[Surgical treatment of suppurative epithelial pilonidal cysts].
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A series of 25 patients suffering from sacrococcygeal cyst-fistula treated by surgical removal and immediate, complete suture of the wound is reported. Functional recovery was complete and there no recurrences. Average postoperative hospitalization was also much shorter than that obtaining when other surgical techniques are used.
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Eighty one consecutive patients with pilonidal abscesses were treated by incision, curettage and primary closure with local instillation of 2% fusidic acid gel (Fucidin Caviject). Normal activity was resumed early (mean 13 days) with a low recurrence rate (13%). The regimen allows treatment as an outpatient, healing time is short and there is an early return to work. These features provide potential financial benefits to the Health Service, employee and employer.
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Many procedures have been advocated to treat pilonidal disease, suggesting that no one method is highly efficacious. In the office, the surgical approach is directed towards three aspects of the condition: pilonidal abscess, recurrent pilonidal disease following surgery and chronic pilonidal disease following spontaneous rupture of an abscess or secondary to incision and drainage. In managing the acute pilonidal abscess, an intradermal injection is given over the indurated, fluctuant area as well as the midline orifice which can almost always be identified. The midline orifice is incised and the incision carried into the abscess cavity. The edges of the cavity are excised. Healing takes place secondarily. A second procedure is rarely needed.
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The authors report 42 cases of pilonidal cyst on which 27 have been operated with the L-shaped skin graft "LLL-plasty". This technic has been applied to large pilonidal lesions, half of which were failures of other methods. Though the excision was large, the suture was easily practised with this technic. The healing time is around 13 days. The rate of relapse is small, but could be improved with more rigor in the indication and with constant medical supervision of the patients, imposing strict hygienic rules.