Danne Julia, Gwini Stella, McKenzie Dean, Danne Peter
St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
Epworth Healthcare, Richmond, Australia.
Ostomy Wound Manage. 2017 Mar;63(3):47-53.
Pilonidal sinus (PS) disease is an inflammatory skin and subcutaneous tissue condition that presents with infection, acute abscess, chronic discharging wounds, and/or pain. Surgery with open healing by secondary intention typically is used to achieve the fastest healing time with minimal recurrence rates. A retrospective analysis was conducted of data extracted from the medical records of 73 consecutive patients who had symptomatic natal cleft PS over a 10-year period to compare use of NPWT to alginate-based/gauze daily dressing (DD) changes in terms of healing time and recurrence. Variables extracted included age, gender, PS wound diameter (small <1 cm, medium 1 cm to 3 cm, large >3 cm), and time in weeks to achieving the endpoint (epithelialization). Risk factors examined that can affect healing or recurrence of previously operated PS disease included initial drainage before excision and risk factors for impaired healing (morbid obesity as determined by body mass index [BMI] ≥35, chronic infective skin conditions, and ongoing therapy with immuno-modulating drugs or chemotherapy), and loss to follow-up. Data were collected and analyzed using the chi-squared statistic, Kaplan-Meier curves, and Cox regression models. The total time of follow-up was 390 weeks for the DD group and 311 weeks for NPWT group. Patient mean age was 26.5 ± 10.7 years, most (53, 72.6%) were male, and 12 (16.4%) had comorbidities potentially affecting healing. Nine (9) were treated with primary closure and 62 patients were treated with open healing by secondary intention (2 additional patients receiving DD were excluded from the analysis because they had small sinuses that made NPWT unfeasible). Among participants, 30 (48%) received DD and 32 had NPWT. The median time to healing was 10 weeks (95% CI: 7-17) in the DD group and 8 weeks (95% CI: 7-9) in the NPWT group (not significantly different). In patients who healed, the average time to healing was 15.0 ± 18.1 and 9.8 ± 6.3 weeks in the DD and NPWT groups, respectively (not significantly different). The PS wound recurred in 5 patients - 4 (12.5%) in the DD group and 1 (3.1%) in the NPWT group (P = .355). In univariate analysis, only the presence of comorbidities was found to significantly affect time to healing (HR 95%, CI: 0.40 [0.17-0.93]; P = .033]. Prospective, randomized controlled clinical studies are warranted.
藏毛窦（PS）疾病是一种炎症性皮肤和皮下组织疾病，表现为感染、急性脓肿、慢性流脓伤口和/或疼痛。通过二期愈合进行开放愈合的手术通常用于实现最快的愈合时间和最低的复发率。对连续73例有症状的骶尾部藏毛窦患者在10年期间的病历数据进行回顾性分析，以比较负压伤口治疗（NPWT）与藻酸盐基/纱布每日换药（DD）在愈合时间和复发方面的情况。提取的变量包括年龄、性别、藏毛窦伤口直径（小<1厘米、中1厘米至3厘米、大>3厘米）以及达到终点（上皮化）的周数。研究的可能影响既往手术治疗的藏毛窦疾病愈合或复发的危险因素包括切除前的初始引流以及愈合受损的危险因素（根据体重指数[BMI]≥35确定的病态肥胖、慢性感染性皮肤病以及正在使用免疫调节药物或化疗），以及失访情况。使用卡方统计、Kaplan-Meier曲线和Cox回归模型收集和分析数据。DD组的总随访时间为390周，NPWT组为311周。患者平均年龄为26.5±10.7岁，大多数（53例，72.6%）为男性，12例（16.4%）有可能影响愈合的合并症。9例接受一期缝合，62例患者通过二期愈合进行开放愈合（另外2例接受DD治疗的患者被排除在分析之外，因为他们的窦道较小，使NPWT不可行）。在参与者中，30例（48%）接受DD治疗，32例接受NPWT治疗。DD组的中位愈合时间为10周（95%CI：7 - 17），NPWT组为8周（95%CI：7 - 9）（无显著差异）。在愈合的患者中，DD组和NPWT组的平均愈合时间分别为15.0±18.1周和9.8±6.3周（无显著差异）。5例患者藏毛窦复发 - DD组4例（12.5%），NPWT组1例（3.1%）（P = 0.355）。在单因素分析中，仅发现合并症的存在显著影响愈合时间（HR 95%，CI：0.40[0.17 - 0.93]；P = 0.033）。有必要进行前瞻性、随机对照临床研究。
