Pilonidal Cyst Excision: Primary Midline Closure with versus without Closed Incision Negative Pressure Therapy

Abstract

Background: Pilonidal cysts are a painful condition that primarily affect young adult men. In the literature, numerous operative techniques for resolving pilonidal cysts are described, with variable outcomes. The objective of this study was to compare primarily closed midline incisions managed with or without the use of closed incision negative pressure therapy after pilonidal cyst excision.

Methods: Twenty-one patients underwent excision and midline primary closure. Postoperative care composed of closed incisional negative pressure therapy (study group; n = 10) or gauze dressings (control group; n = 11). In both groups, the sutures were partially removed on day 14 and completely removed on day 21. Compared outcomes included the duration of hospitalization, pain on the day of surgical procedure, and on postoperative day 7, and time-to-healing.

Results: The median hospital stay was about 9 hours and 23 hours in the study and control groups, respectively (P < 0.05). The median pain scores on the day of operation were 1.20/10 in the study group and 3.36/10 in the control group (P < 0.05). On day 7, study group showed median pain score 0.9/10 and control group showed 2.63/10 (P < 0.05). The mean healing time was 23.8 and 57.9 days in the ciNPT group and gauze group, respectively (P < 0.05).

Conclusion: These outcomes supported the incorporation of closed incision negative pressure therapy into our surgical treatment protocol for pilonidal cysts.

Fig. 1.

Flowchart of surgeries and follow-up of patients up to discharge. NPWT, Negative pressure wound therapy; ciNPT, closed incision negative pressure therapy; POD, postoperative day.

Fig. 2.

Patient in the ventral decubitus position under spinal anesthesia and sedation with exposure of the intergluteal cleft.

Fig. 3.

A, Wedge incision around the cyst; B, block removal of the cyst; C, creation of small skin flap to facilitate closure without tension; D, final aspect of the sutured skin.

Fig. 4.

A, Placement of ciNPT dressing; B, superior view of the dressing once a seal has been created; C, lateral view of the foam location; D, vacuum created and no leakage detected.

Fig. 5.

Visual Analogic Scale (VAS) used to determine patient-related pain.

Fig. 6.

Distribution of pain scores in patients receiving incision management with ciNPT or standard dressings at 6 hours after operation. Each symbol represents 1 patient.

Fig. 7.

Distribution of the hours between the conclusion of operation and discharge from the hospital in patients receiving incision management with ciNPT or standard dressings. Each symbol represents 1 patient.

Fig. 8.

Distribution of pain scores in patients receiving incision management with ciNPT or standard dressings on postoperative Day 7. Each symbol represents 1 patient.

Fig. 9.

Photographs showing appearance after removal of all sutures on POD 21. A, representative photograph of a patient in the ciNPT group. B, Representative photograph of a patient in the control group.

Fig. 10.

Distribution of the days from operative procedure to complete incision healing in patients receiving incision management with ciNPT or standard dressings. Each symbol represents 1 patient.