Secondary healing versus midline closure and modified Bascom natal cleft lift for pilonidal sinus disease

Pilonidal sinus disease is a common disease in young employed male adults. Ongoing discomfort usually indicates an operative intervention. The main drawback is however the complication of wound healing. Numerous techniques for surgical treatment have been proposed, which underlies the lack of a superior technique.

A retrospective study was performed on the medical notes of 62 patients operated for a pilonidal sinus between May 2005 and December 2006. Used techniques were: 'modified Bascom procedure', 'excision and primary closure' and 'excision with secondary wound healing'. Patients' characteristics, operative parameters and data on outcome were included. The primary endpoint was wound healing.

Twenty-five patients underwent the modified Bascom procedure, 19 underwent surgical excision with primary midline closure and 18 underwent surgical excision with secondary wound healing. There were no demographical differences between the groups of patients. The modified Bascom technique showed a significantly reduced wound healing time (29 days) compared to primary closure (52 days, p < 0.01) and secondary healing (62 days, p < 0.01). The duration of this modified procedure was significantly longer (49, 33 and 24 minutes respectively, p < 0.01).

Wound healing remains an important problem in the surgical treatment of pilonidal disease. Significant faster convalescence can be achieved using the modified Bascom procedure. Wide local excision as primary therapy should not be advocated.