Investigation of a One-Time Phenol Application for Pilonidal Disease

Abstract

Objective: To investigate wound healing rates and postoperative recovery of patients after a one-time phenol application for pilonidal disease. Subjects and Methods: A total 30 consecutive patients with chronic pilonidal disease ranging from midline to complex sinuses were enrolled in the study. No preoperative laboratory examinations or bowel preparation were required. No antibiotic prophylaxis or sedation was used. A small incision was made on the midline and hair/debris in the sinuses was removed. A cotton swab with saturated phenol was moved into the cavity and the phenol was left for 2 min. No special dressing was necessary and patients left the hospital immediately afterwards. Patients filled out a daily questionnaire for 7 days. We did not intervene in the wounds with a second phenol application or curettage during the observation period. Wounds were inspected at weekly intervals for 2 months. Results: At the end of the third day, 97% of the patients were pain-free and 100% of the patients were free from analgesics. Time off work was 2 days for most patients (93.3%). Twenty-eight (93.3%) patients were satisfied with the procedure, they found it easy and painless and suggested the procedure to other patients. Twenty-five (83%) patients were asymptomatic at the end of 2 months’ observation and the remaining 5 patients had unhealed sinuses. Mean time for wound healing was 25 days (range 10–63 days). There were 4 recurrences after a mean of 14 months’ follow-up and the overall success rate was 70%. Conclusions: A one-time phenol application was an effective treatment for pilonidal disease with acceptable wound healing rates, less postoperative pain and less time off work. Hence it can be an alternative treatment modality.

Treatment of pilonidal disease by phenol application

“…It is recommended that any sinus orifice smaller than 3 mm should be enlarged to apply phenol much easier and more comfortably (9,11). Orifice dilation is often achieved by a clamp, but in some cases either a small incision is done or a 1 cm diamond shaped skin is excised along with the sinus orifice (9,16,27,30,31).…”

“…The curettage of the sinus is often done in order to remove granulation tissue (24,31,32). Some authors use a clamp to evacuate the sinus contents, while others clean the sinus with a gauze sponge (11,17,20,22).…”

“…The methods are various. There are techniques that adjust the amount of phenol based on sinus volume measurements (14,16,31). The amount of phenol in the application is usually determined by injecting a certain amount of phenol solution into the sinus and then by checking the overflow from the other sinus orifice (1,18,30).…”

“…In some other cases, 1-4 mL of liquid phenol is injected by using a venous catheter into the sinus (14,16,17,19,21,30). Phenol impregnated into small piece of cottons can also be used (11,31). Phenol is kept in the sinus for approximately 1-3 min.…”

“…Duration of the phenol in the sinus tract is an important factor for success of the application. Many studies have reported the duration of phenol in the sinus as approximately 2-8 min (20,27,31,33). However, in one study, it has been reported that protein structure of the hair was destructed at least 9 min after phenolization (23).…”