Comparative study of Primary Suturing Versus V-Y Advancement Flap Technique in Resurfacing Post Excisional Defect in Cases with Pilonidol Sinus Disease

Abstract

BACKGROUND: Multiple treatments has been identified for pilonidal disease but no protocol has been designed and studies emerged by comparing treatment cost, morbidity, and return to work state The primary aim of advancement flap is to transfer the scar tension that obtained from side-to-side closure to good cosmetical closure from flap. For putting the flap, we need to know its dynamics. First step is movement of flap into the defect created by excision of pilonidal sinus. Flap movement demonstrates secondary defect. Primary purpose of flap is to closing the primary defect, while reducing secondary defect size. AIM AND OBJECTIVES To compare the rate of occurrence and nature of complications in primary suturing and v-y advancement flap technique in resurfacing post excisional defect in cases with pilonidal sinus disease. MATERIAL AND METHODS: The study was a prospective, parallel group, comparative study among patients admitted with pilonidal sinus in general surgery wards at Govternment Rajaji Hospital, Madurai Medical College, Madurai. Fifty patients were randomized into two groups of primary suturing and v-y advancement flap. Complications in both intraoperative and postoperative periods were noted and patients were followed up for 6months. RESULTS: The male : female ratio was noted to be approximately 5:1. The mean age of presentation of pilonidal disease is in the mid-twenties. Occupation has a role in the development of pilonidal disease. It seen in people who have a work pertaining to prolonged duration of sitting and close to vibrating surface. Disease is common in hirsute males with deep natal cleft and presence of sinus (single and/or multiple) is almost a constant feature of all patients who presented with pilonidal disease. The incidence of increased body mass index with the incidence and even recurrence of pilonidal sinus. The most common organisms found in the pilonidal sinus are the anaerobic organisms. Wound infection which was more (p value-0.04 significant) in primary suturing. Wound dehiscence was more (p value-0.04 significant) in the patients undergoing primary closure. Collection which was noted in patients undergoing both primary suturing and flap study. Recurrence rate is more (p value-0.018 significant) with primary suturing when compared with v-y advancement flap. Our study shows the hospital stay duration found to be very less (p value-0.000 significant) in patients treated with flap procedures than who underwent primary suturing. CONCLUSION: Pilonidal sinus is found more commonly in hairy, obese males with sedentary life style. It is treated more effectively, with no recurrence rate and less complications by wide local excision followed by asymmetric closure by unilateral or bilateral V-Y fascio-cutaneous advancement flap than primary closure