Outcome of Rhomboid Flap for a Controversial Affair “The Sacrococcygeal Pilonidal Disease”: An Eastern Hospital Experience
Main Article Content
Abstract
Pilonidal sinus disease is one Clinical disease that has been shrouded with controversies in the medical literature for close to 200 years. The controversies and debates stem from the names given to it historically relating to its origin from sacrococcygeal infundibulum, congenital dermal sinus and sacrococcygeal ectodermal sinus to Jeep disease during world war II and finally post anal pilonidal sinus. The controversy related to its aetiology congenital vs acquired even the pathogenesis continued to be debated for over a century. Today the aetiology may have been sorted but there is no universal accepted modality of treatment among Surgeons. Even within the community the choice of procedure varies from a general surgeon, to a colorectal surgeon and even among cosmetic surgeons. No other disease in history has seen the variety of surgical armamentarium options available to the treating Clinician from non operative management to Sclerosing agents, Excision with primary closure, laying open the wound to flaps and recently to Minimally invasive surgical modalities like pit picking to Endoscopic Pilonidal Sinus Treatment (EPiST) and finally Video Assisted-Ablation of Pilonidal Sinus (VAAPS). Just when we have assumed that all surgical procedures have been covered enter SiLaC procedure Sinus Laser assisted Closure and SMILE procedure Sinus Pilonidal Minimally Invasive Laser Excision!
Albeit the optimal therapy that reduces recurrences and a universally accepted standard procedure incites debates among the surgical fraternity. Hence it continues to loom in controversies! The abhor associated with Sacrococcygeal Pilonidal disease persists among Surgeons worldwide simply cause its unmerited and viewed by many as a reprehensible condition hence the procedure continues to be passed along to the junior most in the surgical chain of command. The burden of costs and the social impact of sacrococcygeal pilonidal disease are enormous. At times Patients continue to be under wound care management for an amazing three to five years. Sacral Pilonidal Disease is prevalent in Saudi Arabia therefore the aim of our study was to report the outcome at a year follow up using the Classical Limbergs Flap for sacral pilonidal disease.
Keywords:
Sacrococcygeal pilonidal sinus, pilonidal abscess, Limberg flap, necrosis, recurrent pilonidal disease
Article Details
How to Cite
UL HASAN, Uwais Riaz; HASAN, Khathija.
Outcome of Rhomboid Flap for a Controversial Affair “The Sacrococcygeal Pilonidal Disease”: An Eastern Hospital Experience.
Medical Research Archives, [S.l.], v. 12, n. 8, sep. 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/5656>. Date accessed: 06 sep. 2024.
doi: https://doi.org/10.18103/mra.v12i8.5656.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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[2].Buie LA. Jeep disease. South Med J. 1944;37:103–109.
[3].Gage M. Pilonidal sinus: sacrococcygeal ectodermal cysts and sinuses. Ann Surg. 1939;109:291–303.
[4].Patey DH, Scarff RW. Pathology of postanal pilonidal sinus; its bearing on treatment. Lancet. 1946;2:484–486.
[5].Sondenaa K, Andersen E. Patient characteristics and symptoms of in chronic pilonidal sinus disease. Int J Colorectal Dis. 1995;10(1):39–42. doi: 10.1007/BF00337585.
[6].Spivak H, Brooks VL, Nussbaum M, Friedman I. Treatment of chronic pilonidal disease. Dis Colon Rectum. 1996 Oct. 39 (10):1136-9.
[7].Lesalnieks I, Deimel S, Zülke C, Schlitt HJ. Smoking increases the risk of pre- and postoperative complications in patients with pilonidal disease. J Dtsch Dermatol Ges. 2013 Oct;11(10):1001-5. doi: 10.1111/ddg.12140. Epub 2013 Aug 15. PMID: 23945165.
[8].Latunde Dada AO, Lee-Elliott CE, Carpenter TT. A rare case of vulval pilonidal sinus diagnosed on ultrasound. J Obstet Gynaecol. 2013 Feb;33(2):211-2.
[9].Kushwaha P, Merritt A, Aslam MB. A rare case of vulval pilonidal sinus: incidental diagnosis. BMJ Case Rep. 2015 Jul 27;2015.
[10].K. Ballas, K. Psarras, S. Rafailidis, et al.Interdigital pilonidal sinus in a hairdresser J. Hand Surg., 31 (3) (2006), pp. 290-2.
[11].Al-Qassim Z, Reddy K, Khan Z, Reddy IS. Pilonidal sinus cyst of the penis: a rare manifestation of a common disease. BMJ Case Rep. 2013 May 21;2013:bcr2013009718. doi: 10.1136/bcr-2013-009718. PMID: 23697453; PMCID: PMC3670004.
[12].Shanmugathas N, Yassin M, Ross C, Minhas S. Pilonidal Sinus Disease of the Penis: A Case Report and Review of the Literature. Andrologia. 2021;53(1):e13837. doi:10.1111/and.13837
[13].A.Hammood Z, Abdullah H et al. Pilonidal Sinus of Breast, a Case Report with Literature Review. Ann Med Surg (Lond). 2022;73:103138. doi:10.1016/j.amsu.2021.103138
[14].R. Burney Treatment of pilonidal disease by minimal surgical excision under local anesthesia with healing by secondary intention: results in over 500 patients Surgery, 164 (6) (2018), pp. 1217-1222
[15].Clothier PR, Haywood IR. The natural history of the post anal pilonidal sinus. Ann R College Surg England. 1984;66(3):201–203.
[16].Khodakaram, K., Stark, J., Höglund, I., & Andersson, R. E. (2017). Minimal excision and primary suture is a cost-efficient definitive treatment for pilonidal disease with low morbidity: a population-based interventional and a cross-sectional cohort study. World journal of surgery, 41, 1295-1302.
[17].Doll D, Novotny A, Rothe R, Kristiansen JE, Wietelmann K, Boulesteix AL, Düsel W, Petersen S. Methylene Blue halves the long-term recurrence rate in acute pilonidal sinus disease. Int J Colorectal Dis. 2008 Feb;23(2):181-7.
[18].Cihan A, Ucan BH, Comert M, Cesur A, Cakmak GK, Tascilar O. Superiority of asymmetric modified Limberg flap for surgical treatment of pilonidal disease. Dis Colon Rectum 2005;49:244-9.
[19].Ertan T, Koc M, Gocmen E, Aslar K, Keksek M, Kilic M. Does technique alter quality of life after pilonidal sinus surgery? Am J Surg 2005; 190: 388–92.
[20].Schoeller T, Wechselberger G, Otto A, Papp C. Definite surgical treatment of complicated recurrent pilonidal disease with a modified fascio cutaneous V-Y advancement flap. Surgery 1997; 121: 258–63.
[21].Azab AS, Kamal MS, Saad RA, Abou al Atta KA, Ali NA. Radical cure of pilonidal sinus by a transposition rhomboid flap. Br J Surg 1984; 71: 154–5.
[22].Topgül K, Ozdemir E, Kilic K, Gökbayir H, Ferahköşe Z (2003) Log-term results of Limberg procedure for treatment of pilonidal sinus: a report of 200 cases. Dis Colon Rectum 46:1545–1548
[23].Bascom J. Pilonidal disease. Origin from follicles of hairs and results of follicle removal as treatment. Surgery 1980;87:567–72.
[24].Stelzner F. [Causes of pilonidal sinus and pyoderma fistulans sinifica Langenbecks Arch Chir. 1984;362(2):105-18.
[25].Dahl HD, Henrich MH. [Light and scanning electron microscopy study of the pathogenesis of pilonidal sinus and anal fistula]. Langenbecks Arch Chir. 1992;377(2):118-24.
[26].Gosselink MP, Jenkins L, Toh JWT, Cvejic M, Kettle E, Boadle RA, Ctercteko G. Scanning electron microscope imaging of pilonidal disease. Tech Coloproctol. 2017 Nov;21(11):905-906.
[27].Brearley R Pilonidal sinus: a new theory of origin. Br J Surg. 1969;1362- 67
[28].Marks JHarding KGHughes LE Staphylococcal infection of open granulating wounds. Br J Surg. 1987;7495- 97
[29].Hunt TkConolly WBAronson SBGoldstein P Anaerobic metabolism and wound healing: a hypothesis for the initiation and cessation of collagen synthesis in wounds. Am J Surg. 1978;135328- 332
[30].Allen DBMaguire JJMahdavien M et al. Wound hypoxia and acidosis limit neutrophil bacterial killing mechanisms. Arch Surg. 1997;132991- 996.
[31].Lord PH Millar DM Pilonidal sinus: a simple treatment. Br J Surg. 1965;52298- 300
[32].Coccygeal osteomyelitis managed with wide excision, coccygectomy and perineal musculature reconstruction, with Limberg flap for defect closure. Mugdha Kowli, Pranav Mandovra et al World journal of colorectal surgery 2019:8;1;27-29.
[33].Dill DB, Yousef MK, Goldman A, Hillyard SD, Davis TP. Volume and composition of hand sweat of White and Black men and women in desert walks. Am J Phys Anthropol. 1983 May;61(1):67-73. doi: 10.1002/ajpa.1330610107. PMID: 6869514.
[34].Plewig G, Kligman AM. Berlin Springer-Verlag: 1975. Acne Morphogenesis and treatment; pp. 192–193.
[35].Von Laffert M, Stadie V, Ulrich J, Marsch WC, Wohlrab J. (2011). Morphology of pilonidal sinus disease: some evidence of its being a unilocalized type of hidradenitis suppurativa. Dermatology. 223:349–355.
[36].C orman ML, Nicholls RJ, Fazio VW, Bergamaschi R. Corman's Colon and Rectal Surgery. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2012. 195-203.
[37].Scheinfeld NS. A case of dissecting cellulitis and a review of the literature. Dermatol Online J. 2003;9:8.
[38].Luiz Fernando Nunes, Antonio Kneipp Pitta de Castro Neto et al, Carcinomatous degeneration of pilonidal cyst with sacrum destruction and invasion of the rectum An Bras Dermatol. 2013 Nov-Dec; 88(6 Suppl 1): 59–62.doi: 10.1590/abd1806-4841.20132140.
[39].Lerner HJ, Deitrick G. Squamous cell carcinoma of the pilonidal sinus: Report of a case and review of the literature. J Surg Oncol. 1979;11:177–183.
[40].Karydakis GE. Easy and successful treatment of pilonidal sinus after explanation of its causative process. Aust N Z J Surg. 1992;62:385–389.
[41].Bosche F, Luedi MM, van der Zypen D, Moersdorf P, Krapohl B, Doll D. The hair in the sinus: sharp-ended rootless head hair fragments can be found in large amounts in pilonidal sinus nests. World J Surg. 2018;42:567–573.
[42].Johnson EK, Vogel JD, Cowan ML, Feingold DL, Steele SR., Clinical Practice Guidelines Committee of the American Society of Colon and Rectal Surgeons. The American Society of Colon and Rectal Surgeons' Clinical Practice Guidelines for the Management of Pilonidal Disease. Dis Colon Rectum. 2019 Feb;62(2):146-157.
[43].Armstrong JH, Barcia PJ. Pilonidal sinus disease. The conservative approach. Arch Surg. 1994 Sep;129(9):914-7; 917-9.
[44].Sevinç B, Damburacı N, Karahan Ö. Long term results of minimally invasive treatment of pilonidal disease by platelet rich plasma. J Visc Surg. 2020 Feb;157(1):33-35.
[45].Maurice Ba, Greenwood Rk. A Conservative treatment of pilonidal sinus. Br j surg. 1964 Jul;51:510-2.
[46].Kaymakcioglu N, Yagci G, Simsek A, Unlu A, Tekin OF, Cetiner S, Tufan T. Treatment of pilonidal sinus by phenol application and factors affecting the recurrence. Tech Coloproctol. 2005 Apr;9(1):21-4.
[47].Enriquez-Navascues J., Emparanza J., Alkorta M. Meta-analysis of randomized controlled trials comparing different techniques with primary closure for chronic pilonidal sinus. Tech. Coloproctol. 2014;18[10]:863.
[48].Lesalnieks I, Ommer A, Petersen S, Doll D, Herold A. German national guideline on the management of pilonidal disease. Langenbecks Arch Surg. 2016 Aug;401(5):599-609. doi: 10.1007/s00423-016-1463-7. Epub 2016 Jun 16. PMID: 27311698.
[49].Horwood J., Hanratty D., Chandran P. Primary closure or rhomboid excision and Limberg flap for the management of primary sacrococcygeal pilonidal disease? A meta-analysis of randomized controlled trials. Colorectal Dis. 2012;14(2):143–151.
[50].Abu Galala KH, Salam IM, Abu Samaan KR, El Ashaal YI, Chandran VP, Sabastian M, Sim AJ. Treatment of pilonidal sinus by primary closure with a transposed rhomboid flap compared with deep suturing: a prospective randomised clinical trial. Eur J Surg. 1999 May;165(5):468-72.
[51].Akca T, Colak T, Ustunsoy B, Kanik A, Aydin S. Randomized clinical trial comparing primary closure with the Limberg flap in the treatment of primary sacrococcygeal pilonidal disease. Br J Surg. 2005 Sep;92(9):1081-4.
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