Outcomes of Coccygectomy Using the “Z” Plasty Technique of Wound Closure

Abstract

Study Design:Technical note.Objectives:Coccygectomy for chronic coccydynia has a high rate of successful clinical outcome. However, the procedure is associated with increased incidence of wound dehiscence and surgical site infection. The main objective was to evaluate the clinical outcomes of coccygectomy using the Z plasty technique of wound closure.Methods:Patients with chronic coccydynia refractory to conservative treatment underwent coccygectomy followed by Z plasty technique of wound closure between January 2013 and February 2018. Primary outcome measure was evaluation of the wound healing in the postoperative period and at follow-up; secondary outcome measure included visual analogue scale (VAS) score for coccygeal pain.Results:Ten patients (male:female 6:4) fulfilled the inclusion criteria. The mean age of patients was 40.78 years (range 19-55 years). The mean follow-up was 1.75 years (range 6 months to 5 years). All wounds healed well with no incidence of wound dehiscence or surgical site infections. The mean VAS improved from 7.33 ± 0.5 to 2.11 ± 1.2 (P < .05). Nine patients reported excellent outcomes and 1 patient reported poor outcome with regards to relief from coccydynia.Conclusion:Z plasty technique of wound closure is recommended as procedure of choice to avoid wound healing problems and surgical site infections associated with coccygectomy. Coccygectomy remains a successful treatment modality for chronic coccydynia.

Coccydynia-A comprehensive review on etiology, radiological features and management options

“…43 A recent modification described by Kulkarni et al adds a Z-plasty to the incision in order to reduce the tension and centrifugal forces acting on the incision, and therefore reducing the incidence of wound related complications. 41 The dissection proceeds with a sacro-coccygeal discectomy from cranial to caudal direction as described by Key to avoid an injury to the rectum, especially in anteverted coccyx; however, some surgeons have described the release of ano-coccygeal ligament first followed by elevating the distal end of the coccyx. 13,41 The amputation can be done at or slightly proximal to the sacrococcygeal junction.…”

“…41 The dissection proceeds with a sacro-coccygeal discectomy from cranial to caudal direction as described by Key to avoid an injury to the rectum, especially in anteverted coccyx; however, some surgeons have described the release of ano-coccygeal ligament first followed by elevating the distal end of the coccyx. 13,41 The amputation can be done at or slightly proximal to the sacrococcygeal junction. Sacro-coccygeal junction can be identified by the cornuate articulation posteriorly.…”

“…47,48 Over-all improvement in symptoms following coccygectomy range from 85 to 100% in literature. 41,44,45,47,48…”

Minimally invasive endoscopic approach to perform complete coccygectomy in patients with chronic refractory coccydynia: illustrative case

“…Finally, meticulous apposition of the flaps without tension is achieved using interrupted subcutaneous 2-0 Vicryl stitches. 13 Many studies have confirmed the effectiveness of coccygectomy in accomplishing pain control in most cases. [14][15][16][17][18][19][20] However, pain-free rates postcoccygectomy may be influenced by the specific etiology causing coccydynia.…”

“… 8 Recently, a “Z” plasty technique was used in wound closure to the distal end of the vertical incision to reduce wound dehiscence and infection rates. 13 In this technique, considering the primary vertical incision as the central limb of the “Z,” the incision is extended in opposite directions at an angle of 60°. Then, the flaps are raised such that the surgical wound looks like a parallelogram.…”