Käser S A, Zengaffinen R, Uhlmann M, Glaser C, Maurer C A
Department of General, Visceral, Vascular, and Thoracic Surgery, Hospital of Baselland, affiliated to the University of Basel, Rheinstrasse 26, 4410, Liestal, Switzerland.
Int J Colorectal Dis. 2015 Jan;30(1):97-103. doi: 10.1007/s00384-014-2057-x. Epub 2014 Nov 5.
Off-midline procedures seem to be the best method of primary wound closure after excision of a pilonidal sinus. Primary wound closure with a Limberg flap was compared to secondary wound healing.
From January 2006 to July 2012, 102 patients with given informed consent (mean age 28 years, men 81%) who had excision of a pilonidal sinus in three hospitals in Switzerland were randomised to group L (Limberg flap, n = 51) or to group E (excision only, n = 51). Primary endpoint was duration of incapacity for work. Follow-up was at 3 weeks and at 1 year postoperative (95% follow-up).
Both groups were comparable with regard to patient characteristics. The median (range) operation time was 60 (30-80) min in group L vs. 30 (10-75) min in group E (p < 0.001). No significant differences were found in postoperative pain and painkiller intake; pain, percentage of patients at work and overall satisfaction at 3 weeks postoperative; and overall duration of incapacity for work and overall satisfaction at 1-year follow-up. The complication rate was 49% in group L vs. 12% in group E (p < 0.001). Complications in group L were seroma (6%), wound dehiscence (45%), skin necrosis (10%), hematoma (6%), infection (4%) and recurrent disease (13%). Complications in group E were recurrent disease (6%) and wound healing disorder (6%).
After excision of a pilonidal sinus, primary wound closure with a Limberg flap has no advantage over secondary wound healing. The main reason for this conclusion is the relatively high complication rate of primary wound closure with a Limberg flap.
在切除藏毛窦后，偏离中线的手术方法似乎是一期伤口闭合的最佳方法。将采用Limberg皮瓣进行一期伤口闭合与二期伤口愈合进行比较。
2006年1月至2012年7月，瑞士三家医院中102例签署知情同意书的藏毛窦切除患者（平均年龄28岁，男性占81%）被随机分为L组（Limberg皮瓣组，n = 51）和E组（仅切除组，n = 51）。主要终点是工作能力丧失的持续时间。术后3周和1年进行随访（随访率95%）。
两组患者特征具有可比性。L组中位（范围）手术时间为60（30 - 80）分钟，E组为30（10 - 75）分钟（p < 0.001）。术后疼痛和止痛药服用量、术后3周时的疼痛、工作患者百分比和总体满意度以及1年随访时的工作能力丧失总持续时间和总体满意度方面均未发现显著差异。L组并发症发生率为49%，E组为12%（p < 0.001）。L组的并发症包括血清肿（6%）、伤口裂开（45%）、皮肤坏死（10%）、血肿（6%）、感染（4%）和疾病复发（13%）。E组的并发症为疾病复发（6%）和伤口愈合障碍（6%）。
切除藏毛窦后，采用Limberg皮瓣进行一期伤口闭合并不优于二期伤口愈合。得出这一结论的主要原因是采用Limberg皮瓣进行一期伤口闭合的并发症发生率相对较高。
