J Korean Surg Soc.  2012 Feb;82(2):63-69. 10.4174/jkss.2012.82.2.63.

S-plasty for pilonidal disease: modified primary closure reducing tension

• Kim JK
• Jeong JC
• Lee JB
• Jung KH
• Bae BK

• KMID: 2212203
• DOI: http://doi.org/10.4174/jkss.2012.82.2.63

Abstract

PURPOSE
S-plasty for pilonidal disease reduces the tension on the midline by distributing it diagonally and flattening the natal cleft. The aim of this study was to evaluate the outcomes of S-plasty on simple midline primary closure and the clinical features of pilonidal patients in a low incidence country.
METHODS
S-plasty was applied on 17 patients from July 2008 to October 2010. Data of these patients were collected with computerized prospective database forms during a perioperative period and via telephone interview for follow-up. Surgical site infection (SSI) was defined according to the Center for Disease Control guidelines. The severity of surgical site infection was graded.
RESULTS
All patients were treated with primary S-plasty. Two patients (11.7%) developed low grade SSI. The average healing time after S-plasty was 18.1 days. No recurrences were observed. The mean follow-up period was 13.5 months (range, 6 to 33 months).
CONCLUSION
We have shown that primary S-plasty for pilonidal disease is simple, and its surgical outcomes are compatible to the results of other surgical treatments. We present primary S-plasty as a feasible treatment option in a low incidence country.

Keyword

Pilonidal sinus; Wound closure techniques; Surgical wound infections; Wound healing; Surgical flaps

MeSH Terms

Centers for Disease Control and Prevention (U.S.)
Follow-Up Studies
Humans
Incidence
Interviews as Topic
Perioperative Period
Pilonidal Sinus
Recurrence
Surgical Flaps
Surgical Wound Infection
Wound Closure Techniques
Wound Healing

Figure

• 

  Fig. 1 S-plasty for pilonidal disease. (A) Decide on area to be excised and mark at outer vertical and horizontal points using ultrasonogram. (B) Draw 1/4 circle (radius is 2 times bigger than width of excision area) from (x) to upper end and from (y) to lower end. (C) Close incision line. Trim line smoothly. (a) Ultrasonogram shows 2.4 × 1.5 × 6 cm pilonidal sinus (ovoid shape hypoechoic lesion). (b) Complete excision of devitalized tissue. (c) After drawing lines perpendicular to wound in order to match margin, wound was closed with mattress sutures of 2-0 Nylon and with 2-0 or 3-0 absorbable polyglycolic acid. (d) Comparing with (Fig. 1D), wound closed with S-plasty reduces tension on midline by distributing it diagonally, flattens the natal cleft, and keeps distal end of incision away from anus.

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