How is complex pilonidal disease treated?

Updated: Jun 11, 2018
  • Author: M Chance Spalding, DO, PhD; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Complex wounds are reconstructed by using muscle and myocutaneous flaps because these flaps typically heal well and cover areas of extensive skin loss. Compared with skin flaps, they are less susceptible to infection and have a predictable vascular supply that promotes safe elevation and better wound healing.

Reconstructions using muscle and myocutaneous flaps are technically demanding, usually requiring the assistance of a plastic surgeon; however, they produce reliable results (with recurrence rates of 6-20%). Among the disadvantages of such procedures is that they necessitate prolonged hospitalization, require longer operating times, and are associated with more serious complications.

A failed flap represents a significant morbidity that ultimately leads to more extensive skin loss and a wound that is difficult to manage. These procedures are reserved for surgical management of complex recurrent wounds when more conservative procedures have failed.

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