[Congenital cutaneous sinus (pilonidal sinus) as the source of recurrent meningitis].
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Humans↗
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Results for “Pilonidal Sinus”
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What is your neurologic diagnosis? Type IV dermoid sinus (pilonidal sinus) in the region of the fourth thoracic vertebra.
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Animals↗
A comparative study between Z-plasty and incision and drainage or excision with marsupialization for pilonidal sinuses.
Pilonidal sinuses are acquired in the natal cleft as a result of dead hairs being pushed into skin abrasions by the movements of the buttock. Traditional surgical approaches have resulted in high recurrence rates. To avoid this, plastic procedures, such as the Z-plasty, have been advocated but have not been generally accepted. In a randomized trial, we compared Z-plasty with incision and drainage or marsupialization and found that no further surgical treatment was required in the Z-plasty group; in the control group, 40 per cent had repeated surgical treatment. We support Z-plasty for pilonidal sinuses.
Drainage↗
Penis: an unusual site for pilonidal sinus.
Pilonidal sinus affects different regions of the body, gluteal cleft being the most common. This condition affecting the penis is extremely rare with only a few case reports around the world. It is prone for complications like infection, actinomycosis, abscess formation, erectile dysfunction and phimosis amongst others. We present a case of Pilonidal sinus of the penis where a pre-operative diagnosis was made and appropriate treatment in the form of circumcision prevented complications.
Adult↗
Decision making in surgery: a pilonidal sinus.
Pilonidal sinus is an unglamorous surgical condition, often left to juniors, that is difficult to treat. Correct decisions in management may influence the prognosis of the condition by avoiding recurrence and continued sepsis.
Clinical Protocols↗
[Pilonidal sinus].
Pilonidal sinus, acute or chronic suppuration of the sacrococcygeal region, is a common benign disease. Its treatment, usually surgical, remains controversial, between wide excision and limited excision and between primary closure and secondary closure. On the basis of our experience and a review of the literature, we propose limited excision with immediate closure for non-infected operations and exposure with immediate resection for pilonidal abscesses. Regardless of the technique used, the morbidity is high, associated with a recurrence rate of between 5 and 40%.
Adult↗
Phenol treatment of pilonidal sinuses.
Pilonidal disease of the natal cleft is a common condition responsible for much morbidity. The results of phenol injection used in 67 patients treated in our Department of Surgery between 1986-1988 are reviewed. Our study shows that this procedure is an effective treatment. Phenol injection of pilonidal sinuses is a simple operation and produces results which are similar those achieved by surgical procedures but has the advantages of a shorter inpatient stay (1-3 days) with a prompt return to work (1-2 weeks).
Adolescent↗
Radical surgery for pilonidal sinus.
Pilonidal sinus disease in 72 patients was treated by radical excision and primary wound closure and the results compared with those other currently practised techniques. A number of factors have been examined in an attempt to identify a group of patients in whom the risk of delayed healing is high.
Adolescent↗
Excision and primary suture of pilonidal sinus.
Pilonidal sinus is a common disabling condition of young adults. Many different operative treatments have been suggested, the ideal treatment is, therefore, controversial. As the recurrence rate for the various procedures is similar, avoidance of a general anesthetic, minimal inpatient stay, and minimal inconvenience and time off work become important considerations. We present our experience with excision and primary closure in 46 patients over a 4-year period. Half the patients had a general anaesthetic, the other half a spinal anaesthetic. Average duration of inpatient stay was 1 day. Early complications (haematoma, wound infection, and minor wound breakdown) occurred in 8%. Early pain was less of a feature after the use of bupivacaine infiltration at the end of the operation. There were 40 patients available for follow-up, with an average of 3 weeks off work and a recurrence rate of 17.5%. Of these patients, three have had the recurrence treated with no further problems.
Adolescent↗
[Ambulatory closed surgery for the treatment of pilonidal sinus].
Pilonidal disease (PD) is a common chronic disorder of the sacrococcygeal region afflecting young people. Despite several methods for treating PD have been described, the management remains controversial. Recent reports have advocated different surgical approaches such as open or closed technique, but recurrence plagues all forms of therapy. We conducted this case review to evaluate the validity of an outpatient closed technique in the treatment of chronic pilonidal disease. Between January 1997 and July 1999, 65 consecutive patients with quiescent chronic PD were electively treated by surgical excision of the cyst and primary closure. There were 47 men (72%) and 18 women (28%) in this study. Patients ranged in age from 14 to 47 years, the average age being 21 years. The median healing time was 8 days and the median time to return to full work was 20 days (range 10-25). Infection and recurrence rates were 1.5% and 4.6% respectively. There was no correlation among recurrence rate, postoperative infection, or prior surgery. Cyst excision and primary closure is a safe, low cost operation with a very high long-term success rate and a negligible rate of complications. It can successfully be performed under local anaesthesia in an outpatient facility.
Adolescent↗
Carcinoma arising in pilonidal sinuses.
Pilonidal carcinoma is an infrequent complication of pilonidal disease. The surgeon's suspicion should be raised in cases of longstanding pilonidal inflammation. The disease occurs most frequently in men. The lesion is often a well-differentiated squamous carcinoma. Wide excisions at the initial procedure following a brief period of local wound care, is the optimum treatment and increases the chances for a five-year survival. Definitive closure of the defect is delayed and accomplished by rotational flaps or skin grafts. It palpable nodes are present in the inguinal region they should be biopsied even though this does not necessarily connote metastasis. When inguinal node metastasis is present, this is associated with a poor prognosis. The incidence of occult node metastasis is not known because no prophylactic groin dissections were performed. Staged groin dissections were not associated with any long-term survivals. The series was too small to determine its palliative potential. Radiation therapy may palliate local bone or soft tissue recurrences. Re-excisions of local soft tissue recurrences can provide, in some instances, long disease-free intervals. Both topical and systemic chemotherapy were administered in more recent cases with poor results, but this series is not large enough to form conclusions for this modality of treatment.
Carcinoma, Squamous Cell↗
Comparison of Karydakis versus midline excision for treatment of pilonidal sinus disease.
Pilonidal sinus disease is associated with a high rate of recurrence and complications. The Karydakis (KAR) method, whereby an asymmetric subcutaneous flap obliterates the anal crease, has been shown to be effective in adults. The goal of this study is to assess the efficacy of the KAR procedure in the operative treatment of children with pilonidal sinus disease compared to those treated via a midline excision (ME). Sixty-eight cases of pediatric pilonidal sinus excision were reviewed over the past 10 years. Data abstracted included surgical approach, complication rate and recurrence rate. Student's t-test or the Chi square test was used for statistical analysis, with P < 0.05 being considered significant. An ME was performed in 44 patients; the KAR method was used in 24 patients. Mean age at diagnosis was 14.4 +/- 4.2 years for the ME group compared to 15.7 +/- 4.3 years for the KAR patients (P = 0.18). Mean operative time was significantly longer with the KAR method (58.7 +/- 25.6 min) compared to 46.3 +/- 18.6 for the primary ME (P = 0.04). Despite the increased operative dissection, there was no difference (P = 0.42) in early post-operative complication rates between groups (25% in the KAR group compared to 34.8% in the ME group). Initial drainage of an abscess had no significant effect upon the recurrence/complication rate in either group. Recurrence rate alone was lower in patients operated on via the KAR approach 0% versus 11.0% using the ME (P = 0.153). Recurrence and complication rates were lower for those patients with a pilonidal sinus treated by the KAR method compared to the ME, but the results did not reach significance. In conclusion, this study does show a potential benefit for children treated with the KAR method for pilonidal sinus. This study mimics the data obtained in adult patients and suggests that a larger study is likely to achieve significance.
Adolescent↗
The evolution of management of pilonidal sinus disease.
Pilonidal sinus disease has for too long been treated by radical methods, probably on the assumption that these were the only ways to prevent recurrence. A review of the literature reveals a sprinkling of papers indicating that simpler methods not only carry less morbidity, but also are associated with a lower recurrence rate. With a detailed 10-year review, the author reports a series of 72 consecutive patients with pilonidal sinus treated successfully as outpatients by conservative methods under local anesthesia. This review, along with the similar experience of others, makes it clear that only simple conservative methods are acceptable in the management of pilonidal sinus.
Adolescent↗
V-Y rotation advancement fasciocutaneous flap for excisional defects of pilonidal sinus.
BACKGROUND: Pilonidal sinus is a common disease that mostly affects young people. Despite numerous treatment modalities, the best technique has not yet been determined and there are many recurrences, causing economic losses and serious discomfort for the patients. METHODS: The authors used V-Y rotation flaps for coverage of the defects after excision and debridement of chronic pilonidal sinuses in eight patients. The results were evaluated and compared with previously reported studies regarding the grade of disease at presentation, duration of surgery, blood loss, hospitalization period and active mobilization periods, complications, and loss of sensitivity. RESULTS: No major complications occurred; hospitalization and immobilization periods were acceptably convenient. Recurrence was not seen, and sensitivity of the gluteal region did not diminish. The outcome was also satisfactory regarding aesthetics, and all the patients were satisfied with the result. CONCLUSION: The authors believe that the V-Y rotation advancement flap is a good alternative method for the treatment of pilonidal sinus.
Adult↗
Cytokeratin expression in pilonidal sinus.
BACKGROUND: Pilonidal sinus (PS) is considered to belong in the category of follicular occlusion diseases (acne triad). OBJECTIVES: The aim of our study was to elucidate the pathogenesis of PS by evaluating its cytokeratin (CK) expression. METHODS: CK expression in nine cases of PS was studied immunohistochemically using six antikeratin antibodies. RESULTS: Infundibular-like epithelium contained CK1, 10 and 14 similar to normal infundibulum, but it did not contain CK17. In non-infundibular-like epithelium, CK14, 16 and 17 were detected similar to that in normal outer root sheath. CK expression in PS was similar to that in hidradenitis suppurativa, suggesting that sinus epithelium may be fragile, hyperproliferative and undifferentiated. CONCLUSIONS: PS can be classified in the same entity as follicular occlusion diseases based on CK expression.
Adult↗
Efficacy and tolerance of a new gentamicin collagen fleece (Septocoll) after surgical treatment of a pilonidal sinus.
OBJECTIVE: Pilonidal sinus is common. It causes substantial loss of working hours. The major disadvantage of open wound treatment is the long time required for healing. Primary wound closure is on the other hand often followed by infection. A controlled, multicentre trial was carried out to evaluate the efficacy of a new gentamicin collagen fleece (Septocoll) combined with primary closure. PATIENTS AND METHODS: One hundred and three patients (88 men, 15 women, median age 30 years) were included. Fifty-one were randomised to gentamicin fleece plus primary closure (Genta Group), and 52 patients to open treatment alone (Open Group). RESULTS: The median interval to wound healing was 17 days in the Genta group and 68 days in the Open group (P = 0.0001, log-rank test). Two patients in Group 1 developed infection within the first two weeks, requiring reopening of the wound, with primary wound healing occurring in 73%. Failure of primary healing (27%) was usually due to seroma or spontaneous dehiscence which subsequently healed. CONCLUSION: The combination of gentamicin collagen fleece (Septocoll) with primary closure resulted in a shorter period to healing than the open technique without unwanted effects.
Adolescent↗
Management of pilonidal sinus.
OBJECTIVE: Pilonidal sinus is a disabling nuisance in young adults, yet its management remains controversial. METHODS: Patients admitted to Prince Abdulrahman Sudery Hospital, Al Jouf, Kingdom of Saudi Arabia, over a period of 10-years from January 1990 to December 1999 were evaluated in this retrospective study. We compared 2 most commonly performed surgical operations in 272 patients consisting of group A, 176 patients, managed by excision and primary closure and group B, 96 patients, managed by excision and healing by the second intention. RESULTS: More than 90% of group A achieved primary healing within 10 days. Although 100% of group B achieved eventual healing, it took a significantly longer period, mean 48 days (p<0.0001). Failure of primary healing occurred in 16 (9.1%) group A patients but 6 (3.4%) of these were amenable to secondary closure and still achieved healing in a shorter period of time than group B (p<0.05). There was no significant difference in the recurrence in the 2 groups. CONCLUSION: We conclude that although hospital stay and consumption of inpatient hospital resources was greater for group A, excision and primary closure is a superior option for most patients and especially for patients who are largely young and active.
Adult↗
Does technique alter quality of life after pilonidal sinus surgery?
BACKGROUND: Pilonidal sinus is a common disease in young adults that carries high postoperative morbidity and patient discomfort. Controversy still exists about the best surgical technique for the treatment of the disease in terms of recurrence rate and patient discomfort. METHODS: From January 2000 to November 2003, 100 consecutive age- and sex-matched patients with chronic pilonidal sinus disease were randomized to receive surgical treatment in the forms of either excision and primary closure or rhomboid excision and Limberg flap. Time to return to work and to complete healing were recorded. To evaluate quality of life and patient comfort, all patients were asked to complete a questionnaire including short form 36, Visual Analogue Scale, time to sitting on toilet without pain, and time to walking without pain 3 months after surgery. RESULTS: Each group was composed of 50 patients. Mean follow-up was 19 months. There was a significant difference between the groups in terms of length of hospital stay (P=.005), time to complete healing (P<.001), time off work (P<.001), and wound infection rate (P=.03). Statistically significant differences were noted between the groups in items of general health perception (71.1+/-11.7 vs 78.2+/-14.1; P=.008), social functioning (87.3+/-32.8 vs 110.4+/-33.8; P=.001), and pain (54.5+/-14.0 vs 67.5+/-18.4; P<.001). Times to sitting on toilet and walking without pain showed significant differences between the groups (P=.006 and P<.001, respectively). The mean postoperative Visual Analogue Scale scores were 6.5+or= 1.7 and 7.4+/- 1.4, respectively (P<.001). CONCLUSIONS: Shorter hospital stay, earlier healing, shorter time off work, lower ratio of complications, lower pain perception, and improved general health perception are the main advantages of te Limberg flap technique in pilonidal sinus surgery. All together, these parameters add to patient comfort and satisfaction after surgical treatment.
Adolescent↗