Singh Raghubir, Pavithran Nevil M
Department of General Surgery, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India.
Asian J Surg. 2005 Jul;28(3):198-201. doi: 10.1016/S1015-9584(09)60343-2.
To retrospectively analyse the results of pilonidal sinus managed using wide excision with primary eccentric closure with various adipo-fascio-cutaneous flaps.
Data from 50 consecutive patients who had elective surgery for chronic pilonidal sinus with wide excision of all the sinuses and primary eccentric closure with various adipo-fascio-cutaneous flaps (40 lateral advancements, 4 Z-plasties, four rotations, 1 rhomboid and 1 V-Y advancement) were retrospectively analysed. Special emphasis was placed on partial obliteration of the natal cleft, duration of wound healing, postoperative morbidity and hospital stay, loss of work days, cosmetic outcome and recurrence.
In all patients, partial obliteration of the natal cleft was achieved by eccentric primary wound closure, with good cosmesis. Superficial necrosis of the flaps occurred in five patients (3 Z-plasties, 2 rotation flaps). None had collection, haematoma, infection or recurrence.
Complete eccentric excision and partial obliteration of the natal cleft using various adipo-fascio-cutaneous flaps ensured reliable wound healing with fewer dressings and morbidity, shortened hospital stay and early resumption of work, good cosmesis and prevention of early and late recurrence. The lateral advancement flap is a viable option in the treatment of chronic pilonidal sinus.
回顾性分析采用广泛切除并结合不同脂肪筋膜皮瓣进行一期偏心缝合治疗藏毛窦的结果。
回顾性分析50例因慢性藏毛窦择期手术患者的数据，这些患者均接受了所有窦道的广泛切除，并采用不同脂肪筋膜皮瓣进行一期偏心缝合（40例侧方推进皮瓣、4例Z成形术、4例旋转皮瓣、1例菱形皮瓣和1例V-Y推进皮瓣）。特别关注臀沟的部分闭合、伤口愈合时间、术后发病率和住院时间、误工天数、美容效果及复发情况。
所有患者通过偏心一期伤口缝合实现了臀沟的部分闭合，美容效果良好。5例患者（3例Z成形术、2例旋转皮瓣）出现皮瓣浅表坏死。无一例发生积液、血肿、感染或复发。
采用不同脂肪筋膜皮瓣进行完全偏心切除和臀沟部分闭合可确保伤口可靠愈合，减少换药次数和发病率，缩短住院时间并早日恢复工作，美容效果良好，预防早期和晚期复发。侧方推进皮瓣是治疗慢性藏毛窦的一种可行选择。
