Pilonidal sinus disease.
Abstract: Pilonidal disease is a frequent suppurative condition that occurs twice as often in men as in women, usually between the ages of 15 and 30. Pilonidal disease is located beneath the skin of the sacro-coccygeal region. It presents acutely as an abscess under tension while the chronic form gives rise to intermittent discharge from pilonidal sinus(es). Diagnosis is clinical and usually straightforward. In the large majority of cases, treatment is surgical but there is no consensus as to the 'ideal' technique. Acute abscess must be evacuated and an off-midline incision seems preferable. Excision is the standard definitive treatment but the choice of wide versus limited excision depends on the school of thought. The widespread practice in France is to leave the wound open, relying on postoperative healing by secondary intention. This technique has a low rate of recurrence but has the disadvantages of requiring local nursing care; the healing process is prolonged, usually associated with a temporary but prolonged cessation of activity. Primary wound closure techniques are less restrictive but their recurrence rate is probably higher. A direct midline suture is best after a small excision, but for a more extended wound, plastic reconstruction techniques are preferred; data in the literature favor asymmetric closure techniques such as those described by Karydakis and Bascom.
Copyright © 2013 Elsevier Masson SAS. All rights reserved.
Publication Date: 2013-08-01 PubMed ID: 23911903DOI: 10.1016/j.jviscsurg.2013.05.006Google Scholar: Lookup
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Summary
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This research article delves into the diagnosis and treatment of sinus diseases in horses, underlining the complications that arise due to the substantial size of the sinuses, complex anatomy, and the advanced state of many diseases at the time of diagnosis. The researchers highlight the advancement in diagnostic methods and the enhancements available for treating various sinus disorders.
Diagnostic Challenges
- The article addresses the challenges in diagnosing and treating diseases in the paranasal sinuses and conchae of horses. The large size of these structures in horses, coupled with their intricate anatomy and the limited accessibility, makes the diagnosis complex.
- Further, these diseases are often diagnosed at an advanced stage, which poses more complications in the treatment.
Improved Diagnostic Methods
- The article points to the development of more effective diagnostic methods to address these challenges. Techniques such as nuclear scintigraphy, computed tomography, and direct endoscopy of the sinuses are identified as efficient methods for diagnosing diseases in these complex structures.
Treatment options
- The research also suggests various advancements in the treatment of sinus diseases in horses. Direct sinus endoscopy is recognized as an effective tool for addressing focal lesions.
- For treating diffuse sinus lesions, the use of large frontal bone flaps is identified as an improved approach.
- The authors also recommend standing surgery through a frontal flap as a viable solution for diverse sinus disorders.
- Lastly, the paper discusses the use of intralesional formalin as an increasingly effective treatment for progressive ethmoidal hematomas.
Conclusion
- This research thus provides a comprehensive account of the complications in diagnosing and treating sinus diseases in horses and proposes improved methods for overcoming these challenges.
Cite This Article
APA
de Parades V, Bouchard D, Janier M, Berger A.
(2013).
Pilonidal sinus disease.
J Visc Surg, 150(4), 237-247.
https://doi.org/10.1016/j.jviscsurg.2013.05.006 Publication
Researcher Affiliations
- Service de proctologie médico-chirurgicale, institut Léopold-Bellan, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France. Electronic address: iplb@hpsj.fr.
MeSH Terms
- Biopsy
- Global Health
- Humans
- Incidence
- Pilonidal Sinus / diagnosis
- Pilonidal Sinus / epidemiology
- Pilonidal Sinus / surgery
- Surgical Flaps
- Surgical Procedures, Operative / methods
- Wound Healing
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