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JAMA Surgery Aug 2023The management of pilonidal disease continues to be a challenge due to high rates of recurrence and treatment-associated morbidity. (Review)
Review
IMPORTANCE
The management of pilonidal disease continues to be a challenge due to high rates of recurrence and treatment-associated morbidity.
OBSERVATIONS
There is a heterogeneous repertoire of treatment modalities used in the management of pilonidal disease and wide practice variation among clinicians. Available treatment options vary considerably in their level of invasiveness, associated morbidity and disability, risks of complications, and effectiveness at preventing disease recurrence. Conservative nonoperative management strategies, including persistent improved hygiene, depilation, and lifestyle modification, focus on disease prevention and minimization of disease activity. Epilation techniques using both laser and intense pulse light therapy are also used as primary and adjunct treatment modalities. Other nonoperative treatment modalities include phenol and fibrin injection to promote closure of pilonidal sinuses. The traditional operative management strategy for pilonidal disease involves excision of affected tissue paired with a variety of closure types including primary midline closure, primary off-midline closure techniques (ie, Karydakis flap, Limberg flap, Bascom cleft lift), and healing by secondary intention. There has been a recent shift toward more minimally invasive operative approaches including sinusectomy (ie, trephination or Gips procedure) and endoscopic approaches. Overall, the current evidence supporting the different treatment options is limited by study quality with inconsistent characterization of disease severity and use of variable definitions and reporting of treatment-associated outcomes across studies.
CONCLUSIONS AND RELEVANCE
Pilonidal disease is associated with significant physical and psychosocial morbidity. Optimal treatments will minimize disease and treatment-associated morbidity. There is a need for standardization of definitions used to characterize pilonidal disease and its outcomes to develop evidence-based treatment algorithms.
Topics: Humans; Neoplasm Recurrence, Local; Wound Closure Techniques; Wound Healing; Pilonidal Sinus; Surgical Flaps; Recurrence; Treatment Outcome
PubMed: 37256592
DOI: 10.1001/jamasurg.2023.0373 -
Wounds : a Compendium of Clinical... Aug 2021Activated platelets release a rich broth of growth factors involved in wound healing. One way to deliver activated platelets to wounds is in the form of platelet-rich... (Randomized Controlled Trial)
Randomized Controlled Trial
Activated platelets release a rich broth of growth factors involved in wound healing. One way to deliver activated platelets to wounds is in the form of platelet-rich plasma (PRP) harvested by centrifuging the patient's venous blood after activating the platelets with collagen or calcium chloride and/or autologous thrombin, then delicately removing the supernatant, called platelet-poor plasma (PPP). Platelet-rich plasma is usually injected into the lesion and/or applied topically, then sealed in or over the wound using a moisture-retentive dressing. Platelet-rich plasma (often with PPP) has been applied at different times, depths, and frequencies to chronic and acute wounds using various PRP doses and vehicles to achieve widely differing results. Meta-analyses have reported that PRP improved healing rates of open diabetic foot ulcers and venous ulcers and may reduce pain and surgical site infection (SSI) incidence in open and closed acute surgical wounds. However, inconsistency in study methods and outcome measures limited consistency of pain and SSI results. No consistent effect on healing or deep SSI rates was reported as a result of adding 1 intraoperative dose of PRP in the surgical site before closing elective foot and ankle surgery incisions of 250 patients as compared with 250 similar patients receiving the same procedure without PRP. After decades of research, ideal parameters of PRP delivery and use on each type of wound remain unclear for improving SSI, acute wound pain, and healing outcomes. This installment of the Evidence Corner reviews 2 surgical studies that may provide clues about optimal PRP use. One triple-blind randomized clinical trial (RCT) focused on irrigation of freshly closed carpal ligament surgical incisions with PRP as compared with PPP. Another non-blind RCT explored the effect of injecting PRP into open pilonidal sinus excisions 4 days and 12 days after surgery.
Topics: Diabetic Foot; Humans; Platelet-Rich Plasma; Surgical Wound; Varicose Ulcer; Wound Healing
PubMed: 34357880
DOI: No ID Found -
Diseases of the Colon and Rectum Apr 2022
Topics: Curettage; Humans; Phenol; Pilonidal Sinus; Platelet-Rich Plasma
PubMed: 34985001
DOI: 10.1097/DCR.0000000000002405 -
Scientific Reports Aug 2020The most appropriate surgical treatment for pilonidal sinus disease (PSD) is still in dispute. This study aims to comprehensively compare the outcomes of surgical... (Meta-Analysis)
Meta-Analysis
The most appropriate surgical treatment for pilonidal sinus disease (PSD) is still in dispute. This study aims to comprehensively compare the outcomes of surgical interventions using network meta-analysis. Randomized controlled trial studies were searched systematically to identify all eligible studies in multiple databases and previous publications and Bayesian network meta-analysis was performed. Our primary outcome was the recurrence rate. Differences in the findings of the studies were explored in meta regressions and sensitivity analyses. The risk of bias of each study was assessed using the Cochrane risk of bias tool. Confidence in evidence was assessed using CINeMA (Confidence in Network Meta-Analysis). A total of 39 studies and 5,061 patients were identified and the most common surgical intervention was the Limberg flap. In network meta-analysis, modified Limberg flap and off-midline closure were associated with the lowest recurrence rate. However, the Karydakis flap was associated with shorter operation time by several minutes compared with other interventions and few significant results were found in other outcomes. Modified Limberg flap and off-midline closure provided relatively low recurrence and complications rates. Therefore, they could be two promising surgical interventions for PSD patients.
Topics: Humans; Pilonidal Sinus; Randomized Controlled Trials as Topic; Surgical Procedures, Operative
PubMed: 32792519
DOI: 10.1038/s41598-020-70641-7 -
JAAPA : Official Journal of the... Oct 2022
Topics: Humans; Pilonidal Sinus; Recurrence; Skin Diseases; Treatment Outcome; Wound Healing
PubMed: 36165550
DOI: 10.1097/01.JAA.0000873828.43069.a1 -
The Israel Medical Association Journal... Feb 2022
Topics: Humans; Minimally Invasive Surgical Procedures; Pilonidal Sinus
PubMed: 35187903
DOI: No ID Found -
American Journal of Surgery Apr 2022
Topics: Humans; Neoplasm Recurrence, Local; Pilonidal Sinus; Recurrence; Surgical Flaps; Suture Techniques; Treatment Outcome
PubMed: 34670722
DOI: 10.1016/j.amjsurg.2021.09.010 -
Cirugia Pediatrica : Organo Oficial de... Oct 2021Classic treatment of pilonidal sinus is associated with a high rate of complications and a long and painful postoperative period requiring daily wound care, with a...
INTRODUCTION
Classic treatment of pilonidal sinus is associated with a high rate of complications and a long and painful postoperative period requiring daily wound care, with a decrease in patients' quality of life. The objective of our study was to evaluate the effectiveness and advantages of the endoscopic technique vs. conventional surgery of pilonidal sinus in the pediatric population.
METHODS
A quasi-experimental study was carried out in pediatric patients undergoing pilonidal sinus surgery at a single institution in 2019. Excision and healing by secondary intention (EHSI), excision and primary closure (EPC), and Pediatric Endoscopic Pilonidal Sinus Treatment (PEPSiT) were compared. The surgical technique chosen was surgeon-dependent.
RESULTS
49 patients were studied - 14 undergoing PEPSiT, 23 undergoing EHSI, and 12 undergoing EPC. Full healing process was faster in PEPSiT than in EHSI (11 weeks earlier; 95% CI: 6.2-15.9; p < 0.001). Pain on the Visual Analogue Scale (VAS) and need for analgesics were less in the PEPSiT group (p = 0.001). Mean time to return to normal life was shorter with PEPSiT - 78 days earlier than EHSI (95% CI: 42.2-114.9; p < 0.001) and 39 days earlier than EPC (95% CI: -2.5-81.4; p = 0.06). No complications were recorded with PEPSiT, whereas complication rate with EHSI was 69.6%, and complication rate with EPC was 58.3% (p = 0.001).
CONCLUSIONS
Endoscopic pilonidal sinus treatment is effective, with a short and painless postoperative period, and easy wound care. It allows for an early return to normal life without restrictions.
Topics: Child; Endoscopy; Humans; Neoplasm Recurrence, Local; Pilonidal Sinus; Quality of Life; Recurrence; Treatment Outcome
PubMed: 34606699
DOI: No ID Found