Effect of dead space reduction in pilonidal sinus surgery: Introduction of a novel technique

Pilonidal sinus (PNS) disease affects the skin and subcutaneous tissue of the natal cleft of the buttocks. The treatment is variable and depends on presentation and the extent of disease. The mainstay of surgical management for PNS disease is to excise all sinus tracts and pits. There are numerous surgical techniques and none of them are considered optimal. Residual dead space is responsible for the majority of complications in PNS surgery.

In this study, the authors describe a modified technique of the Karydakis procedure and investigate the effects of this new method.

In this trial, 80 patients were included between January 2014 and January 2015. A new technique in PNS surgery, which can be described as a modified Karydakis procedure, was performed. In this technique, following total sinus excision, the excised defect was closed with the standard Karydakis method, but in order to reduce the dead space under the standard Karydakis flap, an advancement tissue flap with additional skin excision was performed. During a mean follow-up period of 20 months, some complications occurred, including wound dehiscence, the formation of a seroma, the formation of a hematoma, and infection. These complications were monitored.

There were 19 female and 61 male patients with a mean age of 24 years (range, 18-49 years). The mean volume of the sinus was 26 cc (range, 8-80 cc). A total of 10 patients (12.5%) experienced complications. All complications were managed successfully with follow-up treatment and appropriate wound care.

The results of this pilot study suggest this technique may be considered as an alternative surgical method in PNS surgery, provided the results are corroborated by further randomized controlled trials.