Completeness of excision as a measure to prevent pilonidal sinus recurrence

Pilonidal completeness of excision

  • Vesna Sandor Rakic Plastic surgeon
  • Irena Jovanić, M.D. "Suprema lab" Patohistological diagnostics
Keywords: pathohistology, pits, pilonidal sinus, recurrence

Abstract

Background: There are numerous papers on Pilonidal Sinus (PS) detailing uncertainties regarding its etiology, pathogenesis, diagnosis, pathohistology analysis, and treatment.

Methods: Our goal is to use a retrospective and prospective study to determine the necessity of a routine pathohistological (PH) analysis to demonstrate whether Pilonidal Sinus was completely excised, if the wound can be primarily closed and whether recurrence would be prevented. Criteria for radically removed PS: no components of the disease detected at the specimen margins. Each wound was primarily closed with a local fasciocutaneous flap.

Results: Clinical characteristics of 71 patients suffering from PS were examined. We performed a pathohistological analysis of Pilonidal Sinus specimens and measured the dimensions of the tissue specimens containing the sinus components: 1) pathological embedded follicles over 4mm deep, 2) hair shafts, 3) cysts, 4) squamous epithelium or 5) pits “sacral dimple”. There was no recurrence during the 2-7 year follow-up period.

Conclusions: Surgically excised Pilonidal Sinus specimens should include the skin and subcutaneous tissue with superficial fascia, to the muscle fascia with all pathological tissue. A continuous incision should be made from the tip of the coccyx, including all dimples and navicular region of the sinus.  Complete excision does not affect the recurrence rate.

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Published
2021-02-15