J. W. Soliman1, R. Zhu1, I. V. Stettler1, W. Shen1, C. Sutanto1, M. Barnajian1, A. Artinyan1, J. Cohen1, Y. Y. Nasseri1 1Cedars-Sinai Medical Center,Los Angeles, CA, USA
Introduction: Patients with complex and recurrent pilonidal disease undergo various flap-based procedures to reconstruct the post-excision wound defect. In most cases, recurrence and/or dehiscence occur in up to 50% and cosmetic results are subpar. We present an outpatient, durable and cosmetic approach to reconstruction via bilateral gluteal fasciocutaneous flaps with and without compressing tie-over sutures.
Methods: This is a retrospective review of a prospective database. Following elliptical excision of pilonidal disease, gluteal fasciocutaneous advancement flaps are elevated using blunt discontinuous dissection in a 360-degree fashion to allow a tension-free repair. A multilayered closure is then performed using interrupted sutures, starting at the fascial level with careful attention to evert skin edges. For the 21 most recent patients, two full thickness-compressing sutures tied over rolled up gauze were placed at the lower end of the incision. The resulting scar is mid-line. All procedures were outpatient.
Results: Thirty-seven patients, 6 females, with a mean BMI of 26.8 and mean age of 28.9 were studied. Five patients were active smokers and 7 were obese. At a median follow-up of 22 months (range 2-64), there were no recurrences. Twelve (32%) patients had wound dehiscence: 8/16 (50%) of patients without compressing tie-over sutures, and 4/21 (19%) of patients with compressing tie-over sutures. Three of 5 (60%) smokers and 3/7 (43%) obese patients had wound dehiscence. All dehiscence resolved with office hair shaving and wound care.
Conclusion: Bilateral gluteal fasciocutaneous advancement flap closure with compressing tie over suture is a cosmetic outpatient treatment for recurrent and complex pilonidal disease with no recurrence and low dehiscence rate.
