González-Temprano N, Sánchez-Vázquez M, Ayuso-González L, Pisón-Chacón J, Pérez-Martínez A
Servicios de Cirugía Pediátrica, Complejo Hospitalario de Navarra B.
Cir Pediatr. 2011 Aug;24(3):161-4.
We present a retrospective study of our paediatric patients affected by pilonidal disease over the last 5 years.
In all cases a broad excision of the pilonidal tissue was made, without colour signing the different incision sites and primary closure of the defect with no drainage.
Using this technique we treated 20 adolescents (15 girls and 5 boys) of ages between 12 and 15 years (average age 13.3 years) and body mass index between 17 and 33 (mean BMI 26.4 kg/m2). Mean hospitalisation time was 1.45 days. Preoperative antibiotherapy with Amoxicillin-clavulanic was administered to 55% of patients and continued over the first postoperative week. We had four cases with recurrence of the disease (25%) (two of these with two recurrences), which we treated with three primary closures on the midline and three by flattening the cleft. In 2 cases with dehiscence of the wound we allowed treatment by secondary intention. No flaps or marsupialisation were attempted in any case. In all cases the result was aesthetically satisfactory, with maintenance of the intergluteal fold.
In our series we have succeeded in undertaking primary closure of the defect after pilonidal resection without any excessive tension. This treatment enables a rapid return to a normal routine. We considered it important to undertake surgery that maintained the intergluteal fold, especially in patients with a short-term evolution of the disease, reserving flattening the cleft, closure by secondary intention, or primary closure by inserting flaps only for cases of recurrent disease; those with long-term evolution; or patients with complex lesions prior to surgery. Nutritional support to reduce overweight is very important in many patients.
我们对过去5年中患有藏毛窦疾病的儿科患者进行了一项回顾性研究。
在所有病例中，均对藏毛组织进行广泛切除，不对不同切口部位进行染色标记，对缺损进行一期缝合且不放置引流。
我们使用该技术治疗了20名青少年（15名女孩和5名男孩），年龄在12至15岁之间（平均年龄13.3岁），体重指数在17至33之间（平均BMI为26.4kg/m²）。平均住院时间为1.45天。55%的患者术前使用阿莫西林-克拉维酸进行抗菌治疗，并在术后第一周持续使用。我们有4例疾病复发（25%）（其中2例复发两次），我们通过在中线进行3次一期缝合以及通过使裂隙变平进行3次治疗。在2例伤口裂开的病例中，我们采用二期愈合治疗。在任何情况下均未尝试皮瓣或袋形缝合术。在所有病例中，结果在美学上令人满意，臀间沟得以保留。
在我们的系列研究中，我们成功地在藏毛窦切除术后对缺损进行了一期缝合，且没有任何过度张力。这种治疗能够使患者迅速恢复正常日常生活。我们认为进行保留臀间沟的手术很重要，特别是对于疾病病程较短的患者，仅将使裂隙变平、二期愈合或通过插入皮瓣进行一期缝合保留用于复发性疾病、病程较长或术前有复杂病变的患者。在许多患者中，减轻超重的营养支持非常重要。
