Development of an evidence‐based protocol for care of pilonidal sinus wounds healing by secondary intent using a modified reactive Delphi procedure. Part one: the literature review^*

Abstract

This article is in two parts. The overall aim of this section was to review the literature in relation to pilonidal sinus wounds (PSW) healing by secondary intent for a Master's of Science in Wound Healing and Tissue Repair thesis. The purpose of the literature review was to determine if an evidence-based guideline or consensus document existed for the care of these wounds, and if not, to determine the topics from which to develop items for the first round of a modified reactive Delphi questionnaire. Part two will describe the iterative process, the analysis and the results. The review found no best practice guidelines concerning PSW, and only one clinical pathway. Seventeen areas of interest were identified that may contribute to optimal healing conditions or to delayed healing. These included microbiology of infected PSW, signs and symptoms of localised or deeper (spreading) chronic wound infection, swab for c&s, role of topical antiseptics or antimicrobials, systemic antibiotics, local wound interventions, optimal positioning, wound cleansing, principles of moist wound healing/dressing selection, topical negative pressure (TNP) therapy, peri-wound skin decontamination and depilation, pain control, physical activities, optimal nutrition and patient education.

Is conservative treatment an effective option for pilonidal sinus disease in children?

“…In this study, the mean age was 14.94 ± 1.09 years, and the girl to boy ratio was 1.07. In adolescents, especially females, increase in pubertal hormone levels lead to increased gluteal adipose tissue, BMI, and body hair In our study, the male to female ratio was not significantly different. Further studies with larger PSD populations may demonstrate that PSD is frequent and more common in females in the adolescent population.…”

“…The main culprit in the pathogenesis of PSD is increased body hair; 1 hair penetrating the dermis may create a foreign body reaction, resulting in a PS. Other predisposing factors include a narrow, deep gluteal sulcus, daily pouring hair (body hair and head hair), prolonged exposure of the skin to moisture, excessive time spent sitting, poor hygiene, and being overweight . However, there is no single predisposing factor, and the disease is likely multifactorial .…”

Scarless outpatient ablation of pilonidal sinus: a pilot study of a new minimally invasive treatment

“…According to a recent systematic review of the existing literature, the excision of the diseased tissue with healing by secondary intention leads to a better outcome in terms of recurrence (recurrence rate = 4⋅8%) (1). However, this operation involves a long period of hospitalisation, acute postoperative pain and a long recovery time (2-6 months) (9). As far as the wound is concerned, on the one hand healing by primary intention results in faster recovery; on the other hand, there is a higher risk of recurrence (recurrence rate = 10⋅50%) (1).…”

Suture granuloma mimicking a recurrent sacro‐coccygeal pilonidal sinus after Limberg flap

“…Numerous treatment options have been described for this disease. However, no standard therapy has yet been established . Due to high rates of recurrence of up to 42% , two flap techniques have been established in the course of the past three decades.…”