Pilonidal sinus disease

Abstract

Pilonidal disease is a frequent suppurative condition that occurs twice as often in men as in women, usually between the ages of 15 and 30. Pilonidal disease is located beneath the skin of the sacro-coccygeal region. It presents acutely as an abscess under tension while the chronic form gives rise to intermittent discharge from pilonidal sinus(es). Diagnosis is clinical and usually straightforward. In the large majority of cases, treatment is surgical but there is no consensus as to the 'ideal' technique. Acute abscess must be evacuated and an off-midline incision seems preferable. Excision is the standard definitive treatment but the choice of wide versus limited excision depends on the school of thought. The widespread practice in France is to leave the wound open, relying on postoperative healing by secondary intention. This technique has a low rate of recurrence but has the disadvantages of requiring local nursing care; the healing process is prolonged, usually associated with a temporary but prolonged cessation of activity. Primary wound closure techniques are less restrictive but their recurrence rate is probably higher. A direct midline suture is best after a small excision, but for a more extended wound, plastic reconstruction techniques are preferred; data in the literature favor asymmetric closure techniques such as those described by Karydakis and Bascom.

Novel Approaches in Pilonidal Sinus Treatment

“…In such circumstances, the wound should be dressed daily, and infection development should be avoided (de Parades et al, 2013). With the marsupialization technique in which the edges of the wound are sutured, the injury is minimized, and this fastens the healing process (Mentes et al, 2004a).…”

“…With the marsupialization technique in which the edges of the wound are sutured, the injury is minimized, and this fastens the healing process (Mentes et al, 2004a). In recent years, various dressings and negative pressure wound care products are preferred (de Parades et al, 2013).…”

Endoscopic pilonidal abscess treatment: a novel approach for the treatment of pilonidal abscess

“…However, pilonidal abscesses are routinely managed with incision and drainage of the fluctuant swelling accompanied by washout and leaving the wound open for healing by secondary intention. 4 The postoperative course of patients undergoing incision and drainage is associated with prolonged wound healing time, pain, regular wound dressing and delayed return to daily activities. In 2011, Meinero described a novel technique using a fistuloscope for the treatment of anal fistulae.…”

The Dufourmentel modification of the limberg flap: Does it fit all?

“…Hair strands grow beneath the skin, leading to local inflammation, the foreign body reaction and infection. 3 Treatment for acute PD consists of abscess incision and drainage. The chronic form can be managed in many ways, from removal of all the infected tissue or only unroofing the pilonidal sinuses, leaving the wound open to heal by secondary intention before using plastic surgery techniques such as a Karydakis flap (KF) or Limberg flap (LF).…”

“…The chronic form can be managed in many ways, from removal of all the infected tissue or only unroofing the pilonidal sinuses, leaving the wound open to heal by secondary intention before using plastic surgery techniques such as a Karydakis flap (KF) or Limberg flap (LF). 3 The authors of a meta-analysis of 25 trials (2,949 patients) suggested that open radical excision and primary midline closure should be abandoned in favor of sinusotomy/sinectomy or en bloc resection with off-midline primary closure. 4 The authors of the present article performed radical excision with primary midline closure before the introduction of the Dufourmentel modification of the Limberg flap (DMLF), but the outcomes were poor, especially in patients with PD and laterally localized sinuses.…”