Effects of Bathing Habits on Postoperative Wound Complications Following Sacrococcygeal Pilonidal Sinus Surgery: A Retrospective Analysis of 67 Adolescent Patients

INTRODUCTION

Sacrococcygeal pilonidal sinus disease generally affects young people and impacts their quality of life. Few published studies assessing the characteristics of the disease in the adolescent population exist.

OBJECTIVE

In this paper, the authors aim to evaluate the effects of bathing habits on wound complications in adolescent patients following Karydakis flap surgery for sacrococcygeal pilonidal sinus.

MATERIALS AND METHODS

The medical records of 79 adolescent patients who underwent sacrococcygeal pilonidal sinus surgery between January 2014 and December 2017 at the Surgery Clinic of Malatya State Hospital (Malatya, Turkey) were evaluated retrospectively. Following exclusion, 67 patients were evaluated for demographics, body mass index (BMI), previous abscess formation, bathing frequency, number of sinus pits, and postoperative wound infection and dehiscence. The total follow-up time for the 67 patients was 90 days.

RESULTS

The BMIs of patients with previous abscess formation were significantly higher (P = .029). In the cases with abscess, the number of pilonidal sinus pits was significantly higher (P = .039) There was a statistically significant difference between postoperative complication rates according to the number of baths per week. Wound infection rates were found to be higher in patients who bathed more than twice weekly during the 28 days after surgery (P = .005). No statistical significance was observed in complication rates from days 28 to 90 after the surgery between those who bathed twice weekly and more than twice weekly (P > .05).

CONCLUSIONS

Postoperative wound complications in adolescent patients treated with Karydakis flap surgery for sacrococcygeal pilonidal sinus are more frequent in those who bathe more than twice weekly during the first 28 days postoperatively.

A rare case of squamous cell carcinoma arising from chronic sacrococcygeal pilonidal disease

Pilonidal disease is a chronic disorder which is observed in boys and men between ages of 15 and 40 years old in Caucasian race. Malignant degeneration and carcinoma arising from chronic sacrococcygeal pilonidal disease are observed extremely rare and are described in the group of Marjolin cancer. Carcinoma can be seen on a place with long-term inflammation process as it was in the case described in the patient's article. First time squamous cell carcinoma arising from chronic sacrococcygeal pilonidal disease was described in 1900 by Wolff. The incidence of carcinoma arising in pilonidal disease is less than 0,1% and in the whole medical journals less than 100 patients are reported. This article presents the case of a patient with diagnosed squamous cell carcinoma arising from chronic sacrococcygeal pilonidal disease. In this article was presented the clinical features, pathogenesis, treatment options and prognosis of this rare disease. KEY WORDS: Pilonidal disease, Skin carcinoma, Squamous cell carcinoma, Surgery.

Recurrent Pilonidal Sinus Cyst on Penis

Pilonidal sinus, including one or more sinus canals and hairs, is a disease with a chronic course showing acute attacks which is often encountered in the general population, usually affecting young adults, at a rate in males twice that of females. Pilonidal sinus on the penis is so rare that very few cases have been reported in literature. A 20-year-old male presented to the urology outpatient clinic with the complaint of a suppurative lesion with discharge on the skin of the penis which had been ongoing for approximately three months. Clinical examination revealed an indurated, erythematous, ulcerative lesion, 3 cm x 2 cm in size, in the middle of the ventral aspect of the penile shaft. We present the first case in literature of recurrent pilonidal sinus related to Actinomyces israelii, located on the penis.

Five-year Follow-up and Recurrence Rates Following Surgery for Acute and Chronic Pilonidal Disease: A Survey of 421 Cases

OBJECTIVE

The aim of the present study was to investigate the outcomes of different treatment options for acute and chronic pilonidal disease in a single large cohort of patients.

MATERIALS AND METHODS

Four hundred and twenty-one consecutive patients (171 with chronic disease and 250 with acute abscess formation) who underwent surgery between 2003 and 2012 were included in the present study. Primary outcomes included symptomatic recurrence, time to wound healing, and time off from work. The median follow-up was 5.3 years.

RESULTS

In patients with acute abscess formation, the relapse rate was significantly higher (P = 0.0001) if they were treated with abscess excision (38.9%) compared with a wide local excision (13.3%). Time to relapse was significantly longer (P = 0.0205) in patients treated with wide local excision (median 7 vs 3 months), whereas time to wound healing and the days off from work were similar among groups. In chronic disease, the relapse rate was similar in patients treated with wide local excision followed by secondary wound healing (11.3%) when compared with patients treated with limited excision (27.6%) or wide excision with primary wound closure (26.8%). The time to wound healing was shortest in patients with primary wound closure following wide local excision, and the time off from work was not significantly different between groups.

CONCLUSION

Wide local excision with secondary wound healing seems to be the favorable operation method for acute and chronic pilonidal disease.

[Pilonidal sinus--surgical management at our surgical clinic]

INTRODUCTION

pilonidal sinus disease is a benign disease with incidence 26 cases per 100 thousands inhabitants each year. The origin of this disease is in sacrococcygeal region with maximum between 15th and 25th year of life. Males suffer from pilonidal sinus disease most often. The synonym of this disease is Jeep's disease and originate in Second World War. We distinguish acute and chronic phase of this disease. The acute phase is characterized by presence of abscess whereas the chronic phase is featured by intermittently secreting fistula. Malignant reversion is described at chronic phase in 0.1%.

METHODS

We performed retrospective study of our cohort of 53 patients that undewent radical surgical treatment at our department between September 1st 2006 and December 31st 2009.

RESULTS

We evaluated 39 patients that were controlled repetitively after operation. Males were in majority. The median of age was 24 years. 38 patients underwent the incision for abscess in preoperative period. The intermittently secreting fistula was diagnosed at 46 patients at the time of operation. 41% patients suffered from wound infections and 56% from dehiscence of wound (7 patients with partial dehiscence) after radical excision. We used 5 modifications of wound closure after radical excision.

DISCUSSION

The choice of adequate method of wound closure after excision of pilonidal sinus was, is and will be discussed among experts. We could find many types of methods of wound closure including plastic with flaps in the scientific literature. In our country there is preferred more primary wound closure than plastic with flap. Our results are comparable with the previously published results.

CONCLUSION

The treatment of pilonidal sinus has to be radical. We can conclude that usage of our technique of underlaid sutures decreases the prevalence of postoperative infection and risk of wound dehiscence. The proper types of technique of wound closure could not be evaluated with statistical signifikance because of small number of patients in our cohort.

Severe pyomyositis caused by Panton–Valentine leucocidin-positive methicillin-sensitive Staphylococcus aureus complicating a pilonidal cyst

BACKGROUND

To our best knowledge, Panton-Valentine leucocidin (PVL)-positive methicillin-sensitive Staphylococcus aureus (MSSA) has not been described yet as cause for severe pyomyositis.

CASE REPORT

We present a 23-year-old apparently healthy male patient without any typical predisposing findings who developed severe pyomyositis secondary to an operated pilonidal cyst. In the follow-up, the patient showed signs of immunocompromisation. The causative agent for purulent infection of multiple muscles was a MSSA strain harbouring PVL toxin.

RESULTS

In the reported case, aggressive antibiotic and surgical treatment with additional application of immunoglobulins has lead to recovery from the disease without relapse.

CONCLUSIONS

PVL-positive S. aureus are associated with skin diseases, multiple abscesses and often complicated by severe sepsis and necrotising pneumonia. Under such circumstances, the mortality rate can reach up to 75%. In addition, the PVL toxin can cause immunocompromisation and might be therefore involved in the aetiology of pyomyositis. Aggressive antibiotic and surgical treatment with additional application of immunoglobulins is recommended for treatment.

Pilonidal sinus of the glans penis associated with actinomyces case reports and review of literature

Pilonidal sinus is a well-recognized condition that occurs most commonly in the sacrococcygeal area of younger men. It is hypothesized to be an acquired chronic inflammation condition due mainly to hair trapped beneath the surface. A pilonidal sinus in the sacrococcygeal region is associated with recurrent infection, abscess formation, cellulitis, fistulae, and rarely, squamous cell carcinoma. A pilonidal sinus of the penis is a rare entity. The association of a penile pilonidal cyst and Actinomyces is even more uncommon with only three cases reported previously. Two cases of pilonidal sinus are reported in this paper. One of the cases was associated with actinomycosis. Pilonidal sinus of the penis should be considered in the clinical and pathological differential diagnosis and has to be distinguished from balanoposthitis, epidermal cyst, and carcinoma. The knowledge about possible association with actinomycosis is important to ensure early treatment.

The prevalence of anaerobic infection in pilonidal sinus of the sacrococcygeal region and its effect on the complications

Bacteriologic characteristics of pilonidal disease of the sacrococcygeal region were assessed in two groups of patients: patients with disease recurrence (group A), and patients who first ever presented for surgical treatment (group B). The frequency of anaerobic colonization was studied. Bacterial colonization is frequently present in patients with pilonidal disease of the sacrococcygeal region. Samples of the skin over the sacrococcygeal sinus showed the presence of bacterial colonization in 78% and 70% of group A and group B patients, respectively. Analysis of sinus fluid samples revealed the presence of bacteria in 88% of group A patients and 78% of group B patients. Anaerobic colonization in the content of pilonidal sinus was found in approximately 2/3 (64%) group A patients and about a half (52%) group B patients. Considerable bacterial colonization was also recorded in skin swab samples, i.e. in 48% of group A patients and 38% of group B patients. Anaerobic bacteria were rarely detected in pure cultures (in group A 6% skin swab, and 20% of sinus fluid samples, and in group B, 4% of skin swab and 12% of sinus fluid samples). Anaerobes were mostly detected in combined cultures (42% of skin swab and 44% of sinus fluid samples from group A, 32% of skin swab and 40% of sinus fluid samples from group B). Surgical methods to considerably reduce the conditions for anaerobic bacterial colonization of the wound should be the methods of choice in the management of pilonidal disease of the sacrococcygeal region.

The treatment of pilonidal disease of the sacrococcygeal region by the method of limited excision and open wound healing

Results of the surgical treatment of the pilonidal disease of the sacrococcygeal region in correlation with anaerobic infection are analyzed. Fifty patients with the disease recurrence (group A) and fifty patients presenting for operative treatment for the first time (group B) were observed. Twenty-five patients from group B were operated on by the method of limited excision and wound healing by open granulation and the other half were operated on by the method of excision and primary suture. The material for bacteriologic examination was obtained during the operative procedure. All patients underwent control examination at twelve months after the surgery. Recurrence was found in three (6%) group A patients and two (8%) group B patients operated on by the method of excision and open wound healing. Perioperative bacteriologic analysis showed anaerobic colonization in all study patients. Among the patients operated on by the method of excision and primary suture, recurrence was recorded in six (24%) cases. Bacteriologic analysis pointed to anaerobic colonization in five, and to aerobic colonization in only one patient. The significantly lower recurrence rates recorded with the method of limited excision and wound healing open granulation, were explained by favorable conditions for healing in such a wound (reduced conditions for anaerobic infection) compared to wound healing after excision and primary suture.

Pilonidal sinus of the penis. A report of two cases, one of them associated with actinomycosis

Pilonidal sinus is a long-standing chronic inflammatory condition which occurs most commonly in the sacrococcygeal area and it is rare in the penis. Two cases of penile pilonidal sinus in patients aged 25 and 28 years are reported and the literature is reviewed. The lesion is acquired and has to be distinguished from balanoposthitis, epidermal cyst and carcinoma. For pilonidal sinus to occur at this site, it is hypothesized that the coronal sulcus acts as a cleft where hair may accumulate and be driven into the shaft and prepuce by the natural movement between these two surfaces. One of our cases was associated with actinomycosis. Actinomycosis associated with pilonidal sinus of the penis is extremely rare and there are only two previous reports. It is suggested that pilonidal sinus may have been predisposed to the infection with the actinomyces organisms. Information stating that penile pilonidal sinus and actinomycosis may occur simultaneously is necessary to accomplish an early diagnosis.

[Surgical revision of the pilonidal sinus with single shot antibiosis]

For a therapy of the pilonidal sinus there are different surgical and non-surgical methods to be found in literature. In our surgical wing 140 male patients have been operated on this disease from September 1990 to July 1992. 16 cases out of these 140 were re-operations. Using a special surgical technique we applied the excision with a primary closure under single-shot antibiosis in 139 cases. By modifying this antibiosis prophylaxis we could reach a primary success healing rate of up to 96%. A retrospective study among our patients showed a recurrence rate of 5%.

Bacteriology and complications of chronic pilonidal sinus treated with excision and primary suture

Two prospective studies were undertaken to examine the role of bacteria in the outcome after excision and primary suture for chronic pilonidal sinus disease. In the first study 52 consecutive patients were given cloxacillin as prophylaxis. In a second randomised study 51 patients were given 2 g cefoxitin intravenously (n = 25) or no prophylaxis (n = 26). From 49 out of 98 patients (50%) no microorganisms were isolated from sinuses preoperatively. Wound complications were observed postoperatively in 61% of the patients (63/103). A postoperative bacteriology sample was positive in 47 of 49 samples (96%). Preoperative presence of bacteria was not significantly associated with wound complications. Anaerobe isolates were present in 40% of patients preoperatively whereas aerobes were cultured in 43% postoperatively. After an observation period of 30-42 months, recurrences were 13% among the patients (7/52) who had been given cloxacillin. No recurrences were seen in the last study after an observation period of 18-30 months, for an overall 7% in both studies. We conclude that preoperative bacterial isolates, usually anaerobes, in chronic pilonidal sinuses do not influence the complication rate since bacterial isolates from infected wounds are mostly aerobes.

Microbiology of infected pilonidal sinuses

Aspirates of pus from infected pilonidal sinuses in 75 patients showed bacterial growth. Anaerobic bacteria only were recovered in 58 (77%) specimens, aerobic bacteria only in three (4%), and mixed aerobic and anaerobic bacteria in 14 (19%). Two hundred and nine isolates were recovered: 147 anaerobes (2.0 isolates a specimen) and 62 aerobes (0.8 a specimen). The predominant anaerobes were Bacteroides sp (81 isolates, including 29 Bacteroides fragilis group) and 51 anaerobic cocci. The predominant aerobes were Escherichia coli (n = 15), Proteus sp (n = 9), group D streptococcus (n = 7), and Pseudomonas sp (n = 7). This study highlights the polymicrobial nature and predominance of anaerobic bacteria in infected pilonidal sinuses.

[Combined surgical and medical treatment of pilonidal cysts and fistulae as prevention of recurrence]

The possibility of reducing the incidence of postoperative recurrences of pilonidal fistulas by using preoperative doses of Cephoxitine and primary surgical closure is described.

Aerobic and anaerobic bacteriology of pilonidal cyst abscess in children

Aspirates of pus from pilonidal abscesses in 25 children were studied for aerobic and anaerobic bacteria. A total of 76 isolates (63 anaerobic and 13 aerobic) were recovered from the patients, accounting for 2.52 anaerobes and 0.52 aerobes per specimen. Anaerobic organisms were recovered from all the specimens, and in eight cases (32%) they were mixed with aerobic organisms. The predominant anaerobic organisms were Bacteroides sp (36 isolates, including ten B fragilis group and ten B melaninogenicus group), Gram-positive anaerobic cocci (16). Fusobacterium sp (five), and Clostridium sp (four). The predominant aerobic organisms were Escherichia coli (four) and group D streptococci, alpha-hemolytic streptococci, and Proteus sp (two of each). We believe this study is the first to demonstrate the mixed anaerobic and aerobic bacteriology of pilonidal cyst abscesses in children.