| Failed pilonidal surgery: new paradigm and new operation leading to cures. | |
| | |
MedLine Citation:
|
PMID: 12361421 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
HYPOTHESIS: Refractory pilonidal disease is due to damage of the epidermis in the deep gluteal cleft by moisture and bacteria, rather than to damage in deep tissues. A new paradigm suggests that a procedure to change the shape of the gluteal cleft will improve results. DESIGN: Before-and-after trial. SETTING: Community private practice with extensive experience in pilonidal disease, providing ambulatory and hospital care. PATIENTS: Thirty-one patients with severe refractory pilonidal disease, with a median follow-up of 20 months in 27 patients (87%). Patients had undergone a total of 141 operations with wounds still open for a combined total of 252 years. INTERVENTION: The deep gluteal cleft was reshaped with a skin flap. Deep tissue was left essentially intact. MAIN OUTCOME MEASURES: Number healed, time to healing, number of operations required. RESULTS: Wounds in all 31 patients healed, 28 after a single procedure. The time to healing was rapid, within 1 week in 22 patients. There were no recurrences. CONCLUSIONS: For refractory pilonidal disease, the cleft lift procedure produced rapid results by drawing intact skin over the cleft and bringing the suture line out to open air. The failures of old methods and success of this new one suggest a need for a paradigm shift in our understanding of pilonidal disease. The source of disease is not the deep tissue but rather the epidermis in the moist, hypoxic, and bacteria-laden gluteal cleft. This also has implications for initial treatment of pilonidal disease, where simple, nonoperative treatments are often effective. |
| | |
Authors:
|
John Bascom; Thomas Bascom |
Publication Detail:
|
Type: Journal Article |
Journal Detail:
|
Title: Archives of surgery (Chicago, Ill. : 1960) Volume: 137 ISSN: 0004-0010 ISO Abbreviation: Arch Surg Publication Date: 2002 Oct |
Date Detail:
|
Created Date: 2002-10-03 Completed Date: 2002-10-24 Revised Date: 2004-11-17 |
Medline Journal Info:
|
Nlm Unique ID: 9716528 Medline TA: Arch Surg Country: United States |
Other Details:
|
Languages: eng Pagination: 1146-50; discussion 1151 Citation Subset: AIM; IM |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Follow-Up Studies Humans Pilonidal Sinus / physiopathology, surgery* Recurrence Reoperation Surgical Flaps* Treatment Outcome Wound Healing |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Lessons learned from the evacuation of an urban teaching hospital.
Next Document: Overall clinical breast examination as a factor in delayed diagnosis of breast cancer.