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Intradermal absorbable sutures to close pilonidal sinus wounds: a safe closure method?

Surgery Today volume 44, pages 1638–1642 (2014)Cite this article

Abstract

Purpose

The aim of this study was to demonstrate the safety of using intradermal absorbable sutures for pilonidal sinus skin closure.

Methods

The study was prospectively carried out in 203 patients randomized into two groups of patients. In the first group (103 patients), interrupted sutures were used; in the second group (100 patients), a continuous intradermal suture was used. We have analyzed the time off work, time to walk without pain, time to sit on the toilet without pain, wound infections, satisfaction rate and esthetic results.

Results

There were no significant differences between the groups with regard to the time off work, time to walk without pain and time to sit on a toilet without pain. There was also no significant difference between the groups with regard to the wound infection rates (p = 0.64). The study suggested that the patients’ satisfaction was higher when an intradermal suture was used (p = 0.001). Similarly, a better cosmetic appearance of the scar was obtained with an intradermal suture (p = 0.01).

Conclusions

Our results suggest that using intradermal sutures after excision and primary closure of the pilonidal sinus is safe and has advantages in terms of the cosmetic results and patient satisfaction.

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References

  1. Mahdy T. Surgical treatment of the pilonidal disease: primary closure or flap reconstruction after excision. Dis Colon Rectum. 2008;51:1816–22.

    CAS  PubMed  Article  Google Scholar 

  2. Chintapatla S, Safarani N, Kumar S, Haboubi N. Sacrococcygeal pilonidal sinus: historical review, pathological insight and surgical options. Tech Coloproctol. 2003;7:3–8.

    CAS  PubMed  Article  Google Scholar 

  3. Allen-Mersh TG. Pilonidal sinus: finding the right track for treatment. Br J Surg. 1990;77:123–32.

    CAS  PubMed  Article  Google Scholar 

  4. Kotaluoto S, Pauniaho SL, Helminen M, Kuokkanen H, Rantanen T. Wound healing after open appendectomies in adult patients: a prospective, randomised trial comparing two methods of wound closure. World J Surg. 2012;36(10):2305–10.

    CAS  PubMed  Article  Google Scholar 

  5. Glough JV, Alexander-Williams J. Surgical and economic advantages of polyglycolic-acid suture material in skin closure. Lancet. 1975;1(7900):194–5.

    CAS  PubMed  Google Scholar 

  6. Johnson RG, Cohn WE, Thurer RL, McCarthy JR, Sirois CA, Weintraub RM. Cutaneous closure after cardiac operations: a controlled, randomized, prospective comparison of intradermal versus staple closures. Ann Surg. 1997;226(5):606–12.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  7. Rousseau JA, Girard K, Turcot-Lemay L, Thomas N. A randomized study comparing skin closure in cesarean sections: staples vs subcuticular sutures. Am J Obstet Gynecol. 2009;200(3):265.e1–4.

    PubMed  Article  Google Scholar 

  8. Tanaka Y, Sadahiro S, Ishikawa K, Suzuki T, Kamijo A, Tazume S, Yasuda M. Optimal suture materials for contaminated gastrointestinal surgery: does infection influence the decrease of the tensile strength of sutures? Surg Today. 2012;42(12):1170–5.

    CAS  PubMed  Article  Google Scholar 

  9. Doll D, Novotny A, Rothe R, Kristiansen JE, Wietelmann K, Boulesteix AL, Dusel W, Petersen S. Methylene Blue halves the long-term recurrence rate in acute pilonidal sinus disease. Int J Colorectal Dis. 2008;32:181–7.

    Google Scholar 

  10. Isbister WH, Prasad J. Pilonidal disease. Aust N Z J Surg. 1995;65:561–3.

    CAS  PubMed  Article  Google Scholar 

  11. Erdem E, Sungurtekin U, Nessar M. Are postoperative drains necessary with the Limberg flap for treatment of pilonidal sinus? Dis Colon Rectum. 1998;41(11):1427–31.

    CAS  PubMed  Article  Google Scholar 

  12. Ertan T, Koc M, Gocmen E, Aslar AK, Keskek M, Kilic M. Does technique alter quality of life after pilonidal sinus surgery? Am J Surg. 2005;190(3):388–92.

    PubMed  Article  Google Scholar 

  13. Maghsoudi H, Nezami N, Ghamari AA. Ambulatory treatment of chronic pilonidal sinuses with lateral incision and primary suture. Can J Surg. 2011;54(2):78–82. doi:10.1503/cjs.026309.

    PubMed Central  PubMed  Article  Google Scholar 

  14. McCallum IJD, Peter MK, Julie B. Healing by primary closure versus open healing after surgery for pilonidal sinus systemic review and meta-analysis. BMJ. 2008;336:868–71.

    PubMed Central  PubMed  Article  Google Scholar 

  15. El-Shaer WM. The modified gluteal sliding placation closure in the treatment of chronic pilonidal sinus. Int J Colorectal Dis. 2010;25:887–94.

    PubMed  Google Scholar 

  16. Khaira HS, Brown JH. Excision and primary closure of pilonidal sinus. Ann R Coll Surg Engl. 1995;77:242–4.

    CAS  PubMed Central  PubMed  Google Scholar 

  17. Brasel KJ, Gottesman L, Vasilevsky CA, Members of the Evidence-Based Reviews in Surgery Group. Meta-analysis comparing healing by primary closure and open healing after surgery for pilonidal sinus. J Am Coll Surg. 2010;211(3):431–4.

    PubMed  Article  Google Scholar 

  18. Schoeller T, Wechselberger G, Otto A, Papp C. Definite surgical treatment of complicated recurrent pilonidal disease with a modified fasciocutaneous V-Y advancement flap. Surgery. 1997;121:258–63.

    CAS  PubMed  Article  Google Scholar 

  19. Morell V, Brian LC. Surgical treatment of pilonidal disease: comparison of three different methods in fifty-nine cases. Mil Med. 1991;156:144–6.

    CAS  PubMed  Google Scholar 

  20. Milone M, Di Minno MN, Musella M, Maietta P, Ambrosino P, Pisapia A, Salvatore G, Milone F. The role of drainage after excision and primary closure of pilonidal sinus: a meta-analysis. Tech Coloproctol. 2013. (Epub ahead of print).

  21. Zimmerman CE. Outpatient excision and primary closure of pilonidal cysts and sinuses. Long-term follow-up. Am J Surg. 1984;148:658–9.

    CAS  PubMed  Article  Google Scholar 

  22. Al-Hassan HK, Francis IM, Negl EN. Primary closure or secondary granulation after excision of pilonidal sinus. Acta Chir Scand. 1990;156:695–9.

    CAS  PubMed  Google Scholar 

  23. Khatri V, Espinosa MH, Amin AK. Management of recurrent pilonidal sinus by simple V-Y fasciocutaneous flap. Dis Colon Rectum. 1994;37:1232–5.

    CAS  PubMed  Article  Google Scholar 

  24. Serour F, Somekh E, Krutman B, Gorenstein A. Excision with primary closure and suction drainage for pilonidal sinus in adolescent patients. Pediatr Surg Int. 2002;18:159–61.

    CAS  PubMed  Article  Google Scholar 

  25. Spivak H, Brooks VL, Nussbaum M, Friedman I. Treatment of chronic pilonidal disease. Dis Colon Rectum. 1996;39:1136–9.

    CAS  PubMed  Article  Google Scholar 

  26. Sondenaa K, Nesvik I, Gullaksen FP, Furnes A, Harbo SO, Weyessa S, Soreide JA. The role of cefoxitin prophylaxis in chronic pilonidal sinus treated with excision and primary suture. J Am Coll Surg. 1995;180:157–60.

    CAS  PubMed  Google Scholar 

  27. Perruchoud C, Vuilleumier H, Givel JC. Pilonidal sinus: how to choose between excision and open granulation versus excision and primary closure? Study of a series of 141 patients operated on from 1991 to 1995. Swiss Surg. 2002;8:255–8.

    CAS  PubMed  Article  Google Scholar 

  28. Dalenback J, Magnusson O, Wedel N, Rimback G. Prospective follow-up after ambulatory plain midline excision of pilonidal sinus and primary suture under local anaesthesia efficient, sufficient, and persistent. Colorectal Dis. 2004;6:488–93.

    CAS  PubMed  Article  Google Scholar 

  29. Anyanwu AC, Hossain S, Williams A, Montgomery AC. Karydakis operation for sacrococcygeal pilonidal sinus disease: experience in a district general hospital. Ann R Coll Surg Engl. 1998;80:197–9.

    CAS  PubMed Central  PubMed  Google Scholar 

  30. Al-Khayat H, Al-khayat H, Sadeq A, Groof A, Haider HH, Hayati H, Shamsah A, Zarka ZA, Al-Hajj H, Al-Momen A. Risk factors for wound complication in pilonidal sinus procedures. J Am Coll Surg. 2007;205(3):439–44.

    PubMed  Article  Google Scholar 

  31. Bascom J, Bascom T. Utility of the cleft lift procedure in refractory pilonidal disease. Am J Surg. 2007;193:606–9.

    PubMed  Article  Google Scholar 

  32. Holmebakk T, Nesbakken A. Surgery for pilonidal disease. Scand J Surg. 2005;94:43–6.

    CAS  PubMed  Google Scholar 

  33. Jenkinon C, Coulter A, Wright L. Short form 36 (SF36) health survey questionnaire: normative data for adults of working age. Br Med J. 1999;306:1437–40.

    Article  Google Scholar 

  34. Ware JE, Sherbourne CD. The MOS-36 item short form health survey (SF36): I. Conceptual framework and item selection. Med Care. 1992;30:473–83.

    PubMed  Article  Google Scholar 

  35. Bodian CA, Freedman G, Hossain S, Eisenkraft JB, Beilin Y. The visual analog scale for pain: clinical significance in postoperative patients. Anesthesiology. 2001;95:1356–61.

    CAS  PubMed  Article  Google Scholar 

  36. El-Khadrawy O, Hashish M, Ismail K, Shalaby H. Outcome of the rhomboid flap for recurrent pilonidal disease. World J Surg. 2009;33(5):1064–8.

    PubMed  Article  Google Scholar 

  37. Milone M, Musella M, Salvatore G, Leongito M, Milone F. Effectiveness of a drain in surgical treatment of sacrococcygeal pilonidal disease. Results of a randomized and controlled clinical trial on 803 consecutive patients. Int J Colorectal Dis. 2011;26(12):1601–7. doi:10.1007/s00384-011-1242-4.

    PubMed  Google Scholar 

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Conflict of interest

All the authors have nothing to declare.

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Affiliations

  1. University “Federico II” of Naples, Via Pansini 5, 80131, Naples, Italy

    Marco Milone, Mario Musella, Paola Maietta, Paolo Bianco, Caterina Taffuri, Giuseppe Salvatore & Francesco Milone

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  1. Marco Milone
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  2. Mario Musella
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  3. Paola Maietta
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  4. Paolo Bianco
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  5. Caterina Taffuri
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  6. Giuseppe Salvatore
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  7. Francesco Milone
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Correspondence to Marco Milone.

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Milone, M., Musella, M., Maietta, P. et al. Intradermal absorbable sutures to close pilonidal sinus wounds: a safe closure method?. Surg Today 44, 1638–1642 (2014). https://doi.org/10.1007/s00595-013-0741-z

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  • DOI: https://doi.org/10.1007/s00595-013-0741-z

Keywords

  • Sinus
  • Pilonidal
  • Intradermal
  • Suture
  • Surgery
  • Skin