R. M. Dorman1, K. D. Bass1,2 1State University Of New York At Buffalo,Department Of Surgery,Buffalo, NY, USA 2Women And Children’s Hospital Of Buffalo,Department Of Pediatric Surgery,Buffalo, NY, USA
Introduction: Extracellular matrix is used in various applications. We sought to use a new device that incorporates a porcine extracellular matrix with a basement membrane (ACELL) for adolescent pilonidal disease. Pilonidal disease is characterized by deep sinus tracts that result in large soft tissue abscesses. Current treatment includes debridement with the following options: primary closure, saline dressings, or negative pressure dressings. Primary closure results in a high rate of recurrence therefore wound care is favored in our practice. Saline dressings are the most inexpensive method, but are associated with the most pain and longest recovery time. Negative pressure dressings are more expensive but reduce the number of dressing changes, and accelerate wound healing reducing duration of wound care and pain. The goals for children with pilonidal disease are accelerating wound healing while minimizing painful dressing changes, in order to return to baseline function. Experience with ACELL in other wound applications prompted our investigation with children.
Methods: A series of 4 patients with pilonidal abscess were debrided. Three occurred in the gluteal cleft, and the fourth in the umbilicus. In the first patient, the wound deficit was filled with ACELL powder and a sheet of 2-ply ACELL was placed to close the wound. In the second patient, two sinus tracts were debrided, packed with ACELL, and a sheet of 5-ply ACELL was applied. In the third patient, powder and a 6-ply ACELL was applied as a roll filling the dead space. In the last patient, an umbilical sinus 3 cm deep was packed with ACELL powder followed by a roll of 2 ply ACELL sheet. Patients were evaluated weekly postoperatively and more powder and sheet ACELL material was added if their wound deficit was still present. Measurements were taken in three dimensions to characterize wounds.
Results: Resolution of wound deficit was graphed vs. time. Pain was assessed by scoring 0-10. The graph depicts rapid wound healing by both depth and maximum diameter. The rate of wound healing increased as the volume or thickness (ply) of ACELL material in the wound deficit increased. Two of the patients had failed wound healing with saline dressing changes prior to ACELL application. These 2 patients specifically were highly satisfied with minimal pain scores in their first week postoperative compared to their time with saline dressings. All 4 patients had no pain after 1 week when bolster sutures were removed.
Conclusion: The use of ACELL in adolescent pilonidal disease was extremely well tolerated with decreased pain compared to saline dressings. The rate of wound healing was accelerated by the volume of ACELL material used. The patient satisfaction with the device was high. This experience supports a prospective study.
