Cutting seton for pilonidal disease: a new approach

I present a technique for dealing with chronic pilonidal disease that avoids use of general anesthesia, long hospital stay, complex wound care and prolonged disability that has so often been associated with more traditional surgical treatment in the past. Satisfactory resection was achieved by means of a single cutting seton (garrotte) in 8 patients, 5 males and 3 females ranging in age from 18 years to 31 years, all of whom had had prior unsuccessful incision and drainage for long-standing disease with local abscesses and suppuration. The seton was applied in an ambulatory care setting under local anesthesia. It was tied and progressively tightened over a period of two weeks. Complete excision of the diseased area was achieved and revascularization of the wounds site occurred with optimum healing by secondary intention, leaving an acceptable scar. It required minimal wound care. There were no recurrences over an average follow-up period of 22.5 months. All patients were uniformly satisfied. The encouraging preliminary results for this novel technique suggest that it is simple, safe and effective. It requires evaluation in a larger series with longer follow-up.