Effectiveness of fascial tissue flaps and skin flaps with layered sutures for repair of wounds after excision of sacrococcygeal pilonidal sinus_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHEN Wanghaonan , ZHANG Mingyue , TAO Kerong , YOU Xing ,  SUN Guangfeng

Department of Burns and Plastic Surgery, the Second Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China;

Corresponding author：

SUN Guangfeng, Email: sgfzyt@163.com

Keywords：

Sacrococcygeal region; pilonidal sinus; skin flap; fascial tissue flap; wound repair

DOI：

10.7507/1002-1892.202301035

Video：

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Objective To investigate the feasibility and effectiveness of fascial tissue flaps and skin flaps with layered sutures for repairing wounds after excision of sacrococcygeal pilonidal sinus. Methods Between March 2019 and August 2022, 9 patients with sacrococcygeal pilonidal sinus were admitted, including 7 males and 2 females with an average age of 29.4 years (range, 17-53 years). The disease duration ranged from 1 to 36 months, with a median of 6 months. There were 7 cases with obesity and dense hair, 3 cases with infection, and 2 cases with positive bacterial culture of sinus secretion. The wound area after excision ranged from 3 cm×3 cm to 8 cm×4 cm, with a depth of 3-5 cm, reaching the perianal or caudal bone; there were 2 cases with perianal abscess formation and 1 case with caudal bone inflammatory edema. Enlarged resection was performed during operation, and the fascial tissue flap and skin flap were designed and excised at both left and right sides of the buttock, ranging from 3.0 cm×1.5 cm to 8.0 cm×2.0 cm. A cross drainage tube was placed at the bottom of the wound, and the fascial tissue flap and skin flap were advanced and sutured in three layers, namely, 8-string sutures in the fascial layer, barbed wire reduction sutures in the dermis, and interrupted skin sutures. Results All 9 patients were followed up 3-36 months, with an average of 12 months. All incisions healed by first intention, and no complication such as incisional dehiscence or infection in the operative area occurred. There was no recurrence of sinus tracts, the shape of gluteal sulcus was satisfactory, both sides of buttocks were symmetrical, local incision scar was concealed, and the shape disruption was minimal. Conclusion Fascial tissue flaps and skin flaps with layered sutures for repairing wounds after excision of sacrococcygeal pilonidal sinus can effectively fill the cavity and reduce the incidence of poor incision healing, with the advantages of small trauma and simple operation.

Citation： CHEN Wanghaonan, ZHANG Mingyue, TAO Kerong, YOU Xing, SUN Guangfeng. Effectiveness of fascial tissue flaps and skin flaps with layered sutures for repair of wounds after excision of sacrococcygeal pilonidal sinus. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(4): 478-481. doi: 10.7507/1002-1892.202301035 Copy

1.	Kanat BH, Sözen S. Disease that should be remembered: Sacrococcygeal pilonidal sinus disease and short history. World J Clin Cases, 2015, 3(10): 876-879.
2.	李婉迪, 栾杰, 穆大力. 手术治疗骶尾部藏毛疾病的现状与进展. 中华整形外科杂志, 2020, 36(9): 1062-1066.
3.	黄子宸, 李晨, 郑丽华. 藏毛窦手术治疗的研究进展. 中国临床医生杂志, 2023, 51(2): 148-152.
4.	Demiryilmaz I, Yilmaz I, Peker K, et al. Application of fasciocutaneous V-Y advancement flap in primary and recurrent sacrococcygeal pilonidal sinus disease. Med Sci Monit, 2014, 20: 1263-1266.
5.	Bascom J. Pilonidal disease: origin from follicles of hairs and results of follicle removal as treatment. Surgery, 1980, 87(5): 567-572.
6.	Karydakis GE. Easy and successful treatment of pilonidal sinus after explanation of its causative process. Aust N Z J Surg, 1992, 62(5): 385-389.
7.	孔令红, 刘晓刚, 王丽宁, 等. 藏毛窦囊肿18例临床病理分析. 诊断病理学杂志, 2021, 28(5): 332-336.
8.	Ardelt M, Dittmar Y, Kocijan R, et al. Microbiology of the infected recurrent sacrococcygeal pilonidal sinus. Int Wound J, 2016, 13(2): 231-237.
9.	Zubaidi AM, Alali MN, AlShammari SA, et al. Outcomes of sinus laser therapy in sacrococcygeal pilonidal sinus disease: A single-center experience. Cureus, 2022, 14(9): e29388. doi: 10.7759/cureus.29388.
10.	Harries RL, Alqallaf A, Torkington J, et al. Management of sacrococcygeal pilonidal sinus disease. Int Wound J, 2019, 16(2): 370-378.
11.	Iesalnieks I, Ommer A, Herold A, et al. German National Guideline on the management of pilonidal disease: update 2020. Langenbecks Arch Surg, 2021, 406(8): 2569-2580.
12.	马传玉, 罗明雷. 偏中线缝合技术治疗慢性藏毛窦的效果. 中华医学美学美容杂志, 2022, 28(4): 320-322.
13.	Hemmingsson O, Binnermark F, Odensten C, et al. Excision and suture in the midline versus Karydakis flap surgery for pilonidal sinus: randomized clinical trial. BJS Open, 2022, 6(2): zrac007. doi: 10.1093/bjsopen/zrac007.
14.	Zhong Y, Li Y, He B, et al. Primary exploration and application of V-Y plasty with preserved flap in treatment of pilonidal sinus disease. Asian J Surg, 2022, 45(7): 1502-1504.
15.	Yang YP, Yu LY, Wang YZ, et al. Comparative analysis on the effect of Z-plasty versus conventional simple excision for the treatment of sacrococcygeal pilonidal sinus: A retrospective randomised clinical study. Int Wound J, 2020, 17(3): 555-561.
16.	Alkurt EG, Vardar YM, Tüzün İS. Comparison of limberg flap and karydakis flap repair in pilonidal sinus surgery: A prospective case-control study. Cureus, 2022, 14(9): e28933. doi: 10.7759/cureus.28933.
17.	Serup CM, Svarre KJ, Kanstrup CTB, et al. Long-term outcome after Bascom’s pit-pick procedure for pilonidal sinus disease: A cohort study. Colorectal Dis, 2022. doi: 10.1111/codi.16383.
18.	常宇微, 陈奕铭, 康悦. 藏毛窦的外科治疗和方式选择. 中国医师进修杂志, 2021, 44(9): 860-864.
19.	Driouch J, Braumann C, Dehnst J, et al. Results of the Limberg flap procedure in acute and chronic pilonidal abscesses. Chirurg, 2022, 93(2): 182-189.
20.	Stauffer VK, Luedi MM, Kauf P, et al. Common surgical procedures in pilonidal sinus disease: A meta-analysis, merged data analysis, and comprehensive study on recurrence. Sci Rep, 2018, 8(1): 3058. doi: 10.1038/s41598-018-20143-4.

1. Kanat BH, Sözen S. Disease that should be remembered: Sacrococcygeal pilonidal sinus disease and short history. World J Clin Cases, 2015, 3(10): 876-879.
2. 李婉迪, 栾杰, 穆大力. 手术治疗骶尾部藏毛疾病的现状与进展. 中华整形外科杂志, 2020, 36(9): 1062-1066.
3. 黄子宸, 李晨, 郑丽华. 藏毛窦手术治疗的研究进展. 中国临床医生杂志, 2023, 51(2): 148-152.
4. Demiryilmaz I, Yilmaz I, Peker K, et al. Application of fasciocutaneous V-Y advancement flap in primary and recurrent sacrococcygeal pilonidal sinus disease. Med Sci Monit, 2014, 20: 1263-1266.
5. Bascom J. Pilonidal disease: origin from follicles of hairs and results of follicle removal as treatment. Surgery, 1980, 87(5): 567-572.
6. Karydakis GE. Easy and successful treatment of pilonidal sinus after explanation of its causative process. Aust N Z J Surg, 1992, 62(5): 385-389.
7. 孔令红, 刘晓刚, 王丽宁, 等. 藏毛窦囊肿18例临床病理分析. 诊断病理学杂志, 2021, 28(5): 332-336.
8. Ardelt M, Dittmar Y, Kocijan R, et al. Microbiology of the infected recurrent sacrococcygeal pilonidal sinus. Int Wound J, 2016, 13(2): 231-237.
9. Zubaidi AM, Alali MN, AlShammari SA, et al. Outcomes of sinus laser therapy in sacrococcygeal pilonidal sinus disease: A single-center experience. Cureus, 2022, 14(9): e29388. doi: 10.7759/cureus.29388.
10. Harries RL, Alqallaf A, Torkington J, et al. Management of sacrococcygeal pilonidal sinus disease. Int Wound J, 2019, 16(2): 370-378.
11. Iesalnieks I, Ommer A, Herold A, et al. German National Guideline on the management of pilonidal disease: update 2020. Langenbecks Arch Surg, 2021, 406(8): 2569-2580.
12. 马传玉, 罗明雷. 偏中线缝合技术治疗慢性藏毛窦的效果. 中华医学美学美容杂志, 2022, 28(4): 320-322.
13. Hemmingsson O, Binnermark F, Odensten C, et al. Excision and suture in the midline versus Karydakis flap surgery for pilonidal sinus: randomized clinical trial. BJS Open, 2022, 6(2): zrac007. doi: 10.1093/bjsopen/zrac007.
14. Zhong Y, Li Y, He B, et al. Primary exploration and application of V-Y plasty with preserved flap in treatment of pilonidal sinus disease. Asian J Surg, 2022, 45(7): 1502-1504.
15. Yang YP, Yu LY, Wang YZ, et al. Comparative analysis on the effect of Z-plasty versus conventional simple excision for the treatment of sacrococcygeal pilonidal sinus: A retrospective randomised clinical study. Int Wound J, 2020, 17(3): 555-561.
16. Alkurt EG, Vardar YM, Tüzün İS. Comparison of limberg flap and karydakis flap repair in pilonidal sinus surgery: A prospective case-control study. Cureus, 2022, 14(9): e28933. doi: 10.7759/cureus.28933.
17. Serup CM, Svarre KJ, Kanstrup CTB, et al. Long-term outcome after Bascom’s pit-pick procedure for pilonidal sinus disease: A cohort study. Colorectal Dis, 2022. doi: 10.1111/codi.16383.
18. 常宇微, 陈奕铭, 康悦. 藏毛窦的外科治疗和方式选择. 中国医师进修杂志, 2021, 44(9): 860-864.
19. Driouch J, Braumann C, Dehnst J, et al. Results of the Limberg flap procedure in acute and chronic pilonidal abscesses. Chirurg, 2022, 93(2): 182-189.
20. Stauffer VK, Luedi MM, Kauf P, et al. Common surgical procedures in pilonidal sinus disease: A meta-analysis, merged data analysis, and comprehensive study on recurrence. Sci Rep, 2018, 8(1): 3058. doi: 10.1038/s41598-018-20143-4.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of fascial tissue flaps and skin flaps with layered sutures for repair of wounds after excision of sacrococcygeal pilonidal sinus

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