment. Every method used in the treatment of sinus pilonidalis has its own recurrence rate [2,[12][13][14]. Surgical methods also have different recurrence rates [15][16][17][18][19].…”

“…Radical excision has been the most preferred surgical procedure but the reconstruction step, which is closely related to postoperative morbidity and recurrence, is still controversial. High recurrence and high infection rates and long hospitalization periods appear to be the main problems with the primary closure technique, whereas marsupialization with secondary healing of the granulating wound takes time and requires regular outpatient dressing [1][2][3][4][5].…”

Modified Bascom's Asymmetric Midgluteal Cleft Closure Technique for Recurrent Pilonidal Disease

“…14 The surgical principle of wound lateralization, first described by Karydakis, 14 has been applied after asymmetric and oblique elliptical skin incisions to create a thick flap and advance it across the midline. [14][15][16][17][18][19] Except for avoiding the consequence of a midline scar, the natural cleft becomes more shallow, which reduces the acute direction of sacral hairs into the natal crevasse. 14 Inspired by the Karydakis operation, Bascom's cleft closure technique for unhealed presacral wounds emphasizes the obliteration of the deep cleft, the creation of a healthy skin-covered shallow furrow, the positioning of the suture line off the midline, and tissue tension relief between the coccyx and the skin.…”

Erhöhtes Rezidivrisiko nach primärem medianem Wundverschluss bei Patienten mit Pilonidalsinus

“…Folgende Faktoren werden als prädisponierend in der Entstehung angenommen: männliches Geschlecht, Übergewicht, starke Behaarung in der Rima ani, mangelnde Hygiene, sitzende Tätigkeiten, eine tiefe Glutealfurche [21]. Die in der Glutealfalte freiliegenden losen Haare spießen sich durch eine wiederholte Einwirkung (Reiben der Gesäßseiten) in die Haut hinein,dadurch werden Entstehung der Fremdkörpergranulome und Sekundärinfektionen begüns-tigt.Die Haarinsertion findet dabei fast ausnahmslos in der Mittellinie statt.Verständlich sind daher die von manchen Autoren [18,26,37] postulierte Operationsziele: Reduktion der Tiefe der Glutealfurche und Verlagerung der Operationswunde nach lateral von der Mittellinie. Die entsprechenden chirurgischen Eingriffe beinhalten meist eine plastische Deckung des durch die Exzision des Sinus pilonidalis entstandenen Defektes, z.…”

“…Es wurde betont, dass nach der Exzision des Sinus die resultierende Wunde lateral von der Mittellinie liegen soll. Die Anwendung einer asymmetrischen Exzision resultierte bei Fishbein et al[18] ebenfalls in einer niedrigen Rezidivrate von 2%.…”