World Journal of Surgery

, Volume 34, Issue 12, pp 3042–3046 | Cite as

Local Administration of Antibiotics by Gentamicin–Collagen Sponge does not Improve Wound Healing or Reduce Recurrence Rate After Pilonidal Excision with Primary Suture: A Prospective Randomized Controlled Trial

  • Roland E. Andersson
  • Gudrun Lukas
  • Stefan Skullman
  • Anders Hugander
Article
First Online:

Abstract

Background

Excision and primary suture for pilonidal disease is associated with a high rate of wound infection and recurrences. This randomized, controlled study was designed to analyze the effect of local application of a gentamicin-containing collagen sponge (Collatamp®) in reducing the wound infection rate and recurrences after excision of pilonidal sinus and wound closure with primary midline suture.

Methods

From March 2003 to November 2005, 161 patients with symptomatic pilonidal disease were operated on at 11 hospitals with traditional wide excision of the sinus and all of its tracts. The patients were randomized to filling of the cavity with a gentamicin-containing collagen sponge (Collatamp®) before wound closure or to closure with no additional treatment. Information about the treatment allocation was hidden until the end of the study. Information about wound healing was noted at follow-up at the outpatient department after 2–4 days, 2 weeks, 3 months, and 1 year.

Results

No statistically significant differences were observed between the groups during follow-up. Patients who received prophylaxis with Collatamp® had slightly fewer wounds with exudate at 2–4 days and 2 weeks of follow-up (2% vs. 10%, p = 0.051 and 57% vs. 65%, p = 0.325, respectively), a slightly larger proportion of healed wounds at 3 months follow-up (77% vs. 66%, p = 0.138) but not at 1 year (85% vs. 90%, p = 0.42, respectively), and slightly more reoperations (10% vs. 4%, p = 0.213).

Conclusions

This randomized, controlled study showed no significant differences in the rates of wound infection, wound healing, and recurrences when a gentamicin–collagen sponge was added to the surgical treatment of pilonidal disease with excision and primary midline suture. This does not support the use of gentamicin–collagen sponge for the surgical treatment of pilonidal disease.

Keywords

Collagen Sponge Pilonidal Sinus Wound Infection Rate Hidradenitis Suppurativa Lateral Tract 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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References

  1. 1.
    Sondenaa K, Andersen E, Nesvik I, Soreide JA (1995) Patient characteristics and symptoms in chronic pilonidal sinus disease. Int J Colorectal Dis 10:39–42CrossRefPubMedGoogle Scholar
  2. 2.
    da Silva JH (2000) Pilonidal cyst: cause and treatment. Dis Colon Rectum 43:1146–1156CrossRefPubMedGoogle Scholar
  3. 3.
    Chintapatla S, Safarani N, Kumar S, Haboubi N (2003) Sacrococcygeal pilonidal sinus: historical review, pathological insight and surgical options. Tech Coloproctol 7:3–8CrossRefPubMedGoogle Scholar
  4. 4.
    Bascom JU (1983) Pilonidal disease: long-term results of follicle removal. Dis Colon Rectum 26:800–807CrossRefPubMedGoogle Scholar
  5. 5.
    Al-Khamis A, McCallum I, King PM, Bruce J (2010) Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Cochrane Database Syst Rev 1:CD006213PubMedGoogle Scholar
  6. 6.
    Petersen S, Koch R, Stelzner S et al (2002) Primary closure techniques in chronic pilonidal sinus: a survey of the results of different surgical approaches. Dis Colon Rectum 45:1458–1467CrossRefPubMedGoogle Scholar
  7. 7.
    Lord PH, Millar DM (1965) Pilonidal sinus: a simple treatment. Br J Surg 52:298–300CrossRefPubMedGoogle Scholar
  8. 8.
    Bascom J, Bascom T (2007) Utility of the cleft lift procedure in refractory 8 pilonidal disease. Am J Surg 193:606–609CrossRefPubMedGoogle Scholar
  9. 9.
    Bascom J (2008) Surgical treatment of pilonidal disease. BMJ 7649:842–843CrossRefGoogle Scholar
  10. 10.
    Sondenaa K, Diab R, Nesvik I, Gullaksen FP, Kristiansen RM, Saebo A, Komer H (2002) Influence of failure of primary wound healing on subsequent recurrence of pilonidal sinus. Combined prospective study and randomised controlled trial. Eur J Surg 168:614–618CrossRefPubMedGoogle Scholar
  11. 11.
    Kronborg O, Christensen K, Zimmermann-Nielsen C (1985) Chronic pilonidal disease: a randomized trial with a complete 3-year follow-up. Br J Surg 72:303–304CrossRefPubMedGoogle Scholar
  12. 12.
    Lundhus E, Gottrup F (1993) Outcome at three to five years of primary closure of perianal and pilonidal abscess. A randomized, double-blind clinical trial with a complete three-year followup of one compared with four days’ treatment with ampicillin and metronidazole. Eur J Surg 159:555–558PubMedGoogle Scholar
  13. 13.
    Chaudhuri A, Bekdash BA, Taylor AL (2006) Single-dose metronidazole vs. 5-day multi-drug antibiotic regimen in excision of pilonidal sinuses with primary closure: a prospective, randomized, double-blinded pilot study. Int J Colorectal Dis 21:688–692CrossRefPubMedGoogle Scholar
  14. 14.
    Brook I (1989) Microbiology of infected pilonidal sinuses. J Clin Pathol 42:1140–1142CrossRefPubMedGoogle Scholar
  15. 15.
    Søndenaa K, Nesvik I, Andersen E, Natås O, Søreide JA (1995) Bacteriology and complications of chronic pilonidal sinus treated with excision and primary suture. Int J Colorectal Dis 10:161–166CrossRefPubMedGoogle Scholar
  16. 16.
    Jørgensen LG, Sørensen TS, Lorentzen JE (1991) Clinical and pharmacokinetic evaluation of gentamycin containing collagen in groin wound infections after vascular reconstruction. Eur J Vasc Surg 5:87–91CrossRefPubMedGoogle Scholar
  17. 17.
    Ruszczak Z, Friess W (2003) Collagen as a carrier for on-site delivery of antibacterial drugs. Adv Drug Deliv Rev 55:1679–1698CrossRefPubMedGoogle Scholar
  18. 18.
    Musella M, Guido A, Musella S (2001) Collagen tampons as aminoglycoside carriers to reduce postoperative infection rate in prosthetic repair of groin hernias. Eur J Surg 167:130–132CrossRefPubMedGoogle Scholar
  19. 19.
    Gruessner U, Clemens M, Pahlplatz PV, Sperling P, Witte J, Rosen HR, Septocoll Study Group (2001) Improvement of perineal wound healing by local administration of gentamicin-impregnated collagen fleeces after abdominoperineal excision of rectal cancer. Am J Surg 182:502–509CrossRefPubMedGoogle Scholar
  20. 20.
    Mortensen J, Kraglund K, Klaerke M, Jaeger G, Svane S, Boné J (1995) Primary suture of anorectal abscess. A randomized study comparing treatment with clindamycin vs. clindamycin and Gentacoll. Dis Colon Rectum 38:398–401CrossRefPubMedGoogle Scholar
  21. 21.
    Buimer MG, Ankersmit MF, Wobbes T, Klinkenbijl JH (2008) Surgical treatment of hidradenitis suppurativa with gentamicin sulfate: a prospective randomized study. Dermatol Surg 34:224–227CrossRefPubMedGoogle Scholar
  22. 22.
    Gustafsson UM, Graf W (2006) Randomized clinical trial of local gentamicin–collagen treatment in advancement flap repair for anal fistula. Br J Surg 93:1202–1207CrossRefPubMedGoogle Scholar
  23. 23.
    Haase O, Raue W, Böhm B, Neuss H, Scharfenberg M, Schwenk W (2005) Subcutaneous gentamicin implant to reduce wound infections after loop-ileostomy closure: a randomized, double-blind, placebo-controlled trial. Dis Colon Rectum 48:2025–2031CrossRefPubMedGoogle Scholar
  24. 24.
    Friberg O (2007) Local collagen-gentamicin for prevention of sternal wound infections: the LOGIP trial. APMIS 115:1016–1021CrossRefPubMedGoogle Scholar
  25. 25.
    Eklund AM (2007) Prevention of sternal wound infections with locally administered gentamicin. APMIS 115:1022–1024CrossRefPubMedGoogle Scholar
  26. 26.
    Holzer B, Grüssner U, Brückner B, Houf M, Kiffner E et al (2003) Efficacy and tolerance of a new gentamicin collagen fleece (Septocoll) after surgical treatment of a pilonidal sinus. Colorectal Dis 5:222–227CrossRefPubMedGoogle Scholar
  27. 27.
    Rao MM, Zawislak W, Kennedy R, Gilliland R (2010) A prospective randomised study comparing two treatment modalities for chronic pilonidal sinus with a 5-year follow-up. Int J Colorectal Dis 25:395–400CrossRefPubMedGoogle Scholar
  28. 28.
    Vogel P, Lenz J (1992) Die Behandlung des Sinus pilonidalis mittels Excision und Primarnaht unter Verwendung eines lokalen, resorbierbaren Antibioticumtragers. Ergebnisse einer prospektiven, randomisierten Untersuchung. Chirurg 63:748–753PubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2010

Authors and Affiliations

  • Roland E. Andersson
    • 1
  • Gudrun Lukas
    • 1
  • Stefan Skullman
    • 2
  • Anders Hugander
    • 1
  1. 1.Department of SurgeryLänssjukhuset RyhovJönköpingSweden
  2. 2.Department of SurgeryKärnsjukhusetSkövdeSweden

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