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Prospective randomized controlled trial comparing V-Y advancement flap with primary suture methods in pilonidal
Tarik Zafer Nursal1, Ali Ezer, Kenan Calişkan
1Başkent University, Department of General Surgery, Adana, Turkey. tznursal@hotmail.com
American Journal of Surgery
|April 14, 2009
Summary
The V-Y advancement flap (VYAF) is not superior to simple closure for pilonidal sinus disease. Simple closure is often sufficient, but patients with risk factors should be informed of recurrence risks.
Area of Science:
- Surgical Innovation
- Wound Healing
- Pilonidal Sinus Disease Treatment
Background:
- Pilonidal sinus disease (PSD) has no ideal treatment, with high recurrence rates for simple closure.
- The V-Y advancement flap (VYAF) aims to flatten the natal cleft and reduce suture line tension.
Purpose of the Study:
- To compare the V-Y advancement flap (VYAF) with two simple primary closure techniques for PSD.
- To evaluate postoperative complications, recurrence rates, and patient satisfaction.
Main Methods:
- A prospective randomized controlled study involving 238 patients with PSD.
- Comparison of VYAF, all-layer (AL) closure, and subcutaneous suture (SS) closure techniques.
- Data collected included demographic variables, wound tension, defect dimensions, and follow-up for recurrence.
Main Results:
- Surgical site infection rates were 10.2% (VYAF), 23.9% (AL), and 17.4% (SS).
- Wound dehiscence rates were 10.2% (VYAF), 11.9% (AL), and 7.4% (SS).
- No significant difference in recurrence rates (P = .648) or patient satisfaction was found between groups. Predictors of recurrence included younger age, prior recurrence, discharge, and infection.
Conclusions:
- V-Y advancement flap (VYAF) offers no significant advantage over simple primary closure for PSD regarding complications or recurrence.
- Simple primary closure is generally sufficient for most PSD cases.
- Informed consent should highlight recurrence risks for patients with specific predictors like prior disease or infection.
