Factors influencing surgical decisions in chronic pilonidal sinus disease

Pit picking vs. Limberg flap vs. primary open method to treat pilonidal sinus disease – A cohort of 327 consecutive patients

“…Patients with single porous PSD presented with large subcutaneous tract systems intraoperatively require larger excisions, whereas other patients with multiple openings (>5) revealed only small tracts in the midline. This is in line with the literature saying that there is no robust correlation between the number of skin openings and the size or the extent of the required excision [ 29 ]. Thus, the focus on large excisions should be abandoned, and fistula tracts should be “dyed” intraoperatively, followed by meticulous exploration and complete tract excision using trephines or tract excision tools such as the metal-rod-guided AMI FiXcision round knife, which is longer than the trephines available.…”

Sinus pilonidalis in patients of German military hospitals: a review

“…Overall, nicotine abuse, patients with just one sinus and patients who had suffered from PSD for less than 5 months showed a higher rate of conversion to a clinically acute abscending pilonidal sinus than non-smokers who had suffered from PSD for more than 5 months [ 15 ]. Patients who fulfill criteria which have been correlated with a conversion from a sub-acute or chronic disease state to an acute disease state requiring emergent intervention should therefore preferably be recommended for prompt elective surgery.…”

S3-Leitlinie: Sinus pilonidalis. 2. revidierte Fassung 2020

“…Weiterhin abszedieren Pilonidalsinus mit weniger Pori häufiger als Fistelsysteme mit multiplen Pori [141]. Eine lange Krankheitsdauer führt nicht per se zur Ausbildung von extensiveren Fistelgängen und Pori, sodass aus der Anzahl der Pori nicht auf das Ausmaß der notwendigen Exzision ex ante geschlossen werden soll [133].…”

“…Al-Khayat et al [26] sahen Adipositas und Rauchen als schwerwiegende Risikofaktoren für Wundkomplikationen. Gleiches beschreiben Cubukcu et al [112] sowie Doll et al [141] für die Adipositas. In anderen Publikationen konnte dies jedoch nicht bestätigt werden [405,428].…”