Efrat Z, Perri T, Meizner I, Chen R, Ben-Rafael Z, Dekel A.
Department of Obstetrics and Gynecology, Rabin Medical Center, Petah Tiqva, Israel.

We report on a newborn in whom an echogenic protrusion arising in the caudal region was detected at 12 weeks' gestation. Subsequent ultrasound examinations at weeks 15 and 22 failed to demonstrate this finding. After birth, the infant was found to have a pilonidal sinus. The pilonidal sinus may represent a remnant of the embryonic appendage ('human tail') that usually disappears by the end of the 8th week of gestation. This case might support the theory of congenital pilonidal sinus origin.

Glomus coccygeum may mimic glomus tumour
Pathology 2002 Aug;34(4):339-43

Santos LD, Chow C, Kennerson AR.
Department of Anatomical Pathology, South Western Area Pathology Service, Liverpool, NSW, Australia. Leonardo.Santos@swsahs.nsw.gov.au

We reviewed all cases of pilonidal sinus excision specimens from our surgical pathology records from 1990 to 2000 to determine the presence of glomus coccygeum. We found only two cases of glomus coccygeum, also known as coccygeal body. We describe the histology and immunohistochemical findings of two glomera coccygea incidentally discovered in pilonidal sinus excision specimens, and review the world's English literature.

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Papa CA, Ramsey ML, Tyler WB.
Division of Dermatology and Department of Pathology, Geisinger Medical Center.

Pilonidal sinus is an acquired condition that usually develops in the sacrococcygeal area or other hair-bearing areas. It has also been described as an occupational disease, especially when present interdigitally. We describe the case of a 47-year-old dog groomer with interdigital pilonidal sinus and briefly review the postulated pathogenesis, clinical characteristics, differential diagnosis, and treatment.

Gupta PJ.
Gupta Nursing Home, Nagpur, India.

BACKGROUND: The surgical approach to pilonidal sinus disease is open to debate. This prospective, randomized study was aimed to compare the outcome of the excision and marsupialization and the sinus excision technique by radiofrequency. MATERIALS AND METHODS: Thirty patients of chronic pilonidal sinus disease were randomly assigned to radiofrequency sinus excision (n = 15) and excision and marsupialization (n = 15). The parameters measured included intraoperative and postoperative data, wound-related complications, and recurrence. Patient satisfaction score was assessed at 1-year follow-up. RESULTS: The operation time, postoperative pain, hospital stay, and off work periods were significantly less (p < 0.05) in the technique employing radiofrequency surgery. At 1-year follow-up, there was 1 case of recurrence in each group. The patients from radiofrequency group expressed better satisfaction than the patients operated by marsupialization. CONCLUSION: Radiofrequency sinus excision technique needs a shorter hospital stay with reduced postoperative pain and early resumption to work in comparison with the sinus excision and marsupialization technique.

Lynch JB, Laing AJ, Regan PJ.

Department of Plastic, Reconstructive and Hand Surgery, University College Hospital Galway, Galway, Ireland. 

No single treatment option available for symptomatic pilonidal disease is entirely satisfactory. In our department, we have treated successfully three cases of pilonidal disease with vacuum-assisted closure therapy. We describe our initial experience with this technique. In two cases, the pilonidal sinus was primarily excised, a split skin graft applied to cover the defect, and the vacuum-assisted closure pump applied over the skin graft for a period of four days on a continuous negative pressure of 50 mmHg. The third case was treated and completely healed with vacuum-assisted closure therapy alone. To our knowledge, this is the first report in the literature describing the use of vacuum-assisted closure therapy for this condition. We propose this therapy as an alternative adjunctive treatment for pilonidal disease.

Mentes BB, Leventoglu S, Cihan A, Tatlicioglu E, Akin M, Oguz M.
Colorectal Surgery Division, Department of Surgery, Gazi University Medical School, Ankara, Turkey.

PURPOSE.METHODS. We analyzed the well-documented records of 238 patients with sacrococcygeal pilonidal sinus who underwent wide excision with a Limberg transposition flap and were followed up for longer than 1 year postoperatively. After the first 40 operations, we modified this flap reconstruction by tailoring the rhomboid excision asymmetrically to place the lower pole of the flap 1-2 cm lateral to the midline. Wound infection rates, hospitalization, time required for free mobilization, and recurrence rates were recorded. RESULTS. Postoperative infection developed in two patients (0.8%), which was easily managed by wound care, antibiotics, removal of skin staples, prolonged drainage, or a combination of these treatments. The mean hospitalization was 2.10 +/- 0.20 days (range 1-3 days), and the mean time required for recovery and return to daily activities was 8.00 +/- 2.50 days (range 4-17 days). There were only three recurrences (1.26%) after a mean follow-up of 29.20 +/- 3.10 months (range 12-38 months). Since we started performing our modification of the technique by lateralization of the inferior apex, no further recurrences have been seen. The recurrence rate differed significantly between the classical Limberg flap group and the modified Limberg flap group ( P = 0.004) CONCLUSION. These results provide further evidence that wide excision with a Limberg transposition flap reconstruction is an effective surgical method for primary or recurrent pilonidal sinus, associated with a low complication rate, short hospitalization and disability, and a low recurrence rate. A modification of the technique was devised to further enhance wound healing and reduce the risk of recurrence.To investigate the results of wide rhomboid excision with Limberg transposition flap reconstruction to treat pilonidal sinus.

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Breuninger H.
Universitats-Hautklinik, Tuebingen. 

A pilonidal sinus is a invagination of the skin over the sacrum containing a tuft of hair which enlarges by repeated friction causing the hairs to penetrate the skin. It may become symptomatic if an infection occurs. There are similarities with acne inversa, which is present in about 23% of cases. Acne inversa is an inflammation of the sebaceous glands and terminal hair follicles, chiefly in the intertriginous areas. The first manifestation can occur at any time from puberty to advanced age. 90% of patients are smokers. Initially giant comedones and indolent subcutaneous nodules are found; they progress to form draining sinus tracts. Conservative treatment, incision and/or surgical removal of the abscesses and fistulas is futile. The method of choice is the early complete surgical excision of the involved skin extending into normal tissue both laterally and at the base. In most cases healing of the defects by secondary intention is uneventful.

Nessar G, Kayaalp C, Seven C. Department of Gastrointestinal Surgery, Turkiye Yuksek Yhtisas Hospital, Syhhiye, Ankara, Turkey.

BACKGROUND: The treatment of the symptomatic pilonidal sinus is surgical with one of the most extensive being excision of the diseased tissue down to the sacral fascia. The closure of the defect is the matter of debate. An elliptical rotation flap has been used for pilonidal sinus treatment with no recurrence rate. METHODS: From April 1996 to June 2001, 20 patients were treated with this technique. The surgical procedure is a vertical elliptical excision of the diseased tissue and an elliptical cutaneous rotation flap to close the defect. RESULTS: Twenty patients underwent with this technique, mean age 23.4 years (range 18 to 34). Mean follow-up was 42 months. All patients were discharged on the first postoperative day. Primary healing was achieved in all of the patients in 2 weeks. No recurrence was observed. CONCLUSIONS: Elliptical rotation flap is recommended for patients selected for defect closure. It offers improved patient comfort, shorter hospital stay, and no recurrence rate.

Treatment of pilonidal sinus disease using fibrin glue as a sealant.
Techniques in Coloproctology   August 2004

Greenberg R, Kashtan H, Skornik Y, Werbin N.
Department of Surgery A, Tel-Aviv Medical Center Sackler Faculty of Medicine Tel-Aviv University

BACKGROUND. Complete excision is the preferred treatment for pilonidal sinus disease. We describe a new technique of excision and tension-free primary closure of pilonidal sinus disease, combined with application of fibrin glue in order to obliterate the dead space and to promote wound healing. METHODS. A curved incision of the carried out, 2-3 cm lateral to the opening of the sinus, done under general or spinal anesthesia, and a thick flap was created by undercutting the medial edge and advancing it across the midline. The sinus was completely excised with all of its extensions. The flap was then sutured back to its original place by several interrupted monofilament mattress sutures. Then, 2-4 ml of fibrin glue was injected through the original pilonidal sinus opening to the sinus bed in order to obliterate the dead space. RESULTS. Thirty patients with pilonidal sinus disease were treated by this technique. In four patients, there was a temporary purulent discharge through the opening of the sinus, and there were no other complications. The mean period for returning to daily activities and to work for patients was 11 days (SD=6 days). No infection or recurrent disease was noticed during the follow-up period (23+/-3 months). CONCLUSIONS. Complete excision with tensionfree closure with fibrin glue application may be a useful technique for the treatment of pilonidal sinus disease.

Zorcolo L, Capra F, Scintu F, Casula G.
Chirurgia Generale II, Universita degli Studi di Cagliari, Cagliari, Italy.

AIM: Pilonidal sinus is a considerable source of problems in young patients both in terms of discomfort and in time off to work. Many procedures have been proposed for its treatment but most of them present substantial persistence/recurrence rates. Surgical procedures avoiding a wound in the midline are most likely to succeed. Bascom's technique is the simplest and successful method. The aim of this study is to retrospectively evaluate the results of the Bascom's procedure performed by the authors as to healing time and recurrence rate. All patients with chronic pilonidal disease, treated with Bascom's technique were re-viewed. Complications, healing time and long-term follow-up were considered. RESULTS: A total of 74 patients (52 males, and 22 females), were admitted to the study. The mean age was 26 years; 69 had a small sinus with 1-2 tracks. Three patients (4%) had postoperative bleeding or wound infection. Mean healing time was 39 days but all patients were able to return to work within 1 week from the operation. The mean period of follow-up was 45 months. Six patients developed recurrence (9,2%). Only 3 of them, (because symptomatic) required a second operation. CONCLUSION: Bascom's technique is simple and suitable for one-day surgery with local anesthesia. It also gives favorable results as to return to work and rate of recurrence. Therefore, it is suggested as the procedure of choice in the initial treatment of symptomatic pilonidal disease.

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