Authors
Korablina S.S.1, Lavreshin P.M.1, Muravyev А.V.1, Gobejishvili V.K.1, Gobedzhishvili V.V.2, Zhirnosenko A.O.3
1 Stavropol State Medical University, Stavropol
2 I.M. Sechenov First Moscow State Medical University, Moscow
3 Pirogov National Medical and Surgical Center, Moscow
Abstract
Rationale: The prevalence of the disease, young age of the patients, and results of treatment which are not satisfactory for surgeons today determine the urgency of the work. According to literary sources after the operations concerning pilonidal sinus in 16–30% of operated patients there are wound complications, in 13-17% there are recurrences of the disease, in 13–17% there are hypertrophic scars after the wound healing.
Methods: Improving the studied patients treatment results by introducing new methods of operations, optimization of diagnostics and treatment in preoperative and postoperative periods. The article presents the results of examination and treatment of 86 patients with pilonidal sinus complicated by secondary fistulas in the coccyx-sacral-gluteal region. By studying the prevalence, intensity of the inflammatory process, topographic and anatomical structure of the coccyx-sacral-gluteal region, and wound size after excision of the coccygeal sinus, the authors suggested two surgical variants, at the end of which intradermal sutures were used. To predict excessive scar formation and control the effectiveness of anti-scar therapy, the dynamics of proteins concentration in the acute phase of inflammation, the level of antibodies to the scar antigen were studied.
Results: The suggested surgeries allowed to remove pathologically changed tissues most radically, to reduce significantly the size of the postoperative wound, to provide drainage of wound discharge, to form intergluteal fold without disturbing blood supply to the wound edges, to improve tissue regeneration processes which considerably improved the disease outcomes.
Conclusion: A comprehensive approach to the examined patients treatment in comparison with the literature data made it possible to reduce the number of postoperative complications to 10.4%; relapses of the disease up to 3.5%, development of excessive scarring up to 5.8%.
Keywords: pilonidal sinus, secondary fistulas, scarring prediction, diagnosis, treatment.
References
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