Ann Surg Treat Res.  2019 Nov;97(5):261-265. 10.4174/astr.2019.97.5.261.

Inverse ‘D’ incision technique in treatment of pilonidal sinus disease; excision with minimal tissue loss, closure without tension and lateral location of the suture line

• Dogan S
• Cetin F
• Gurleyik E

• KMID: 2461902
• DOI: http://doi.org/10.4174/astr.2019.97.5.261

Abstract

PURPOSE
Surgical excision is the preferred treatment modality for sacrococcygeal pilonidal sinus (PS). Notably, the desirable features of an ideal surgical intervention are excision with minimal tissue loss, closure without tension, and a lateral suture line. The present study aimed to investigate early outcomes of surgical excision through the inverse D (á—¡) incision based on tissue loss, wound tension, and suture line location.
METHODS
This prospective study was comprised of 80 patients with PS in whom excision of PS was performed through the "˜á—¡' incision to minimize tissue loss with a tensionless primary surgical wound closure. The suture line was located laterally in all patients. Early and late postoperative complications, duration of hospital stay, return to work, and recurrence rates were investigated. The mean duration of the follow-up period was 36 months.
RESULTS
Sixty-three patients (78.8%) were male. PS in all patients was surgically removed by subcutaneous excision through a "˜á—¡' incision. Laterally placed surgical wounds were closed primarily with interrupted vertical mattress sutures. No general complications were encountered. Five patients (6.3%) experienced early postoperative surgical site complications. On average, the duration of hospital stay and return to work were 2.4 days and 3.8 days, respectively. Recurrence was seen in 1 case (1.3%) during the follow-up period. Satisfaction score was high in 83.8% of patients.
CONCLUSION
The method of sinus excision using the "˜á—¡' incision with a primary suture facilitates excision with minimal tissue loss and closure without tension with an off-midline suture. It is both a simple and effective surgical technique for the treatment of sacrococcygeal PS.

Keyword

Complication; Pilonidal sinus; Recurrence; Surgery

MeSH Terms

Follow-Up Studies
Humans
Length of Stay
Male
Methods
Pilonidal Sinus*
Postoperative Complications
Prospective Studies
Recurrence
Return to Work
Sutures*
Wounds and Injuries

Figure

• 

  Fig. 1 Excision with minimal tissue loss, closure without tension, and off-midline suture. (A) Preoperative drawing of the inverse D (ᗡ) incision and sinus pits at the midline. (B) Subcutaneous excision of the sinus via inverse ‘ᗡ’ incision. (C) Operative wound after excision with minimal tissue loss. (D) Primary, tensionless, and off-midline closure of surgical wound.

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