Document Detail


Prospective randomized controlled trial comparing V-Y advancement flap with primary suture methods in pilonidal disease.
MedLine Citation:
PMID:  19362290     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: An ideal treatment method for the widely prevalent pilonidal sinus disease is not yet available. The most commonly practiced technique is simple closure following resection of the effected tissue. However, high recurrence rates in some series have led to the search for other methods. One of these methods is the V-Y advancement flap (VYAF), which in theory results in the flattening of the natal cleft without tension in the suture line. METHODS: In this prospective randomized controlled study, the VYAF method was compared to 2 simple primary closure techniques. In 238 patients, following resection, in the AL (all layers) group, all layers were closed with polypropylene sutures. In the SS (subcutaneous suture) group, polyglactin subcutaneous sutures were used to approximate the wound edges. Skin was closed separately in the SS group. In addition, demographic variables, past history, physical examination findings, defect dimensions, and wound tension were recorded. RESULTS: Surgical site infection was observed in 23.9%, 17.4%, and 10.2% of the patients in AL, SS, and VYAF groups, respectively (P = .129). Early wound dehiscence without infection was detected in 11.9%, 7.4%, and 10.2% of the patients in groups AL, SS, and VYAF, respectively (P = .665). Mean follow-up was 29.7 +/- 15.6 months. Survival (time without recurrence) was not significantly different between groups (P = .648). In the whole group, independent predictors of recurrence according to logistic regression analysis were younger age, recurrent disease, presence of discharge on physical examination, and development of postoperative surgical site infection. CONCLUSIONS: VYAF is not superior to simple primary closure techniques in terms of postoperative complications, recurrence, and patient satisfaction. For most cases, simple primary closure would suffice. Patients should be informed of the increased risk of recurrence if any of the independent predictors (being a recurrent case, presence of discharge, development of postoperative infection) are present.
Authors:
Tarik Zafer Nursal; Ali Ezer; Kenan Cali?kan; Nurkan T?rer; Sedat Belli; G?khan Moray
Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial     Date:  2009-04-10
Journal Detail:
Title:  American journal of surgery     Volume:  199     ISSN:  1879-1883     ISO Abbreviation:  Am. J. Surg.     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-02-01     Completed Date:  2010-02-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370473     Medline TA:  Am J Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  170-7     Citation Subset:  AIM; IM    
Copyright Information:
Copyright 2010 Elsevier Inc. All rights reserved.
Affiliation:
Ba?kent University, Department of General Surgery, Adana, Turkey. tznursal@hotmail.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Female
Humans
Kaplan-Meiers Estimate
Logistic Models
Male
Patient Satisfaction
Pilonidal Sinus / surgery*
Postoperative Complications / prevention & control
Prospective Studies
Recurrence / prevention & control
Surgical Flaps*
Surgical Wound Dehiscence
Surgical Wound Infection
Suture Techniques*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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