Rashidian N, Vahedian-Ardakani J, Baghai-Wadji M, Keramati M R, Saraee A, Ansari K, Adman A A
Resident of General Surgery, Iran University of Medical Sciences, Tehran, Iran.
J Wound Care. 2014 Dec;23(12):630-3. doi: 10.12968/jowc.2014.23.12.630.
Although there are various therapeutic modalities to manage patients suffering from sacrococcygeal pilonidal sinus disease, there remains controversy over a standard method to treat such patients. In this study the postoperative outcomes after three different surgical methods of wound repair in patients with sacrococcygeal pilonidal sinus were compared.
Patients were divided randomly into three different groups. All of the patients underwent a wide excision of their pilonidal sinus; the subsequent surgical wound was left open in the first group (lay open group) whereas it was repaired with a simple primary closure and a rhomboid flap in the second and third groups. Variables including length of hospitalisation, time for wound healing, time off work, recurrence and surgical complications were evaluated.
A total of 60 patients with an average age of 27.61 years were studied, including 47 (78.3%) men and 13 (21.7%) women. Postoperative hospitalisation time was significantly shorter in patients who were treated using the simple primary closure method than those with the rhomboid flaps. However, there were no differences in terms of postoperative hospitalisation time between the lay open and simple primary groups or the lay open and rhomboid groups. The period of absence from work was significantly shorter in patients who were managed by a simple primary closure or rhomboid flap technique comparing to those whose wound was left open (p<0.05). Complete wound healing had a significantly shorter course in the rhomboid flap and the simple primary closure techniques compared to those within the lay open group. In terms of complications, postoperative infection and haemorrhage were more common in the lay open group than in the other two. Recurrence was about 5% in patients who were treated with the lay open method in an 18-month follow-up period; however, no recurrence was observed in the other two groups.
Considering the earlier wound healing period, less days absent from work, lower complication levels and recurrence rates, the simple primary closure or rhomboid flap techniques appear to be better options to treat the subsequent wound after a wide excision of pilonidal sinus when compared to the lay open method. The simple primary closure method causes no cosmetic disfiguration and the most promising option among the three techniques assessed.
The authors have declared that no conflict of interest exists.
尽管有多种治疗方式用于骶尾部藏毛窦疾病患者的治疗，但对于此类患者的标准治疗方法仍存在争议。本研究比较了骶尾部藏毛窦患者三种不同手术伤口修复方法后的术后结果。
将患者随机分为三组。所有患者均接受藏毛窦广泛切除术；第一组（敞开组）术后手术伤口敞开，而第二组和第三组分别采用简单一期缝合和菱形皮瓣修复伤口。评估包括住院时间、伤口愈合时间、休假时间、复发情况及手术并发症等变量。
共研究了60例平均年龄为27.61岁的患者，其中男性47例（78.3%），女性13例（21.7%）。采用简单一期缝合方法治疗的患者术后住院时间明显短于采用菱形皮瓣治疗的患者。然而，敞开组与简单一期缝合组之间以及敞开组与菱形皮瓣组之间的术后住院时间并无差异。与伤口敞开的患者相比，采用简单一期缝合或菱形皮瓣技术治疗的患者休假时间明显更短（p<0.05）。与敞开组相比，菱形皮瓣和简单一期缝合技术的伤口完全愈合过程明显更短。在并发症方面，敞开组术后感染和出血比其他两组更常见。在18个月的随访期内，采用敞开法治疗的患者复发率约为5%；然而，其他两组未观察到复发情况。
考虑到伤口愈合时间更早、休假天数更少、并发症水平更低以及复发率更低，与敞开法相比，简单一期缝合或菱形皮瓣技术似乎是藏毛窦广泛切除术后后续伤口治疗的更好选择。简单一期缝合方法不会导致美容缺陷，是所评估的三种技术中最有前景的选择。
作者声明不存在利益冲突。
