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. 2008 Jul;90(5):371-6.
doi: 10.1308/003588408X285955.

Sinus excision, release of coccycutaneous attachments and dermal-subcuticular closure (XRD procedure): a novel technique in flattening the natal cleft in pilonidal sinus treatment

Deya M Marzouk  1 , Ahmed A Abou-Zeid, Anthony Antoniou, Amyn Haji, H Benziger
Affiliations

Sinus excision, release of coccycutaneous attachments and dermal-subcuticular closure (XRD procedure): a novel technique in flattening the natal cleft in pilonidal sinus treatment

Deya M Marzouk et al. Ann R Coll Surg Engl. 2008 Jul.

Abstract

Introduction: The objective of this study was to analyse, prospectively, the outcome of a new technique - excision of pilonidal sinus and flattening the natal cleft by division of the coccycutaneous attachments at the lower end of the incision.

Patients and methods: Sixty-six consecutive patients with chronic pilonidal sinuses were treated between 1995 and 2001. The procedure consisted of an elliptical, wide, local excision, release of the coccycutaneous attachments and primary closure using dermal-subcuticular closure (XRD). Suction drains were used until drainage was minimal. The height of skin level at the lower angle of the wound from the coccyx was measured intra-operatively before and after division of the coccycutaneous attachments. Postoperatively, patients were assessed for hospital stay, return to normal activity, complications and recurrence.

Results: Sixty-four patients (97%) were males, median age 27 years. The height of skin level rose from a mean of 1.8 cm (95% CI, 1.78-1.85) to a mean of 3.8 cm (95% CI, 3.77-3.88; P < 0.001). Morbidity affected 12 patients (18%), epidermal separation of the lower wound angles (6 patients), seromas (5 patients) and 1 wound dehiscence at 2 weeks. All other wounds healed primarily without dehiscence. There were no recurrences after a median follow-up of 22.5 months (range, 12-38 months).

Conclusions: Release of the coccycutaneous attachments is an easy technique to learn, which seems to be an effective way of flattening the natal cleft and may result in lower recurrence rate. This technique should be tried in uncomplicated pilonidal sinus disease before more complex procedures are attempted.

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Figures

Figure 1
Figure 1
The coccycutaneous fibrous attachments that create the natal cleft are depicted by black lines.
Figure 2
Figure 2
The skin is marked with an elliptical incision, slightly off the mid-line and making the lower end into a comma shape.
Figure 3
Figure 3
Hand-held diathermy is used to divide the coccycutaneous attachments mid-way between the skin and the coccyx.
Figure 4
Figure 4
Checking that the skin of the lower wound angle is now free from deeper attachments. Note eversion of the skin at lower angle (caudal view).
Figure 5
Figure 5
The dermal-subcuticular closure. Suction drain seen at upper end.
Figure 6
Figure 6
The change in skin height from the coccyx at the lower wound angle before and after release of the coccycutaneous attachments (P < 0.001).
See this image and copyright information in PMC

References

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