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. 2022 May 20;5(5):CD013439.
doi: 10.1002/14651858.CD013439.pub2.

Dressings and topical agents for the management of open wounds after surgical treatment for sacrococcygeal pilonidal sinus

Philip J Herrod  1 , Brett Doleman  2 , Edward J Hardy  1 , Paul Hardy  3 , Trevor Maloney  3 , John P Williams  2 , Jon N Lund  4
Affiliations

Dressings and topical agents for the management of open wounds after surgical treatment for sacrococcygeal pilonidal sinus

Philip J Herrod et al. Cochrane Database Syst Rev. .

Abstract

Background: Sacrococcygeal pilonidal sinus disease is a common debilitating condition that predominantly affects young adults, with a profound impact on their activities of daily living. The condition is treated surgically, and in some cases the wound in the natal cleft is left open to heal by itself. Many dressings and topical agents are available to aid healing of these wounds.

Objectives: To assess the effects of dressings and topical agents for the management of open wounds following surgical treatment for sacrococcygeal pilonidal sinus in any care setting.

Search methods: In March 2021, we searched the Cochrane Wounds Specialised Register, CENTRAL, MEDLINE, Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and we scanned reference lists of included studies, reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting.

Selection criteria: We included parallel-group randomised controlled trials (RCTs) only. We included studies with participants who had undergone any type of sacrococcygeal pilonidal sinus disease surgery and were left with an open wound.

Data collection and analysis: We used the standard methodological procedures expected by Cochrane. We used GRADE to assess the certainty of the evidence for each outcome.

Main results: We included 11 RCTs comprising 932 participants. Two studies compared topical negative pressure wound therapy (TNPWT) with conventional open wound healing, two studies compared platelet-rich plasma with sterile absorbent gauze, and the other seven studies compared various dressings and topical agents. All studies were at high risk of bias in at least one domain, whilst one study was judged to be at low risk of bias in all but one domain. All studies were conducted in secondary care. Mean participant ages were between 20 and 30 years, and nearly 80% of participants were male. No studies provided data on quality of life, cost-effectiveness, pain at first dressing change or proportion of wounds healed at 6 or 12 months, and very few adverse effects were recorded in any study. It is unclear whether TNPWT reduces time to wound healing compared with conventional open wound healing (comparison 1), as the certainty of evidence is very low. The two studies provided conflicting results, with one study showing benefit (mean difference (MD) -24.01 days, 95% confidence interval (CI) -35.65 to -12.37; 19 participants), whilst the other reported no difference. It is also unclear whether TNPWT has any effect on the proportion of wounds healed by 30 days (risk ratio (RR) 3.60, 95% CI 0.49 to 26.54; 19 participants, 1 study; very low-certainty evidence). Limited data were available for our secondary outcomes time to return to normal daily activities and recurrence rate; we do not know whether TNPWT has any effect on these outcomes. Lietofix cream may increase the proportion of wounds that heal by 30 days compared with an iodine dressing (comparison 4; RR 8.06, 95% CI 1.05 to 61.68; 205 participants, 1 study; low-certainty evidence). The study did not provide data on time to wound healing. We do not know whether hydrogel dressings reduce time to wound healing compared with wound cleaning with 10% povidone iodine (comparison 5; MD -24.54 days, 95% CI -47.72 to -1.36; 31 participants, 1 study; very low-certainty evidence). The study did not provide data on the proportion of wounds healed. It is unclear whether hydrogel dressings have any effect on adverse effects as the certainty of the evidence is very low. Platelet-rich plasma may reduce time to wound healing compared with sterile absorbent gauze (comparison 6; MD -19.63 days, 95% CI -34.69 to -4.57; 210 participants, 2 studies; low-certainty evidence). No studies provided data on the proportion of wounds healed. Platelet-rich plasma may reduce time to return to normal daily activities (MD -15.49, 95% CI -28.95 to -2.02; 210 participants, 2 studies; low-certainty evidence). Zinc oxide mesh may make little or no difference to time to wound healing compared with placebo (comparison 2; median 54 days in the zinc oxide mesh group versus 62 days in the placebo mesh group; low-certainty evidence). We do not know whether zinc oxide mesh has an effect on the proportion of wounds healed by 30 days as the certainty of the evidence is very low (RR 2.35, 95% CI 0.49 to 11.23). It is unclear whether gentamicin-impregnated collagen sponge reduces time to wound healing compared with no dressing (comparison 7; MD -1.40 days, 95% CI -5.05 to 2.25; 50 participants, 1 study; very low-certainty evidence). The study did not provide data on the proportion of wounds healed. Dialkylcarbamoyl chloride (DACC)-coated dressings may make little or no difference to time to wound healing compared with alginate dressings (comparison 8; median 69 (95% CI 62 to 72) days in the DACC group versus 71 (95% CI 69 to 85) days in the alginate group; 1 study, 246 participants; low-certainty evidence). One study compared a polyurethane foam hydrophilic dressing with an alginate dressing (comparison 3) whilst another study compared a hydrocolloid dressing with an iodine dressing (comparison 9). It is unclear whether either intervention has any effect on time to wound healing as the certainty of evidence is very low.

Authors' conclusions: At present, the evidence that any of the dressings or topical agents contained in this review have a benefit on time to wound healing, the proportion of wounds that heal at a specific time point or on any of the secondary outcomes of our review ranges from low certainty to very low certainty. There is low-certainty evidence on the benefit on wound healing of platelet-rich plasma from two studies and of Lietofix cream and hydrogel dressings from single studies. Further studies are required to investigate these interventions further.

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Conflict of interest statement

Philip J Herrod: I work as a health professional. I received a two‐year research fellowship jointly awarded by the Royal College of Surgeons of England and the Dunhill Medical Trust in 2016. I have published several articles on the management of pilonidal sinus disease previously, however none are cited in this review. I have also recently co‐authored a chapter on pilonidal sinus disease for the next edition of the Oxford Textbook of Surgery

Brett Doleman: I have received a grant from the Association of Anaesthetists of Great Britain and Ireland (AAGBI) for a randomised controlled trial of preventative paracetamol and have previously undertaken a meta‐analysis of preventative paracetamol.

Edward J Hardy: none known.

Paul Hardy: I work as a health professional. I have carried out consultancy for Smith & Nephew. The funding for this was not received by me personally, and I did not benefit from this payment or have access to the funding.

Trevor Maloney: I work as a health professional. Conference fees and travel and accommodation expenses were paid on my behalf by Convatec PLC in 2017. This funding was not paid directly to me or my host institution.

John P Williams: I work as a health professional.

Jon N Lund: I work as a health professional.

Figures

1
1
Risk of bias summary: review authors' judgements about each risk of bias item for each included study
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
3
3
Study flow diagram
1.1
1.1. Analysis
Comparison 1: Topical negative pressure wound therapy versus conventional open wound healing therapy, Outcome 1: Time to wound healing (days)
1.2
1.2. Analysis
Comparison 1: Topical negative pressure wound therapy versus conventional open wound healing therapy, Outcome 2: Proportion of wounds healed at 30 days
1.3
1.3. Analysis
Comparison 1: Topical negative pressure wound therapy versus conventional open wound healing therapy, Outcome 3: Time to return to normal activities (days)
1.4
1.4. Analysis
Comparison 1: Topical negative pressure wound therapy versus conventional open wound healing therapy, Outcome 4: Recurrence
2.1
2.1. Analysis
Comparison 2: Zinc oxide mesh versus placebo mesh, Outcome 1: Proportion of wounds healed at 30 days
3.1
3.1. Analysis
Comparison 3: Lietofix cream versus iodoform dressing, Outcome 1: Proportion of wounds healed at 30 days
4.1
4.1. Analysis
Comparison 4: Hydrogel dressing versus wound cleaning with 10% povidone iodine, Outcome 1: Time to wound healing
4.2
4.2. Analysis
Comparison 4: Hydrogel dressing versus wound cleaning with 10% povidone iodine, Outcome 2: Surgical site infection
5.1
5.1. Analysis
Comparison 5: Platelet‐rich plasma versus absorbent sterile cotton gauze, Outcome 1: Time to wound healing (days)
5.2
5.2. Analysis
Comparison 5: Platelet‐rich plasma versus absorbent sterile cotton gauze, Outcome 2: Time to return to normal daily activities (days)
6.1
6.1. Analysis
Comparison 6: Gentamicin‐impregnated collagen sponge versus no dressing, Outcome 1: Time to wound healing (days)
7.1
7.1. Analysis
Comparison 7: Dialkylcarbamoyl chloride (DACC)‐coated dressing versus alginate dressing, Outcome 1: Proportion of wounds healed
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References to other published versions of this review

Herrod 2019
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