Therapievergleich bei infiziertem Sinus pilonidalis – Unterschiede von Narbenqualität und Outcome nach Sekundärheilung oder Limberglappenplastik im Rahmen einer prospektiven Studie

Abstract

Objective: There are various options for wound treatment after the excision of a pilonidal sinus. The aim of our study was to compare secondary healing to Limberg flap wound closure, with a focus on scar quality and patient complaints, rate of recurrence, period of absence from work as well as functional and aesthetic results one year after surgery. Method: 33 out of 55 patients who underwent pilonidal sinus excision in our department (KlinikumStadtSoest, Soest, Germany) between 2011 and 2012 were enrolled in the study. 16 of these 33 patients had chosen secondary wound healing and 17 were treated with a Limberg flap for defect coverage. First and foremost, we aimed to objectify scar quality and elasticity by measuring the parameters of skin distensibility and mobility. To this end, we used a self-developed method to ascertain the sacral lumbar skin distension quotient (SL quotient) as well as sacral skin mobility. 100 healthy volunteers served as a control group. Also we collected information about pain, time of absence from work and frequency of recurrence and asked patients about their satisfaction with the functional and aesthetic results. Results:The results for the sacral lumbar skin distension quotient were significantly better after Limberg flap wound closure compared with secondary wound healing. As regards distensibility, there was a marked trend to more favourable values in the Limberg group. No differences in distensibility and mobility were observed between the Limberg group and the control group, whereas skin distensibility was significantly reduced (p = 0.001) in secondary healing compared with the control group. Time off work was significantly longer in secondary healing (mean 63 days) than after Limberg flap (mean 29 days). No differences were identified regarding patient satisfaction, pain scores and frequency of recurrence.Dieses Dokument wurde zum persönlichen Gebrauch heruntergeladen. Vervielfältigung nur mit Zustimmung des Verlages.

Impact of geography and surgical approach on recurrence in global pilonidal sinus disease

“…at riskRR in % (95% CI)Nr. at riskPrimary open (1457)0.5 (0.1–0.8)12636.9* (5.3–8.5)851*8.1* (6.3–9.9)752*10* (7.9–12.1)706* 13, 26, 44, 54, 59, 64– 66, 92, 97, 115, 117, 122, 587, 588 Primary median closure (1320)3.9 (2.7–5.1)104312.2 (9.8–14.6)65515.0* (12.2–17.9)554*16.1* (13.1–19.2)507* 13, 44, 54, 59, 64– 66, 97, 115, 122, 123, 180, 211, 588– 590 Primary asymmetric closure (87)0.0* (0.0–0.0)48*0.0* (0.0–0.0)33*2.0* (0.0–6.3)26*7.1* (0.0–22.1)17* 65, 588, 591, 592 Karydakis/Bascom (332)1.5* (0.0–3.2)226*5.9 (2.0–9.8)151NANANANA 66, 298, 587 Limberg/Dufourmentel (434)1.9* (0.5–3.4)278*5.1* (1.2–8.9)54*NANANANA 92, 320, 357, 366, 394, 593– 595 Marsupialization (98)6.0* (1.3–10.6)98*7.1* (1.5–12.7)93*7.1* (1.5–12.7)76*8.8* (2.0–15.5)57* 13, 65, 97, 588 Pit picking (676)<...>…”

A New Surgical Technique for Closure of Pilonidal Sinus Defects: Triangular Closure Technique

“…In a study done by Solla and Rothenberger, the mean healing time for 150 patients who underwent this procedure was shown to be four weeks with a recurrence rate of 6% [18]. In addition, high risk of infection and poor scar formation are the other disadvantages of these methods of management [19]. …”

“…In 1984 Azab and colleagues described the use of a rhomboid excision and Limberg transposition flap in complex pilonidal disease [32], and several authors have reported low recurrence rates and a short period of hospital care when this technique was used [9,19]. Although the Limberg flap not only reduces the depth of the natal cleft but also transposes the midline incision scar laterally, since all the skin required for resurfacing of the rhombic defect is borrowed from one direction, this technique often results in extensive tension on the suture lines and is associated with poor scar formation in the closure of large excisional defects of the sacrococcygeal region (Figure 6).…”

Pilonidal sinus: Secondary wound closure vs. Limberg flap

“…Bisherige Studien zeigen somit insgesamt keine eindeutige Tendenz, welche Behandlungsoption die bessere darstellt [21]. Vor diesem Hintergrund und…”