Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.
Int Wound J. 2019 Jun;16(3):862-865. doi: 10.1111/iwj.12981. Epub 2018 Sep 21.
In the past decades, numerous surgical techniques and conservative treatments for pilonidal sinus disease (PSD) had been discussed and published. There is still no consensus yet of the best techniques because of high recurrence rates and prolonged wound healing. In the case of complicated discharging sinus or recurrent PSD resistant to treatment with antibiotics, we recommend radical excision followed by a regional flap, which can obliterate the dead space with well-vascularised tissue. In this article, we presented the technique of snug suture fixation between the dermis and periosteum using a superior gluteal artery perforator (SGAP) flap. The study demonstrates a few key concepts on the prevention of PSD recurrence, an off-midline, well-perfused flap that allows flattened natal cleft and obliteration of gluteal cleft and eventually showed good aesthetic results. We aim to demonstrate a reliable surgical technique for wound closure of recurrent pilonidal sinus after radical excision followed by reconstruction with an SGAP flap. The history, surgery, and images are described, and the literature is reviewed. The pitfalls of disease recurrence will be discussed in this literature. Keys to successful treatment will be elaborated. An 18-year-old female with recurrent pilonidal sinus disease over right medial gluteal region presented with sacral pain and infection. She developed progressive swelling and burst of abscess from several sinus tracts and did not respond to the treatment with antibiotics alone. After radical excision of the entire pilonidal sinus and adjacent fibrotic tissue, a deep and large defect was measured. A superior gluteal perforator flap was designed based on three perforators from the superior gluteal artery. A medial 3 cm of the SGAP flap was de-epithelised to provide soft tissue bulk to obliterate the deep cavity. Strong sutures were applied to secure the flap to the periosteum. There was no recurrence at 3 years of follow up. The patient stood the operation well and had prompt recovery.
在过去的几十年中，已经讨论和发表了许多针对藏毛窦疾病（PSD）的手术技术和保守治疗方法。由于高复发率和伤口愈合时间延长，仍然没有达成最佳技术的共识。在复杂的有分泌物窦或抗生素治疗无效的复发性 PSD 的情况下，我们建议进行根治性切除，然后进行区域性皮瓣转移，这样可以用血管丰富的组织填充死腔。在本文中，我们介绍了使用臀上动脉穿支（SGAP）皮瓣将真皮和骨膜之间进行紧密缝合固定的技术。该研究展示了一些预防 PSD 复发的关键概念，即中线以外、血供良好的皮瓣，可使骶尾部裂平坦化，臀裂消失，最终获得良好的美学效果。我们旨在展示一种可靠的手术技术，用于根治性切除后复发的藏毛窦的伤口闭合，然后用 SGAP 皮瓣重建。描述了病史、手术和图像，并回顾了文献。本文将讨论疾病复发的陷阱，并阐述成功治疗的关键。一位 18 岁女性，右侧臀中肌内侧有复发性藏毛窦疾病，表现为骶尾部疼痛和感染。她的几个窦道逐渐肿胀并脓肿破裂，单独使用抗生素治疗无效。在根治性切除整个藏毛窦和相邻的纤维组织后，测量出一个深而大的缺损。根据臀上动脉的三个穿支设计了臀上动脉穿支皮瓣。SGAP 皮瓣的内侧 3 厘米去表皮化，以提供软组织体积来填充深部腔隙。用强有力的缝线将皮瓣固定到骨膜上。随访 3 年后无复发。患者对手术耐受良好，恢复迅速。
