Novel Approaches in Pilonidal Sinus Treatment

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Abstract

Pilonidal sinus is a very common inflammatory disease of the gluteal region. The ideal method of pilonidal sinus treatment should have a low recurrence rate with minimum excision. Moreover, the treatment method should have a short hospitalization time, should let the patient return to his normal life rapidly, should cause minimum loss of labour and should result a small scar only. In the presented review, modalities in pilonidal sinus treatment in the light of current information in the literature are evaluated.

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Most cited references 39

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Easy and successful treatment of pilonidal sinus after explanation of its causative process.

G Karydakis (1992)

Hair insertion causes pilonidal sinus, it prevents spontaneous recovery, delays healing of any wound in the depth of the natal cleft, and is the cause of recurrence. An understanding of the hair insertion process made it possible to avoid hair insertion in 6545 cases of the condition with the use of the advancing flap operation. Results have proved this to be an easy and successful way of treating and preventing recurrence of pilonidal sinus. Furthermore, that understanding has introduced the possibility of preventing pilonidal sinus, through ways simpler than the simplest operation.

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Healing by primary closure versus open healing after surgery for pilonidal sinus: systematic review and meta-analysis.

Julie Bruce, Iain McCallum, M. King (2008)

To determine the relative effects of open healing compared with primary closure for pilonidal sinus and optimal closure method (midline v off-midline). Systematic review and meta-analyses of randomised controlled trials. Cochrane register of controlled trials, Cochrane Wounds Group specialised trials register, Medline (1950-2007), Embase, and CINAHL bibliographic databases, without language restrictions. Primary outcomes were time (days) to healing, surgical site infection, and recurrence rate. Secondary outcomes were time to return to work, other complications and morbidity, cost, length of hospital stay, and wound healing rate. Randomised controlled trials evaluating surgical treatment of pilonidal sinus in patients aged 14 years or more. Data were extracted independently by two reviewers and assessed for quality. Meta-analyses used fixed and random effects models, dichotomous data were reported as relative risks or Peto odds ratios and continuous data are given as mean differences; all with 95% confidence intervals. 18 trials (n=1573) were included. 12 trials compared open healing with primary closure. Time to healing was quicker after primary closure although data were unsuitable for aggregation. Rates of surgical site infection did not differ; recurrence was less likely to occur after open healing (relative risk 0.42, 0.26 to 0.66). 14 patients would require their wound to heal by open healing to prevent one recurrence. Six trials compared surgical closure methods (midline v off-midline). Wounds took longer to heal after midline closure than after off-midline closure (mean difference 5.4 days, 95% confidence interval 2.3 to 8.5), rate of infection was higher (relative risk 4.70, 95% confidence interval 1.93 to 11.45), and risk of recurrence higher (Peto odds ratio 4.95, 95% confidence interval 2.18 to 11.24). Nine patients would need to be treated by an off-midline procedure to prevent one surgical site infection and 11 would need to be treated to prevent one recurrence. Wounds heal more quickly after primary closure than after open healing but at the expense of increased risk of recurrence. Benefits were clearly shown with off-midline closure compared with midline closure. Off-midline closure should become standard management for pilonidal sinus when closure is the desired surgical option.

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State-of-the-art treatment of chronic leg ulcers: A randomized controlled trial comparing vacuum-assisted closure (V.A.C.) with modern wound dressings.

Patty Nelemans, J Vuerstaek, Martino H A Neumann … (2006)

Current treatment modalities for chronic leg ulcers are time consuming, expensive, and only moderately successful. Recent data suggest that creating a subatmospheric pressure by vacuum-assisted closure (V.A.C., KCI Concepts, San Antonio, Texas) therapy supports the wound healing process. The efficacy of vacuum-assisted closure in the treatment of chronic leg ulcers was prospectively studied in a randomized controlled trial in which 60 hospitalized patients with chronic leg ulcers were randomly assigned to either treatment by V.A.C. or therapy with conventional wound care techniques. The primary outcome measure was the time to complete healing (days). Statistical analysis was performed on the intention-to-treat basis. The median time to complete healing was 29 days (95% confidence interval [CI], 25.5 to 32.5) in the V.A.C. group compared with 45 days (95% CI, 36.2 to 53.8) in the control group (P = .0001). Further, wound bed preparation during V.A.C. therapy was also significantly shorter at 7 days (95% CI 5.7 to 8.3) than during conventional wound care at 17 days (95% CI, 10 to 24, P = .005). The costs of conventional wound care were higher than those of V.A.C. Both groups showed a significant increase in quality of life at the end of therapy and a significant decrease in pain scores at the end of follow-up. V.A.C. therapy should be considered as the treatment of choice for chronic leg ulcers owing to its significant advantages in the time to complete healing and wound bed preparation time compared with conventional wound care. Particularly during the preparation stage, V.A.C. therapy appears to be superior to conventional wound care techniques.

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Journal

Journal ID (publisher-id): PMRRAD

Title: Prague Medical Report

Abbreviated Title: Prague Med. Rep.

Publisher: Charles University in Prague, Karolinum Press

ISSN (Print): 1214-6994

ISSN (Electronic): 2336-2936

Publication date Created: 2016

Publication date (Print): 2016

Publication date (Electronic): December 8 2016

Volume: 117

Issue: 4

Pages: 145-152

Article

DOI: 10.14712/23362936.2016.15

SO-VID: e61c93b4-ddf9-4d4a-9f4b-1f83d4f561c9

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Novel Approaches in Pilonidal Sinus Treatment

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Most cited references 39

Easy and successful treatment of pilonidal sinus after explanation of its causative process.

Healing by primary closure versus open healing after surgery for pilonidal sinus: systematic review and meta-analysis.

State-of-the-art treatment of chronic leg ulcers: A randomized controlled trial comparing vacuum-assisted closure (V.A.C.) with modern wound dressings.

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Cited by 11

Most referenced authors 344