Modified off-midline closure of pilonidal sinus disease

Abstract

Background:Numerous surgical procedures have been described for pilonidal sinus disease, but treatment failure and disease recurrence are frequent. Conventional off-midline flap closures have relatively favorable surgical outcomes, but relatively unfavorable cosmetic outcomes.Aim:The author reported outcomes of a new simplified off-midline technique for closure of the defect after complete excision of the sinus tracts.Patients and Methods:Two hundred patients of both sexes were enrolled for modified D-shaped excisions were used to include all sinuses and their ramifications, with a simplified procedure to close the defect.Results:The overall wound infection rate was 12%, (12.2% for males and 11.1% for females). Wound disruption was necessitating laying the whole wound open and management as open technique. The overall wound disruption rate was 6%, (6.1% for males and 5.5% for females) and the overall recurrence rate was 7%.Conclusion:Our simplified off-midline closure without flap appeared to be comparable to conventional off-midline closure with flap, in terms of wound infection, wound dehiscence, and recurrence. Advantages of the simplified procedure include potentially reduced surgery complexity, reduced surgery time, and improved cosmetic outcome.

Five Layers Repair in Management of Pilonidal Sinus

“…Interestingly, wounds closed on the midline of the natal cleft took longer to heal compared with wounds closed off-midline, that may led to infection and other complication and previous studies showed recurrent cases. Recurrence of pilonidal sinus was the most commonly reported outcome by all the included studies [15].…”

Negative pressure wound therapy following excision of pilonidal sinus disease: A retrospective review

“…It is also important to note that recent literature on a variety of flap techniques, such as the Limberg flap or Karydakis flap, has been very promising with high rates of successful wound healing and low rates of reccurrence accompanying the application of these techniques [13]. However, such techniques are not without limitations [13][14][15]. It has been reported that flap techniques are associated with a high rate of postoperative pain as a result of flap mobilisation and multiple sutures [13,15].…”

“…It has been reported that flap techniques are associated with a high rate of postoperative pain as a result of flap mobilisation and multiple sutures [13,15]. This can prolong inpatient length of stay, delay recovery and cause distress to the | 2965 patient [13,15]. Cosmetic outcomes can range from fair to poor based on the size and extent of reconstruction [13,15].…”

“…This can prolong inpatient length of stay, delay recovery and cause distress to the | 2965 patient [13,15]. Cosmetic outcomes can range from fair to poor based on the size and extent of reconstruction [13,15]. Recurrent PSD following flap reconstruction is also highly challenging to manage, often requiring extensive excision resulting in a large defect that is left to heal by secondary intention [13,15].…”

“…Negative pressure wound therapy (NPWT) is a dressing system which serves to accelerate the process of wound healing [15].…”