Surgical reconstruction of pilonidal sinus disease with concomitant extracellular matrix graft placement: a case series

Abstract

Background: Pilonidal sinus disease (PSD) is a chronic inflammatory disease affecting the soft tissue of the sacrococcygeal region and remains a challenging disease for clinicians to treat. The optimal treatment for PSD remains controversial and recent reports describe several different surgical approaches offering different benefits. Approximately 40% of initial incision and drainage cases require subsequent surgery. Due to high recurrence rates and postoperative complications, a more complex revision surgery involving a flap reconstruction may be required. We hypothesised that the combination of an extracellular matrix (ECM) graft with tissue flap reconstruction may decrease the postoperative complications and recurrence rates for PSD. Method: We report a retrospective case series using a surgical flap reconstruction with concomitant implantation of an ovine forestomach ECM graft under a fasciocutaneous flap with an off-midline closure for recurrent PSD, where previously surgical intervention had failed due to wound dehiscence and/or recurrent disease. Results: The case series included six patients. After three weeks, all patients except one were fully healed, and the sixth was fully healed by week 4; all wounds remained fully healed at 12 weeks. All patients achieved good cosmesis and were able to return to normal function without any residual symptoms. Conclusion: This pilot case series explored augmenting a flap reconstruction for complex PSD with advanced ECM graft materials, demonstrating that it may improve outcomes and minimise typical complications seen in flap closure, such as inflammation, infection, haematoma/seroma and hypoperfusion. Although the study had a limited number of participants, long-term outcomes were promising and suggest that further studies are warranted.

Non‐operative management of pilonidal sinus disease; classification and outcome

“…Pilonidal sinus disease (PSD) commonly occurs in the sacrococcygeal area. It is regarded as a distressing disease and a challenge to clinicians owing to; the high morbidity of management methods, high recurrence rates, and several other complications 8,12 . This disease is multifactorial, and an abundant number of risk factors have been reported to be associated with its occurrence 12,13 .…”

“…It is regarded as a distressing disease and a challenge to clinicians owing to; the high morbidity of management methods, high recurrence rates, and several other complications 8,12 . This disease is multifactorial, and an abundant number of risk factors have been reported to be associated with its occurrence 12,13 . In a study by Cevik et al, it was revealed that most of the affected individuals had spent a minimum of 8 hours a day sitting studying 7 .…”

“…Beal et al classified the PNS based on presentation, and Irkörücü et al suggested that a classification system should be used for comparing different techniques in the management of PSD 23,24 . Recurrence is one of the most common complications of PNS, although there is no classification of patients based on the chances of recurrence 12 . In this study, we classified the patients into three classes (Smart score), and each class was associated with several risk factors of recurrence with different scores.…”

“…8,12 This disease is multifactorial, and an abundant number of risk factors have been reported to be associated with its occurrence. 12,13 In a study by Cevik et al, it was revealed that most of the affected individuals had spent a minimum of 8 hours a day sitting studying. 7 In accordance with the previous study, students were the second most commonly affected group in the present study.…”

“…23,24 Recurrence is one of the most common complications of PNS, although there is no classification of patients based on the chances of recurrence. 12 In this study, we classified the patients into three classes (Smart score), and each class was associated with several risk factors of recurrence with different scores. Class I includes those patients that had scores of ≤20, and the chance of recurrence was the lowest.…”