Theodoropoulos George E, Vlahos Kostas, Lazaris Andreas C, Tahteris Emmanouil, Panoussopoulos Dimitrios
Department of Surgery, Samos Military Hospital, Samos Island, Greece.
Dis Colon Rectum. 2003 Sep;46(9):1286-91. doi: 10.1007/s10350-004-6729-4.
Despite the variety of surgical techniques proposed for the treatment of pilonidal disease, recurrence after its operative management remains a common occurrence. Relatively few data exist that focus on an optimal surgical approach that should be followed in cases of recurrent pilonidal disease. The aim of this study was to describe the technical details, analyze the advantages, and present the early results of a modified Bascom asymmetric midgluteal cleft closure technique applied in patients with recurrent pilonidal disease in a military hospital setting.
Among the 72 male military service patients (median age, 21; range, 18-26 years) who underwent surgery for pilonidal disease in the Military Hospital of Samos Island, Greece, there were 24 who presented with recurrent pilonidal disease eight months to four years after one to four operations each, which were performed before their enrollment in the Army (total of 43 operations). One or two midline pits were evident in 41.6 percent of the patients, whereas the rest had more complex disease. Three patients presented with acute purulent disease and required initial incision and drainage. The modified Bascom technique was applied, which involved an asymmetric ellipse-like, gluteal fat-preserving excision of the affected skin, the pilonidal sinus, and lateral tracts, a thick skin and fat tongue of tissue mobilization, and finally, complete lateralization of wound closure and flattening of midgluteal groove.
All patients tolerated the procedure well, with minimal to moderate postoperative discomfort. Full return to military duty was possible in three weeks after surgery. There was one case of limited primary healing failure. No recurrences have developed in a short median follow-up period of ten months.
The suggested modified Bascom technique is an attractive, safe, easily performed operation with minimal morbidity and can be reliably used as a second-line surgical option for recurrent pilonidal disease.
尽管针对藏毛窦疾病提出了多种手术技术，但手术治疗后的复发仍是常见现象。关于复发性藏毛窦疾病应采用的最佳手术方法的数据相对较少。本研究的目的是描述一种改良的巴斯科姆不对称臀间裂闭合技术的技术细节，分析其优点，并展示在军事医院环境中应用于复发性藏毛窦疾病患者的早期结果。
在希腊萨摩斯岛军事医院接受藏毛窦疾病手术的72名男性军人患者（中位年龄21岁；范围18 - 26岁）中，有24例在入伍前分别接受了1至4次手术（共43次手术），术后8个月至4年出现复发性藏毛窦疾病。41.6%的患者有一或两个中线窦口，其余患者病情更为复杂。3例患者出现急性化脓性疾病，需要先行切开引流。采用改良的巴斯科姆技术，包括对受影响皮肤、藏毛窦和侧支进行不对称椭圆形、保留臀肌脂肪的切除，掀起一块厚的皮肤和脂肪组织瓣，最后完全将伤口闭合偏向一侧并使臀间沟变平。
所有患者对手术耐受性良好，术后不适轻微至中度。术后三周即可完全恢复军事任务。有1例出现有限的一期愈合失败。在中位随访期10个月的短时间内未发生复发。
所建议的改良巴斯科姆技术是一种有吸引力、安全、易于实施且发病率极低的手术，可可靠地用作复发性藏毛窦疾病的二线手术选择。
