What is the efficacy of excision and laying open of sinus tract for treatment of pilonidal disease?

Updated: Jun 11, 2018
  • Author: M Chance Spalding, DO, PhD; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Answer

An option has been described in which the pilonidal sinus is excised and the tract is laid open to allow healing by secondary intention; this technique, which is intended to ensure adequate drainage for the cavity, [22] avoids the wound infections that can be seen after primary closure. This technique can be either the primary treatment option or a secondary option chosen with a view to wound tension. In cases where the primary closure is not free of tension, the wound can be left to heal by laying the tract open.

Even after the pilonidal sinus has been excised down to healthy presacral fascia, the wound is still considered contaminated. Aerobic and anaerobic organisms are found in 50-70% of wounds.

The disadvantages of laying the tract open are the inconvenience to the patient, with frequent dressing changes, and the need for close observation of the wound to ensure proper wound healing and to avoid premature closure of the skin edges. The average time for wound healing to occur is approximately 6 weeks. Laying the tract open is always appropriate when a cellulitis is surrounding the pilonidal sinus. Not uncommonly, wounds may require 4-6 months to heal, but the average healing time is approximately 2 months.

The recurrence rate is in the range of 8-21%. The reduced recurrence rate is believed to be due to the more broad-based, flattened, and hairless scar produced by secondary intention. [23] This prevents buttocks friction, hair penetration, and hair follicle infection. Although advantages exist, the disadvantages associated with these open wounds (ie, aggressive management in the form of frequent dressing changes and close observation by the patient and surgeon) must be taken into account.

Because of the poor quality of life that results from open excision and packing in the surgical treatment of pilonidal disease, Spyridakis et al evaluated whether platelet-derived growth factors (PDGFs) could speed the wound-healing process. [24] Results from a controlled trial involving 52 patients indicated that postoperative treatment with local infusion of growth factors hastens recovery.

In this study, [24] patients who received the PDGFs went back to their normal activities approximately 17 days after surgery, when mean wound volume was about 10 cm3, whereas control group patients returned to normal activities around postoperative day 25. Surgical wounds in the platelet group healed completely in 24 days; wounds in the control group took more than 30 days to heal. The authors concluded that PDGFs enhance the healing process, thereby shortening patient recovery time.


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