World Journal of Surgery

, Volume 35, Issue 1, pp 206–211 | Cite as

Wound Infection After Excision and Primary Midline Closure for Pilonidal Disease: Risk Factor Analysis to Improve Patient Selection

  • Sotirios Popeskou
  • Dimitrios ChristoforidisEmail author
  • Christiane Ruffieux
  • Nicolas Demartines



Excision and primary midline closure for pilonidal disease (PD) is a simple procedure; however, it is frequently complicated by infection and prolonged healing. The aim of this study was to analyze risk factors for surgical site infection (SSI) in this context.


All consecutive patients undergoing excision and primary closure for PD from January 2002 through October 2008 were retrospectively assessed. The end points were SSI, as defined by the Center for Disease Control, and time to healing. Univariable and multivariable risk factor analyses were performed.


One hundred thirty-one patients were included [97 men (74%), median age = 24 (range 15-66) years]. SSI occurred in 41 (31%) patients. Median time to healing was 20 days (range 12-76) in patients without SSI and 62 days (range 20-176) in patients with SSI (P < 0.0001). In univariable and multivariable analyses, smoking [OR = 2.6 (95% CI 1.02, 6.8), P = 0.046] and lack of antibiotic prophylaxis [OR = 5.6 (95% CI 2.5, 14.3), P = 0.001] were significant predictors for SSI. Adjusted for SSI, age over 25 was a significant predictor of prolonged healing.


This study suggests that the rate of SSI after excision and primary closure of PD is higher in smokers and could be reduced by antibiotic prophylaxis. SSI significantly prolongs healing time, particularly in patients over 25 years.


Methylene Blue Antibiotic Prophylaxis Primary Closure Hidradenitis Suppurativa Pilonidal Disease 
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.


Conflict of interest



  1. 1.
    Sondenaa K, Andersen E, Nesvik I et al (1995) Patient characteristics and symptoms in chronic pilonidal sinus disease. Int J Colorectal Dis 10:39–42CrossRefPubMedGoogle Scholar
  2. 2.
    McCallum I, King PM, Bruce J (2007) Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Cochrane Database Syst Rev 2007:CD006213Google Scholar
  3. 3.
    Al-Khayat H, Sadeq A, Groof A et al (2007) Risk factors for wound complication in pilonidal sinus procedures. J Am Coll Surg 205:439–444CrossRefPubMedGoogle Scholar
  4. 4.
    Tezel E (2007) A new classification according to navicular area concept for sacrococcygeal pilonidal disease. Colorectal Dis 9:575–576CrossRefPubMedGoogle Scholar
  5. 5.
    Horan TC, Andrus M, Dudeck MA (2008) CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infection in the acute care setting. Am J Infect Control 36:23CrossRefGoogle 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.
    Lee PJ, Raniga S, Biyani DK et al (2008) Sacrococcygeal pilonidal disease. Colorectal Dis 10:639–650 discussion 651–632CrossRefPubMedGoogle Scholar
  8. 8.
    Cruse PJ, Foord R (1980) The epidemiology of wound infection. A 10-year prospective study of 62, 939 wounds. Surg Clin North Am 60:27–40PubMedGoogle Scholar
  9. 9.
    Sondenaa K, Nesvik I, Gullaksen FP et al (1995) The role of cefoxitin prophylaxis in chronic pilonidal sinus treated with excision and primary suture. J Am Coll Surg 180:157–160PubMedGoogle Scholar
  10. 10.
    Sondenaa K, Diab R, Nesvik I et al (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.
    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
  12. 12.
    Lundhus E, Gottrup F (1993) Outcome at three to five years of primary closure of perianal and pilonidal abscess. A randomised, 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.
    Cayci C, Russo M, Cheema F et al (2008) Risk analysis of deep sternal wound infections and their impact on long-term survival: a propensity analysis. Ann Plast Surg 61:294–301CrossRefPubMedGoogle Scholar
  14. 14.
    Veeravagu A, Patil CG, Lad SP et al (2009) Risk factors for postoperative spinal wound infections after spinal decompression and fusion surgeries. Spine (Phila Pa 1976) 34:1869–1872Google Scholar
  15. 15.
    Knobloch K, Gohritz A, Reuss E et al (2008) Nicotine in plastic surgery: a review. Chirurg 79:956–962CrossRefPubMedGoogle Scholar
  16. 16.
    Neumayer L, Hosokawa P, Itani K et al (2007) Multivariable predictors of postoperative surgical site infection after general and vascular surgery: results from the patient safety in surgery study. J Am Coll Surg 204:1178–1187CrossRefPubMedGoogle Scholar
  17. 17.
    Jensen JA, Goodson WH, Hopf HW et al (1991) Cigarette smoking decreases tissue oxygen. Arch Surg 126:1131–1134PubMedGoogle Scholar
  18. 18.
    Bagaitkar J, Demuth DR, Scott DA (2008) Tobacco use increases susceptibility to bacterial infection. Tob Induc Dis 4:12CrossRefPubMedGoogle Scholar
  19. 19.
    Buimer MG, Wobbes T, Klinkenbijl JH (2009) Hidradenitis suppurativa. Br J Surg 96:350–360CrossRefPubMedGoogle Scholar
  20. 20.
    Anaya DA, Dellinger EP (2006) The obese surgical patient: a susceptible host for infection. Surg Infect (Larchmt) 7:473–480CrossRefGoogle Scholar
  21. 21.
    Colak T, Turkmenoglu O, Dag A et al (2010) A randomized clinical study evaluating the need for drainage after Limberg flap for pilonidal sinus. J Surg Res 158(1):127–131CrossRefPubMedGoogle Scholar
  22. 22.
    Erdem E, Sungurtekin U, Nessar M (1998) Are postoperative drains necessary with the Limberg flap for treatment of pilonidal sinus? Dis Colon Rectum 41:1427–1431CrossRefPubMedGoogle Scholar
  23. 23.
    Gurer A, Gomceli I, Ozdogan M et al (2005) Is routine cavity drainage necessary in Karydakis flap operation? A prospective, randomized trial. Dis Colon Rectum 48:1797–1799CrossRefPubMedGoogle Scholar
  24. 24.
    Doll D, Novotny A, Rothe R et al (2008) Methylene blue halves the long-term recurrence rate in acute pilonidal sinus disease. Int J Colorectal Dis 23:181–187CrossRefPubMedGoogle Scholar
  25. 25.
    Yigit T, Yigitler C, Gulec B et al (2005) Do we need to use subcutaneous suture for pilonidal sinus treated with excision and simple primary closure? Acta Chir Belg 105:635–638PubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2010

Authors and Affiliations

  • Sotirios Popeskou
    • 1
  • Dimitrios Christoforidis
    • 1
    • 3
    Email author
  • Christiane Ruffieux
    • 2
  • Nicolas Demartines
    • 1
  1. 1.Division of Visceral Surgery, Department of SurgeryCHUV, University of LausanneLausanneSwitzerland
  2. 2.Institute of Preventive and Social Medicine, BiostatisticsUniversity of LausanneLausanneSwitzerland
  3. 3.Service de Chirurgie Viscérale, BH 15 CHUVLausanneSwitzerland

Personalised recommendations