No-touch excision primary closure in pilonidal disease

Abstract

Many treatment modalities have been advocated for treating pilonidal disease with fervent arguments for each one. Wound infection and recurrence are most challenging complications. No-touch excision primary closure procedure can be described as an elliptical incision, approximation of the edges of the ellipse along the long axis with a continuous suture, deepening the incisions to the postsacral fascia with suitable angle, enough dissection of fasciocutaneous gluteal flaps bilaterally and symmetrically, and tension-free primary closure with double layer sutures. Twenty five consecutive patients were treated with this technique. Mean hospital stay was 1.4 days. Wound infection occurred in one patient with a wide recurrent pilonidal disease (4.5%). No recurrence occurred up to date (between 9 months and 5 years, mean 25.4 months). Tightly closure of the sinus containing elliptical skin piece prevents contamination from sinus, correct angles of the free edges of the flaps provide tight approximation without dead space. Flap dissection enough for tension-free approximation decreases postoperative pain, discomfort, and wound dehiscence.