The Chance Of The Second Operation Of The Infectious Pilonidal Sinus

Background: Pilonidal Sinus(PS)is a kind of rare disease in clinic and often occurs in the sacral tail and the upper gluteal cleft.It is characterized by sacral tail abscess or the sinus tract with hair inside.With the improvement of living standards,the incidence of PS has increased significantly in China.Because of lacking understanding,most of the patients are diagnosed with complex sinus pathways caused by acute infection or repeated attacks.After the first stage of drainage,the wound is large and heals slowly which always takes 2 to 3 months,or even 6 months.In addition,long time dressing change seriously affects the patients' life quality.For some PS patients who received early radical surgery after the drainage treatment,the rates of some complications(e.g.,the incision infection and dehiscence)and recurrence increased.For other PS patients who didn't receive radical surgery or received radical surgery at a late stage,the rate of acute infection also increased.It has been proved that drainage treatment,physiotherapy,and traditional Chinese medicine treatment can promote the infection absorption and wound healing.Full-thickness relaxation suture is efficient to deal with the infective incisions.Among various surgical methods for PS in clinic,the V-Y flap is one of the ideal surgical methods for the treatment sinus.Objective:PS which were at the infectious stage were treated with drainage,dressing,physiotherapy first,and then received radical resection and V-Y flap treatment at 1–2 weeks later.Compared with the traditional treatment method which applied the radical resection and V-Y flap after the first phase of incision and completely healing of the wound,our method was confirmed to be more efficient for PS treatment.Methods:32 PS patients with acute infection were admitted to our hospital and randomly divided into the research group and the control group.The research group recieved a small median high incision(1.0-2.0 cm).Then the incision drainage,dressing change,anti-inflammation treatment,and physiotherapy were performed to promote the inflammation absorption.The inflammatory responses were completely inhibited at 1-2 weeks later.Radical resection and V-Y flap were performed.The control group was treated with a first-stage incision drainage and conventional dressing change.Radical resection and V-Y flap were performed after the incisions were fully healed.Some irrelevant factors,such as the gender,age,hair,and obesity were excluded between the two groups.The operation time,intraoperative blood loss,wound size,total length of hospital stay,recovery time,and recurrence rate of the research group and the control group were analyzed.The incision edema,wound disruption,hematocele,incision infection were also compared.Results: There was no statistical difference in gender,age,and body mass index between the research group and control group.The surgery time,blood volume,total length of hospital stay,and recurrence rate are 26±7 min,13±4 m L,18±4 d,and 6.25% in the research group.The surgery time,blood volume,total length of hospital stay,and recurrence rate were 24±5 min,10±5ml,14±3d,and 6.25% in the control group.There was no significant difference in the above factors between these two groups(P > 0.05).There was statistical difference between the research group(10±4 d)and the control group(25±6 d)in the recovery time(P < 0.05).Incision infection was found in two cases of the research group,and they received drainage treatment and recovered 4 weeks later.Three patients with skin flap edema and one with subcutaneous hematocrit were also observed in the research group,and they were all recovered shortly after the treatment of 10% sodium chloride wet compress and open drainage,respectively.Other patients in the research group all underwent the first phase of wound healing.In the control group,there were5 cases of reinfection after the first stage of incision and drainage.For them,the second incision and drainage were performed before the radical operation.Furthermore,1 patient was found with incision infection,and the drainage was performed for 5 weeks.The incision disruption was observed in one case and the secondary suture was applied.Skin flap edema was found in 3 cases and 10%sodium chloride wet compress treatment was used.The other patients in the control groups all underwent the first stage of wound healing.There was no PS recurrence in these two groups after 2-30 months follow up.Conclusion:For infectious PS,it is simple,safe,and feasible to perform the small incision drainage,anti-inflammatory treatment,constant dressing change,physical therapy,and other comprehensive treatment to achieve the fully inflammation absorption,followed by the radical resection and V-Y flap plasty.Our study confirmed that this method is worthy of clinical promotion for the treatment of PS.