A new surgical approach for pilonidal sinus disease: "de-epithelialization technique''

Abstract

Objective: In the treatment of pilonidal sinus disease different approaches are used such as conservative treatment and fasciocutaneous rotation flap. The aim of this study was to evaluate the efficacy of "de-epithelialization technique" as a new approach in pilonidal sinus disease treatment.

Material and methods: Forty pilonidal sinus disease patients treated with de-epithelialization method were evaluated retrospectively. Patient age, gender, body mass index, wound healing time, visual analog scale scores, operation times, hospital stay duration, drain removal time, cosmetic satisfaction rates, complications, and recurrence rates were evaluated.

Results: The numbers of male and female patients in this study were 39 and 1, respectively. The median age of the patients was 25 years and the mean BMI was 26.6. The mean operating time was 43 min, and all patients were discharged 5 h after the operation. Wound healing time varied from 10 to 20 days. Median follow-up period was 9 months (4-17 months). One patient with high body mass index suffered from partial wound separation. No other complications such as infections and fluid collections (hematoma and seromas) were observed. Maximum cosmetic satisfaction rate was 90% (n=36), and no patient had a recurrence during the follow-up period.

Conclusion: "De-epithelialization" may be considered as a complementary and/or alternative approach to other surgical techniques such as primary closure, rhomboid excision, and Limberg flap in the treatment of pilonidal sinus disease, with acceptable cosmesis and recurrence rates.

Keywords: De-epithelialization; flap; natal cleft; pilonidal sinus disease; sacrococcygeal region.

Figure 1. a–c

(a) Excision of the cyst, (b) partial thickness elliptical intradermal incision, (c) de-epithelialization by applying traction force both at 90° angle to the surface with scalpel blade

Figure 2. a–c

(a) Primary closure of free edges of the de-epithelialized skin, (b, c) inversion and primary closure of de-epithelialized wound

Figure 3. a–f

Drawing of the de-epithelialization technique. (a) Excision of the cyst tissue with surrounding healthy fatty tissue (arrow) and created cyst cavity (star), (b) determination of the oval shaped de-epithelialization line (arrows) with a scalpel, (c) de- epithelialized skin (stars) skin covering the cyst tissue, (d) first suturation of the free edges of de-epithelialized wound with absorbable sutures (arrows), which were fixed to the presacral fascia (star), (e) inversion and second suturation (arrows) for reciprocal overlapping with absorbable sutures (f), Primary closure of the wound with nonabsorbable sutures (arrows)