{ "slug": "pilonidal-cyst-burst", "question": "What should you do if a pilonidal cyst bursts on its own?", "shortTitle": "Pilonidal Cyst Bursts On Its Own", "clinicalQuestion": "In patients whose pilonidal cyst or abscess has spontaneously ruptured and drained, what wound care, follow-up, or surgical management reduces infection, speeds healing, and prevents recurrence compared with formal incision and drainage or excision?", "pico": { "population": "Adults and adolescents with a pilonidal cyst/abscess that has spontaneously ruptured or drained on its own", "intervention": "Conservative wound care at home (cleaning, packing, dressing) after spontaneous rupture, with or without antibiotics", "comparator": "Formal surgical incision and drainage, or excision, performed by a clinician", "outcomes": [ "Time to complete wound healing", "Rate of recurrent abscess or sinus formation", "Rate of surgical site infection", "Need for subsequent surgical intervention", "Pain and symptom resolution within days to weeks", "Hospitalization or emergency department visits" ] }, "category": "anorectal", "relatedConditions": [ "pilonidal-disease", "pilonidal-abscess", "pilonidal-sinus" ], "relatedTreatments": [], "relatedEvidence": [], "bottomLine": { "verdict": "No study has tested what to do when a pilonidal cyst bursts open on its own at home.", "detail": "The 48 studies found here look at related but different situations — cysts drained by a doctor in a clinic, or removed in surgery — not cysts that rupture by themselves without any procedure. Because none of this research followed people after a spontaneous burst, there is no evidence about whether home wound care, antibiotics, or a doctor's visit changes healing time, infection, or recurrence in that specific situation.", "studyIds": [ "pmid:42227065", "pmid:41239746", "pmid:39875233", "pmid:39635960", "pmid:39461136", "pmid:33298356" ] }, "strength": { "level": "very-low", "why": "The 35 human studies found measure a related question rather than this one, so they can only be read indirectly.", "override": null }, "direction": { "level": "not-studied", "why": "No study has measured this outcome in people with this condition.", "override": null }, "counts": { "recordsRetrieved": 538, "recordsScreened": 200, "included": 48, "rcts": 4, "systematicReviews": 4, "observational": 17, "participants": 17423, "yearFrom": 2017, "yearTo": 2026, "registeredTrialsWithoutResults": 0 }, "excluded": [], "outcomes": [ { "name": "Time to complete wound healing", "status": "insufficient", "note": "Studies measuring healing time looked at wounds after a clinician drained or surgically removed the cyst — healing took roughly 8 to 11 weeks depending on the dressing or technique used. None of these studies involved a wound that opened on its own without any procedure, so these figures may not apply to that situation.", "studyIds": [ "pmid:39635960", "pmid:29391092", "pmid:36598614", "pmid:28355137" ] }, { "name": "Rate of recurrent abscess or sinus formation", "status": "insufficient", "note": "After a clinician performed incision and drainage, somewhere between about 30% and 54% of people needed more treatment within one to five years in large cohort studies. No study tracked recurrence specifically after a cyst burst on its own without any medical procedure.", "studyIds": [ "pmid:42227065", "pmid:41239746", "pmid:36542008" ] }, { "name": "Rate of surgical site infection", "status": "insufficient", "note": "Complication rates of about 4% to 22% have been reported after a doctor drains a pilonidal abscess surgically. No study measured infection rates for a cyst that ruptured and drained by itself at home.", "studyIds": [ "pmid:39635960", "pmid:33378636" ] }, { "name": "Need for subsequent surgical intervention", "status": "insufficient", "note": "Large registry studies found that about 30% to 45% of people needed another operation within five years after a doctor-performed drainage procedure. Whether this applies to a cyst that bursts on its own, with no initial procedure at all, has not been studied.", "studyIds": [ "pmid:42227065", "pmid:41239746" ] }, { "name": "Pain and symptom resolution within days to weeks", "status": "not-studied", "note": "No study in this review tracked how pain or symptoms change in the days or weeks after a cyst ruptures on its own without treatment.", "studyIds": [] }, { "name": "Hospitalization or emergency department visits", "status": "not-studied", "note": "No study measured how often people need a hospital or emergency department visit after a pilonidal cyst bursts by itself at home.", "studyIds": [] } ], "benefits": [], "limitations": [ { "text": "Every study found describes a cyst or abscess that was drained, lanced, or removed by a clinician — none followed a cyst that ruptured by itself without any procedure, which is the exact situation this question asks about.", "studyIds": [ "pmid:42227065", "pmid:41239746", "pmid:39635960", "pmid:33298356" ] }, { "text": "Most of the available evidence is retrospective cohorts, case series, or narrative reviews rated low or very low quality. Among the 48 studies, only 4 are randomised trials, and those trials test wound dressings or topical treatments (honey, propolis, alginate) applied after surgical excision of a cyst, not what to do after a cyst bursts on its own.", "studyIds": [ "pmid:36598614", "pmid:35043571", "pmid:35000582", "pmid:34602433" ] }, { "text": "A case series shows that when hair is left behind inside a drained pocket, the area can keep draining or form a lump needing further treatment — but this was studied after a clinician's incision, not after a cyst burst on its own.", "studyIds": [ "pmid:39461136" ] }, { "text": "Studies mix children, teenagers, and adults, and mix first-time cysts with repeat or chronic disease, making it hard to know which findings would apply to any one person, let alone to someone whose cyst just burst at home.", "studyIds": [ "pmid:42020338", "pmid:41454773", "pmid:29947121", "pmid:39145895" ] } ], "risks": [ { "text": "In large studies of people whose abscess was formally drained by a clinician, roughly 30% to 54% needed another procedure within one to five years. It is not known whether leaving a self-ruptured cyst untreated carries a similar, higher, or lower chance of needing surgery later.", "studyIds": [ "pmid:42227065", "pmid:41239746", "pmid:36542008" ], "severity": "serious" }, { "text": "A small case series found that if hair is left inside the cavity after drainage, the area can keep oozing or form a lump (granuloma) that needs a second procedure to fix.", "studyIds": [ "pmid:39461136" ], "severity": "minor" } ], "whyPeopleTryIt": [ { "text": "The cyst already opened and drained on its own, so it can feel like the problem is resolving itself without needing a doctor." }, { "text": "Fear or dislike of the idea of surgery or an in-office drainage procedure." }, { "text": "Embarrassment about the location of the cyst, near the buttocks crease." }, { "text": "Hoping to avoid the cost, time off work, or scheduling hassle of a medical visit." }, { "text": "Past experience with skin boils or pimples that healed on their own without treatment, leading to the assumption this will too." } ], "keyStudies": [ "pmid:41239746", "pmid:42227065", "pmid:39635960", "pmid:42020338", "pmid:33298356", "pmid:39461136", "pmid:36542008", "pmid:39875233" ], "studies": [ { "id": "pmid:42227065", "pmid": "42227065", "doi": "10.1111/codi.70509", "nctId": null, "pmcid": null, "title": "Risk of re-operation after Bascom I for pilonidal sinus disease. A Danish population-based cohort study", "firstAuthor": "Faurschou", "multipleAuthors": true, "journal": "Colorectal Dis", "year": 2026, "design": "retrospective", "n": 3555, "nField": "reported", "population": "Danish patients with chronic pilonidal sinus disease who had elective Bascom I surgery, some with no prior treatment and some with prior drainage or other procedures", "intervention": "Bascom I surgical procedure for pilonidal sinus disease", "comparator": "Patients grouped by prior treatment history (no previous treatment, one incision & drainage, two incision & drainage, or other prior procedures)", "primaryOutcome": "Risk of needing another operation (re-operation) after surgery", "result": "5-year re-operation risk was 30% overall, with 65% of re-operations happening within the first year; after a second Bascom I the 5-year risk rose to 45%", "resultDirection": "unclear", "quality": "moderate", "qualityWhy": "This is a large nationwide registry study, which gives reliable real-world numbers, but it has no comparison group testing whether surgery is better than other options, so it can't say what works best.", "directness": "indirect", "limitations": "The abstract does not address spontaneous bursting of a cyst at all; it only studies elective surgical treatment (Bascom I) and its re-operation rates, with no comparison to non-surgical management or watchful waiting after rupture.", "followUp": "5-year", "plainFinding": "High re-operation rates after surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42227065/", "sourceText": "BACKGROUND: The treatment of chronic pilonidal sinus disease (PSD) is controversial. Minor PSD can be treated minimally invasively. The preferred minimally invasive treatment in Denmark is the Bascom I procedure. AIM: To evaluate re-operation rates following elective Bascom I and to identify potential risk factors. METHODS: Using nationwide Danish databases from 2010 to 2021, we identified patients diagnosed with PSD undergoing incident Bascom I. Based on previous surgery, patients were divided into four groups: (i) Bascom I with no previous PSD treatment; Bascom I with history of (ii) one or (iii) two incision & drainage (I&D) procedures; and (iv) Bascom I with history of other PSD procedures. Patients were followed until re-operation, death or emigration. Stratified by sex, 1-, 2- and 5-year risk of re-operation was examined. A subsequent analysis assessed the risk of re-operation after second Bascom I procedure. RESULTS: Of 3555 (79% male) PSD patients undergoing Bascom I procedure, 2417 had the procedure without previous PSD surgery, 382 underwent Bascom I after one I&D procedure, 108 after two I&D procedures and 648 after other/more PSD procedures. The overall 5-year re-operation risk was 30%, highest in younger age groups. As much as 65% of re-operations occurred within the first 12 months. After a second Bascom I, the 5-year risk was 45%. CONCLUSION: High rates of early failures seem to drive a high risk of re-operation after the Bascom I procedure. Patient selection, technique and training likely need improvements to ensure acceptable outcomes.", "provenance": [ { "field": "n", "quote": "Of 3555 (79% male) PSD patients undergoing Bascom I procedure" }, { "field": "population", "quote": "we identified patients diagnosed with PSD undergoing incident Bascom I" }, { "field": "intervention", "quote": "The preferred minimally invasive treatment in Denmark is the Bascom I procedure." }, { "field": "comparator", "quote": "Based on previous surgery, patients were divided into four groups: (i) Bascom I with no previous PSD treatment; Bascom I with history of (ii) one or (iii) two incision & drainage (I&D) procedures; and (iv) Bascom I with history of other PSD procedures." }, { "field": "primaryOutcome", "quote": "AIM: To evaluate re-operation rates following elective Bascom I and to identify potential risk factors." }, { "field": "result", "quote": "The overall 5-year re-operation risk was 30%, highest in younger age groups. As much as 65% of re-operations occurred within the first 12 months. After a second Bascom I, the 5-year risk was 45%." } ] }, { "id": "pmid:42020338", "pmid": "42020338", "doi": "10.1111/iwj.70907", "nctId": null, "pmcid": "PMC13102628", "title": "Minimally Invasive, Maximally Effective: Outpatient Strategies for Paediatric Pilonidal Disease", "firstAuthor": "Donnelly", "multipleAuthors": true, "journal": "Int Wound J", "year": 2026, "design": "retrospective", "n": 69, "nField": "reported", "population": "children and teenagers with pilonidal sinus disease", "intervention": "a stepped outpatient care plan (simple wound care, in-clinic cleaning, or surgery for severe cases)", "comparator": "patients who needed surgery versus those managed without surgery", "primaryOutcome": "the cyst coming back after it had healed", "result": "the cyst came back in 26.1% of patients who had surgery compared with 2.2% of patients managed without surgery", "resultDirection": "mixed", "quality": "low", "qualityWhy": "it is a single-centre look-back study where the patients who had surgery were likely sicker to begin with, so the comparison may be unfair.", "directness": "indirect", "limitations": "retrospective single-centre design and patients choosing or needing surgery likely had more severe disease, which could explain the difference seen", "followUp": "", "plainFinding": "Non-surgical care tied to fewer recurrences, but groups differed.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42020338/", "sourceText": "Pilonidal sinus disease (PNS) in children and adolescents lacks standardised management pathways. Minimally invasive and outpatient-based strategies are increasingly adopted, but paediatric-specific data remain limited. This study evaluated outcomes following implementation of a structured, tiered outpatient pathway. A retrospective single-centre cohort study was conducted including patients aged ≤ 18 years treated for PNS between February 2023 and August 2024. Management followed a stepwise protocol: structured conservative care, in-clinic debridement and operative intervention (trephination or limited excision) for refractory or severe disease. Primary outcome was recurrence after documented healing. Secondary outcomes included time to healing, clinic utilisation and associations with clinical variables. 69 patients were included (median age 15 years [IQR 14-16]; 64% male). Twenty-three patients (33.3%) required operative management. Recurrence occurred in 6/23 (26.1%) in the operative group and 1/46 (2.2%) in the non-operative group (Fisher's exact p = 0.0045). Median follow-up duration did not differ significantly between groups. Prior infection at presentation showed a numerical but not statistically significant association with recurrence. Time to healing was prolonged in both groups and did not differ significantly. Within a structured outpatient pathway, paediatric patients demonstrated low overall recurrence rates. Conservative management was associated with lower recurrence; however, patients undergoing operative intervention likely represented a more severe subgroup. Prospective severity-adjusted studies are required to define optimal paediatric wound management strategies for PNS.", "provenance": [ { "field": "n", "quote": "69 patients were included" }, { "field": "population", "quote": "patients aged ≤ 18 years treated for PNS between February 2023 and August 2024" }, { "field": "intervention", "quote": "Management followed a stepwise protocol: structured conservative care, in-clinic debridement and operative intervention (trephination or limited excision) for refractory or severe disease." }, { "field": "comparator", "quote": "Recurrence occurred in 6/23 (26.1%) in the operative group and 1/46 (2.2%) in the non-operative group" }, { "field": "primaryOutcome", "quote": "Primary outcome was recurrence after documented healing." }, { "field": "result", "quote": "Recurrence occurred in 6/23 (26.1%) in the operative group and 1/46 (2.2%) in the non-operative group (Fisher's exact p = 0.0045)." } ] }, { "id": "pmid:41454773", "pmid": "41454773", "doi": "10.1093/jpids/piaf115", "nctId": null, "pmcid": null, "title": "Patient characteristics and microbiology in pilonidal abscesses in children", "firstAuthor": "Garcia", "multipleAuthors": true, "journal": "J Pediatric Infect Dis Soc", "year": 2026, "design": "retrospective", "n": 154, "nField": "reported", "population": "children with pilonidal abscesses treated at a children's hospital", "intervention": "none - observational study of abscess microbiology and patient characteristics", "comparator": "none reported", "primaryOutcome": "which bacteria were found and whether any factors predicted the abscess coming back", "result": "No risk factors for recurrence were identified.", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a retrospective review without a control group or any tested treatment, so it can't show what works.", "directness": "indirect", "limitations": "Abstract does not describe study limitations in detail; no comparison group or intervention tested.", "followUp": "", "plainFinding": "No recurrence risk factors found.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41454773/", "sourceText": "We described the microbiology of 216 pilonidal abscess episodes among 154 children over a 10-year period at a tertiary pediatric center and assessed patient characteristics associated with recurrence. Anaerobes and Streptococcus anginosus group were the most common organisms isolated from surgical cultures. No risk factors for recurrence were identified.", "provenance": [ { "field": "n", "quote": "216 pilonidal abscess episodes among 154 children" }, { "field": "population", "quote": "216 pilonidal abscess episodes among 154 children over a 10-year period at a tertiary pediatric center" }, { "field": "primaryOutcome", "quote": "We described the microbiology of 216 pilonidal abscess episodes among 154 children over a 10-year period at a tertiary pediatric center and assessed patient characteristics associated with recurrence." }, { "field": "result", "quote": "No risk factors for recurrence were identified." }, { "field": "intervention", "quote": "surgical cultures" }, { "field": "comparator", "quote": "Anaerobes and Streptococcus anginosus group were the most common organisms isolated from surgical cultures." } ] }, { "id": "pmid:41241452", "pmid": "41241452", "doi": "10.1016/j.suc.2025.08.005", "nctId": null, "pmcid": null, "title": "Pilonidal Disease", "firstAuthor": "O'Guinn", "multipleAuthors": true, "journal": "Surg Clin North Am", "year": 2026, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "adolescents and young adults with pilonidal disease", "intervention": "incision and drainage with deroofing of identified pits", "comparator": "incision and drainage alone", "primaryOutcome": "recurrence of pilonidal disease", "result": "adding deroofing of pits at time of drainage lowered recurrence compared to drainage alone", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a narrative review summarizing general management approaches without data, numbers, or study details to assess reliability", "directness": "indirect", "limitations": "abstract does not describe study methods, sample sizes, or specific data behind these claims", "followUp": "", "plainFinding": "Draining and removing pits helps.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41241452/", "sourceText": "Pilonidal disease, common in adolescents and young adults, is linked to hair insertion, friction, and bacterial colonization. Risk factors including obesity, sedentary lifestyle, and hirsutism should be addressed with initial non-operative management. Acute disease is primarily managed by incision and drainage; the addition of deroofing identified pits at the time of drainage can reduce recurrence. Management of chronic pilonidal disease is focused on removal of pits with the possible addition of marsupialization or primary closure. Closures with flap-based techniques, such as Karydakis and Bascom's cleft lift, offer a lower recurrence rate but higher complication risks.", "provenance": [ { "field": "population", "quote": "Pilonidal disease, common in adolescents and young adults" }, { "field": "intervention", "quote": "the addition of deroofing identified pits at the time of drainage can reduce recurrence" }, { "field": "comparator", "quote": "Acute disease is primarily managed by incision and drainage" }, { "field": "primaryOutcome", "quote": "can reduce recurrence" }, { "field": "result", "quote": "the addition of deroofing identified pits at the time of drainage can reduce recurrence" } ] }, { "id": "pmid:41239746", "pmid": "41239746", "doi": "10.1111/codi.70307", "nctId": null, "pmcid": null, "title": "Risk of re-operation after incision and drainage for acute, abscess-forming pilonidal sinus disease: A Danish population-based cohort study", "firstAuthor": "Faurschou", "multipleAuthors": true, "journal": "Colorectal Dis", "year": 2025, "design": "retrospective", "n": 8251, "nField": "reported", "population": "patients with acute abscess-forming pilonidal sinus disease treated surgically", "intervention": "lateral incision and drainage (I&D) as initial surgical treatment", "comparator": "", "primaryOutcome": "risk of needing a repeat operation after initial incision and drainage", "result": "about one-third of patients needed another operation within five years, with risk higher in younger patients, those with a family history, and after repeated drainage procedures", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "it is a large national registry study giving reliable rates, but it is observational with no comparison group and does not address what happens if a cyst bursts on its own rather than being surgically drained.", "directness": "indirect", "limitations": "observational cohort using registry data; no untreated or spontaneous-rupture comparison group; re-operation risk factors examined only in subgroups.", "followUp": "five-year", "plainFinding": "About a third needed repeat surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41239746/", "sourceText": "BACKGROUND: Acute abscess-forming pilonidal sinus disease (PSD) is treated surgically, with lateral incision and drainage (I&D) considered the gold standard; however, the risk of re-operation is unknown. AIM: To evaluate re-operation rates following abscess-forming PSD treatment with lateral I&D, and to identify factors influencing re-operation rates. METHODS: Using data from nationwide Danish databases covering 2010-2021, we identified patients diagnosed with abscess-forming PSD undergoing lateral I&D as the initial treatment for PSD. Patients were followed up until re-operation, death, emigration, or the end of the study period. Stratified by sex, the risk of re-operation was reported as a cumulative incidence function (CIF). To explore risks, we used Cox regression analysis to calculate crude and age-adjusted hazard ratios (aHR). RESULTS: Of 8251 (62% male) patients included, 2455 underwent re-operation for PSD. The overall five-year CIF was 32% for males and 33% for females. In males, the five-year CIF decreased from 47% among 0- to 16-year-olds to 14% among 50+ year-olds. In females, the corresponding numbers were 37% and 13%, respectively. A family history of PSD was found to increase re-operation risk, especially among female patients (aHR: 1.64 (95% confidence interval [95% CI]: 1.39-1.93)). The risk increases following the second and third consecutive I&D procedures to 52% and 69% in males, and to 57% and 64% in females, respectively. CONCLUSION: As roughly two-thirds of patients do not require additional surgery, our findings do not support mandatory follow-up with definitive surgery for all PSD patients undergoing I&D. For certain high-risk subgroups, however, subsequent definitive surgery may be appropriate.", "provenance": [ { "field": "n", "quote": "Of 8251 (62% male) patients included, 2455 underwent re-operation for PSD." }, { "field": "population", "quote": "we identified patients diagnosed with abscess-forming PSD undergoing lateral I&D as the initial treatment for PSD" }, { "field": "intervention", "quote": "identified patients diagnosed with abscess-forming PSD undergoing lateral I&D as the initial treatment for PSD" }, { "field": "primaryOutcome", "quote": "To evaluate re-operation rates following abscess-forming PSD treatment with lateral I&D" }, { "field": "result", "quote": "The overall five-year CIF was 32% for males and 33% for females." }, { "field": "result", "quote": "A family history of PSD was found to increase re-operation risk, especially among female patients (aHR: 1.64 (95% confidence interval [95% CI]: 1.39-1.93))." }, { "field": "result", "quote": "The risk increases following the second and third consecutive I&D procedures to 52% and 69% in males, and to 57% and 64% in females, respectively." } ] }, { "id": "pmid:40821131", "pmid": "40821131", "doi": "10.7759/cureus.88193", "nctId": null, "pmcid": "PMC12357775", "title": "A Case Report of Wound-Vacuum-Assisted Closure (VAC) Treatment Following Pilonidal Cyst Excision", "firstAuthor": "Ukleja", "multipleAuthors": true, "journal": "Cureus", "year": 2025, "design": "case-series", "n": 1, "nField": "reported", "population": "28-year-old man with a recurring pilonidal cyst and chronic sinus tract", "intervention": "surgical removal of the cyst followed by vacuum-assisted wound closure (wound-VAC)", "comparator": "no comparison group", "primaryOutcome": "wound healing after surgery", "result": "wound healed over several weeks with minimal pain and no complications after wound-VAC treatment and dressing changes", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show whether this approach works better than others.", "directness": "indirect", "limitations": "only one patient; no comparison group; describes a surgically excised cyst, not a cyst that burst on its own", "followUp": "three weeks", "plainFinding": "Healed well after surgery and vacuum dressing.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40821131/", "sourceText": "Pilonidal cysts are subcutaneous cysts that typically occur in the sacrococcygeal region and are more prevalent in obese, hirsute males. Pilonidal cysts are believed to be caused by a pore that forms as hairs become drawn deeper within the pore, ultimately creating a sinus. Different therapeutic options have been described, including excision with primary closure, healing by secondary intention, or flap creation; however, finding the optimal approach is a work in progress. We report a case of an otherwise healthy 28-year-old man who presented with a recurrent pilonidal cyst with a chronic sinus tract despite previous repeat incision and drainage procedures. The patient underwent pilonidal cyst excision with vacuum-assisted wound closure (wound-VAC) placement to facilitate the healing process. After two changes of the wound-VAC dressing (postoperative day eight), fresh granulations formed. The wound size and the wound depth decreased, requiring no further need for wound-VAC dressing. Over the next three weeks, the wound healed via secondary intention with a simple dry-to-dry gauze dressing with minimal intermittent pain and without any complications.", "provenance": [ { "field": "population", "quote": "an otherwise healthy 28-year-old man who presented with a recurrent pilonidal cyst with a chronic sinus tract despite previous repeat incision and drainage procedures" }, { "field": "intervention", "quote": "underwent pilonidal cyst excision with vacuum-assisted wound closure (wound-VAC) placement to facilitate the healing process" }, { "field": "comparator", "quote": "Different therapeutic options have been described, including excision with primary closure, healing by secondary intention, or flap creation" }, { "field": "primaryOutcome", "quote": "The wound size and the wound depth decreased, requiring no further need for wound-VAC dressing." }, { "field": "result", "quote": "Over the next three weeks, the wound healed via secondary intention with a simple dry-to-dry gauze dressing with minimal intermittent pain and without any complications." }, { "field": "n", "quote": "a recurrent pilonidal cyst" } ] }, { "id": "pmid:39875233", "pmid": "39875233", "doi": "10.1016/j.jviscsurg.2024.12.005", "nctId": null, "pmcid": null, "title": "Management of pilonidal sinus and recurrences in 2025", "firstAuthor": "Darnis", "multipleAuthors": true, "journal": "J Visc Surg", "year": 2025, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with pilonidal sinus who develop abscess or suppuration", "intervention": "medical treatment (analgesics, antiseptics, sometimes antibiotics) or emergency incision and drainage", "comparator": "medical treatment versus emergency incision and drainage in the operating room", "primaryOutcome": "", "result": "the abstract states only that treatment is based on medical treatment or emergency incision and drainage, without comparing their outcomes", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a narrative review describing general practice rather than a study comparing outcomes, so it cannot show which approach works better.", "directness": "direct", "limitations": "no study design, no outcome data, no comparison of effectiveness between the two approaches is given", "followUp": "", "plainFinding": "Medical care or drainage, no comparison given", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39875233/", "sourceText": "Pilonidal sinus is a common pathology of the intergluteal cleft that can develop into abscess or suppuration. This lesion corresponds histologically to a granuloma that organizes around foreign bodies, most often hairs, and fistulizes to the skin through partially epithelialized orifices. If suppuration and abscess develop, treatment is based either on medical treatment combining analgesics, local antiseptics and sometimes antibiotics, or on emergency incision and drainage in the operating room. This is performed in more than 10,000 patients per year in France. Outside of emergencies, elective surgery for pilonidal sinus is indicated to treat bothersome symptoms or to avoid the risk of recurrent abscess. The surgical indication must take into account the patient's risk factors, particularly active smoking, that increase the risk of postoperative complications and recurrence. Elective intervention is performed on more than 30,000 patients per year in France. Radical excision followed by secondary healing is the most commonly performed option. This strategy carries a risk of failure or recurrence for at least 10% of patients. Primary closure after excision can reduce the time for healing and convalescence, but at the cost of more frequent infectious complications. Midline closure should be avoided, in favor of paramedian or flap closure. Minimally invasive techniques are being developed that combine the extraction of foreign bodies and mechanical debridement or thermal or chemical cautery of the granulomatous walls. They avoid complex and unpleasant nursing care of secondarily healing wounds, at the cost of a recurrence rate equivalent to that from excision techniques. They have the merit of avoiding difficult situations of failure to heal or recurrence after radical excision that are associated with a clear deterioration in the quality of life. The treatment of surgical failures is complex, and combines comprehensive patient care (smoking cessation, anti-infectious treatments, treatment of excess weight, avoidance of a sedentary lifestyle) and often a repeat operation. Minimally invasive treatments, particularly laser treatments, have their place in these difficult situations.", "provenance": [ { "field": "population", "quote": "If suppuration and abscess develop" }, { "field": "intervention", "quote": "treatment is based either on medical treatment combining analgesics, local antiseptics and sometimes antibiotics, or on emergency incision and drainage in the operating room" }, { "field": "comparator", "quote": "treatment is based either on medical treatment combining analgesics, local antiseptics and sometimes antibiotics, or on emergency incision and drainage in the operating room" }, { "field": "result", "quote": "treatment is based either on medical treatment combining analgesics, local antiseptics and sometimes antibiotics, or on emergency incision and drainage in the operating room" } ] }, { "id": "pmid:39635960", "pmid": "39635960", "doi": "10.1111/codi.17254", "nctId": null, "pmcid": "PMC11683315", "title": "Acute pilonidal abscess: Prospective nationwide audit in the Netherlands", "firstAuthor": "Huurman", "multipleAuthors": true, "journal": "Colorectal Dis", "year": 2024, "design": "prospective-cohort", "n": 208, "nField": "reported", "population": "people with a sudden pilonidal abscess (an infected pocket near the tailbone)", "intervention": "surgical incision and drainage of the abscess", "comparator": "no comparison group; all patients received incision and drainage", "primaryOutcome": "wound healing, time to resume daily activities, and complications", "result": "42.2% of wounds had healed by the time of outpatient follow-up, with a median of 43 days to closure, and 4.4% had complications", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This was an observational study of surgical drainage with no comparison group, so it cannot tell you whether draining is better or worse than letting an abscess burst and heal on its own.", "directness": "indirect", "limitations": "No comparator group (e.g. no surgery or spontaneous rupture), all patients had surgical drainage so results don't show what happens without intervention.", "followUp": "1 year", "plainFinding": "Less than half healed after drainage.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39635960/", "sourceText": "AIM: The aim of this study was to assess Dutch surgical practice and outcomes for acute pilonidal abscess. METHOD: Patients with pilonidal sinus disease (PSD) who underwent surgical treatment between 1 March 2020 and 1 March 2021 at 36 participating hospitals were included in a prospective observational cohort study. For the present study, only patients with an acute abscess were included for analysis. Outcomes included symptoms, wound healing, time to resume daily activities and complications. Follow-up was 1 year and included questionnaires on recurrent abscesses, symptomatic chronic PSD, quality of life and patient-reported experience measures. RESULTS: Of 681 included patients, 208 presented with an acute pilonidal abscess. Incision and drainage (I&D) was performed in 205 of these patients (99%). The wound healing rate after I&D was 42.2% at the outpatient clinic, with a median time to closure of 43 days. The complication rate was 4.4%. One-year questionnaires were completed by 158 out of 205 patients (77.1%). Fifteen patients (7.3%) had a recurrent abscess within 1 year. The symptomatic chronic PSD rate was 8.8%. CONCLUSION: Of all the patients presenting with PSD in this prospective national study cohort, 30% had a pilonidal abscess. Incision and drainage showed a low complication rate but successful wound healing in less than half of the patients. The study showed that 91.2% of patients did not undergo additional surgical treatment for symptomatic chronic PSD within 1 year of follow-up.", "provenance": [ { "field": "n", "quote": "Of 681 included patients, 208 presented with an acute pilonidal abscess." }, { "field": "population", "quote": "only patients with an acute abscess were included for analysis" }, { "field": "intervention", "quote": "Incision and drainage (I&D) was performed in 205 of these patients (99%)." }, { "field": "comparator", "quote": "Incision and drainage (I&D) was performed in 205 of these patients (99%)." }, { "field": "primaryOutcome", "quote": "Outcomes included symptoms, wound healing, time to resume daily activities and complications." }, { "field": "result", "quote": "The wound healing rate after I&D was 42.2% at the outpatient clinic, with a median time to closure of 43 days. The complication rate was 4.4%." }, { "field": "followUp", "quote": "Follow-up was 1 year" } ] }, { "id": "pmid:39461136", "pmid": "39461136", "doi": "10.1016/j.ijscr.2024.110500", "nctId": null, "pmcid": "PMC11541939", "title": "Pilonidal granuloma formation after an incision and drainage procedure is associated with retained hair within the sinus - A case series", "firstAuthor": "Nepomuceno", "multipleAuthors": true, "journal": "Int J Surg Case Rep", "year": 2024, "design": "case-series", "n": 2, "nField": "reported", "population": "teenage boys with pilonidal cysts that had been cut open and drained", "intervention": "pit-picking procedure with removal of granuloma and hair from the sinus", "comparator": "no comparator, same patients followed after initial incision and drainage", "primaryOutcome": "whether the wound healed or kept draining/forming a granuloma", "result": "after incision and drainage, both patients developed a granuloma with ongoing drainage because hair was left inside the sinus; removing the hair and granuloma resolved it", "resultDirection": "harm", "quality": "very-low", "qualityWhy": "only two patients with no comparison group, so it cannot show what works, only what can go wrong", "directness": "indirect", "limitations": "extremely small case series of only two patients, no control group, and it describes drainage after a surgical incision rather than a cyst bursting on its own", "followUp": "", "plainFinding": "Leftover hair caused recurring drainage.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39461136/", "sourceText": "INTRODUCTION AND IMPORTANCE: Pilonidal disease may present with a draining secondary sinus or granuloma, but the development of these findings is not well-characterized. CASE PRESENTATION: Two adolescent males presented with pilonidal disease. The first patient had a gluteal cleft abscess, and an incision and drainage procedure was performed. Although the abscess resolved, the incision site formed a granuloma with intermittent draining wound with granulation tissue. He underwent a pit-picking procedure along with excision of the granuloma. A large amount of hair was also removed from within the pilonidal sinus. The second patient underwent an incision and drainage procedure to treat the pilonidal abscess. The incision site evolved into a granuloma with recurring drainage. A pit-picking procedure was performed, and the granuloma was excised. During the excision, a moderate amount of hair was evacuated from the pilonidal sinus. CLINICAL DISCUSSION: Many pilonidal patients present with a granuloma or secondary sinus at the gluteal cleft, but there has been no documentation of the natural history of this development. The role of hair is central to pilonidal disease pathophysiology and is a known factor in foreign body granuloma formation - a cutaneous inflammatory response to endogenous or exogenous material in the dermis that is not broken down readily by macrophages. CONCLUSION: Even though the pilonidal abscess was drained with an incision, a granuloma was able to form with recurrent drainage when hair was retained within the pilonidal sinus.", "provenance": [ { "field": "n", "quote": "Two adolescent males presented with pilonidal disease." }, { "field": "population", "quote": "Two adolescent males presented with pilonidal disease." }, { "field": "intervention", "quote": "He underwent a pit-picking procedure along with excision of the granuloma." }, { "field": "comparator", "quote": "an incision and drainage procedure was performed" }, { "field": "primaryOutcome", "quote": "the incision site formed a granuloma with intermittent draining wound with granulation tissue" }, { "field": "result", "quote": "Even though the pilonidal abscess was drained with an incision, a granuloma was able to form with recurrent drainage when hair was retained within the pilonidal sinus." } ] }, { "id": "pmid:39145895", "pmid": "39145895", "doi": "10.1007/s00383-024-05821-x", "nctId": null, "pmcid": null, "title": "Management and outcomes of pilonidal patients with secondary sinuses-a cohort study", "firstAuthor": "Liang", "multipleAuthors": true, "journal": "Pediatr Surg Int", "year": 2024, "design": "prospective-cohort", "n": 105, "nField": "reported", "population": "teenagers and young adults with pilonidal disease who also had a draining secondary opening near the tailbone", "intervention": "surgical removal of the pilonidal cyst along with the secondary sinus opening (Gips procedure)", "comparator": "regular hair removal (epilation) versus no regular hair removal after surgery", "primaryOutcome": "whether drainage or the cyst came back after surgery", "result": "most patients healed, but some had the drainage site reopen temporarily, and this usually went away without needing another surgery", "resultDirection": "mixed", "quality": "low", "qualityWhy": "this is a single-group observational study of surgical patients, not a controlled comparison, so it cannot show what works best", "directness": "indirect", "limitations": "no comparison group, single center, and it studies surgically excised cysts rather than cysts that burst on their own", "followUp": "367.0 days", "plainFinding": "Drainage often resolved without more surgery", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39145895/", "sourceText": "BACKGROUND: Patients with pilonidal disease (PD) can present with concurrent draining secondary sinus at the superior gluteal cleft. The natural disease course in the setting of this severe phenotype is poorly characterized. We present the largest cohort of patients with PD and concurrent secondary sinus. METHODS: Patients with PD and concurrent secondary sinus who underwent Gips procedure with secondary sinus excision from 2019 to 2023 were prospectively followed. Patient demographics, drainage recurrence, symptom resolution, treatment, and follow-up period were recorded. Recurrent drainage from previous secondary sinus site was defined as isolated painless serous drainage after the wound had closed for > 3 weeks; recurrent PD was characterized as recurrent pain and bloody drainage after excision. RESULTS: One hundred and five patients (seventy-one males) with a median age of 17.2 years [interquartile range (IQR):15.4-19.0] underwent excision of their disease and were followed for a median of 367.0 days (IQR: 173.2-658.8). Without regular epilation, six patients (5.7%, five males, one female) had recurrent PD. With regular epilation, three patients (2.8%, three males) had recurrent PD. Eight patients (7.5%, six males, two females) had recurrent secondary sinus site drainage. Median time to recurrent drainage was 75.5 days (IQR: 65.2-216.2) after excision and for recurrent drainage to resolve was 72 days (IQR: 49-81). Recurrent secondary sinus site drainage was treated with antibiotics, silver nitrate, debridement, or no treatment. CONCLUSION: Patients who present with PD in the setting of concurrent secondary sinus have a unique, more severe disease phenotype. Excision can be complicated by recurrent drainage from the secondary sinus site that can resolve without repeat surgical excision.", "provenance": [ { "field": "n", "quote": "One hundred and five patients (seventy-one males) with a median age of 17.2 years" }, { "field": "population", "quote": "Patients with PD and concurrent secondary sinus who underwent Gips procedure with secondary sinus excision from 2019 to 2023 were prospectively followed." }, { "field": "intervention", "quote": "underwent Gips procedure with secondary sinus excision" }, { "field": "comparator", "quote": "Without regular epilation, six patients (5.7%, five males, one female) had recurrent PD. With regular epilation, three patients (2.8%, three males) had recurrent PD." }, { "field": "primaryOutcome", "quote": "Patient demographics, drainage recurrence, symptom resolution, treatment, and follow-up period were recorded." }, { "field": "result", "quote": "Excision can be complicated by recurrent drainage from the secondary sinus site that can resolve without repeat surgical excision." } ] }, { "id": "pmid:39136828", "pmid": "39136828", "doi": "10.1007/s10151-024-02973-9", "nctId": null, "pmcid": null, "title": "Efficacy and safety of RD2 Ver.02, a whole blood clot therapy, coupled with a minimally invasive procedure in pilonidal sinus: a phase II study", "firstAuthor": "Ram", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2024, "design": "prospective-cohort", "n": 51, "nField": "reported", "population": "people with pilonidal sinus (infected hair-filled skin tunnel near the tailbone)", "intervention": "a minimally invasive procedure plus injection of a blood-clot product (RD2 Ver.02) into the cavity", "comparator": "none (single-arm study, no comparison group)", "primaryOutcome": "whether the wound fully healed at 3, 6, and 12 months", "result": "82.4% healed at 3 months, 90.2% at 6 months, 82.4% at 12 months, with recurrence in 11.8% of patients", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a small, single-arm study with no comparison group, so it can't show whether this treatment is better than other options.", "directness": "indirect", "limitations": "Open-label, single-arm pilot study with no control group; abstract does not address spontaneous rupture of a cyst, only a specific procedure-based treatment for diagnosed pilonidal sinus.", "followUp": "12 months", "plainFinding": "High healing rate with this specific injected procedure.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39136828/", "sourceText": "BACKGROUND: PNS is caused by an infection in the sacrococcygeal area triggered by hair particle accumulation in skin tunnels, resulting in infection. Surgical options range from simple excision to complex flap constructions. Primary wound healing failure and recurrence rates contribute to the burden of PNS. RD2 Ver.02, a novel autologous whole-blood clot product, demonstrated safety and efficacy in treating complex cutaneous wounds and was investigated for the management of PNS. METHODS: A Phase II open-label, pilot, single-arm prospective study was conducted from May 2021 to May 2023 (Ethics Committee approval #7952-20). Patients with PNS underwent a minimally invasive trephine procedure under local anesthesia followed by RD2 Ver.02 instillation into the cavity. Primary healing was assessed at 3, 6, and 12 months. Secondary outcomes included the collection of adverse events. RESULTS: Overall, 51 patients participated in the study. At 3 months, 42/51 healed (82.4%), 7/51 (13.7%) were granulating but not completely healed, and 2/51 (3.9%) failed to heal. At 6 and 12 months, 46/51 (90.2%) and 42/51 (82.4%) achieved complete healing, respectively. At 6 months, two PNSs recurred after initial healing and an additional four instances of PNS recurrence observed in 12 months, so a total of recurrence in six patients (11.8%). There were five adverse events (AEs) with no severe adverse events. CONCLUSION: RD2 Ver.02 is a safe and effective treatment of PNS when coupled with a minimally invasive trephine PNS procedure. Further comparative studies are needed to fully assess the role of this novel therapy for PNS.", "provenance": [ { "field": "n", "quote": "Overall, 51 patients participated in the study." }, { "field": "population", "quote": "Patients with PNS underwent a minimally invasive trephine procedure under local anesthesia" }, { "field": "intervention", "quote": "a minimally invasive trephine procedure under local anesthesia followed by RD2 Ver.02 instillation into the cavity" }, { "field": "comparator", "quote": "A Phase II open-label, pilot, single-arm prospective study" }, { "field": "primaryOutcome", "quote": "Primary healing was assessed at 3, 6, and 12 months." }, { "field": "result", "quote": "At 3 months, 42/51 healed (82.4%), 7/51 (13.7%) were granulating but not completely healed, and 2/51 (3.9%) failed to heal. At 6 and 12 months, 46/51 (90.2%) and 42/51 (82.4%) achieved complete healing, respectively." }, { "field": "result", "quote": "a total of recurrence in six patients (11.8%)" } ] }, { "id": "pmid:39095220", "pmid": "39095220", "doi": "10.1016/j.surg.2024.06.052", "nctId": null, "pmcid": null, "title": "Utility of synthetic electrospun fiber matrix in general surgery: From head to toe", "firstAuthor": "Hagen", "multipleAuthors": false, "journal": "Surgery", "year": 2024, "design": "retrospective", "n": 19, "nField": "reported", "population": "patients with complex, hard-to-heal wounds of many different causes, including one with a pilonidal cyst", "intervention": "a synthetic electrospun fiber matrix wound dressing applied to the wound", "comparator": "none (no comparison group; before-and-after case series)", "primaryOutcome": "whether the wound met the patient's individual clinical healing goal", "result": "89.5% of patients (17 of 19) met their individual clinical goals after treatment with the matrix, but only one patient in the series had a pilonidal cyst and no separate result was given for that case", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a tiny, uncontrolled retrospective case series mixing many different wound types, with only a single pilonidal cyst case and no isolated outcome for it.", "directness": "indirect", "limitations": "Retrospective, no control group, very small and mixed-etiology sample, and only one case was a pilonidal cyst with no individual outcome reported for it.", "followUp": "", "plainFinding": "No specific pilonidal cyst outcome reported.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39095220/", "sourceText": "BACKGROUND: To highlight the role of a novel synthetic electrospun fiber matrix in the treatment of high-risk wounds across a range of etiologies. METHODS: This was a retrospective study of patients at a single institution who underwent complex wound care treatment with at least 1 application of the electrospun fiber matrix from January 2021 to December 2022. Information regarding patient demographics, wound size and etiologies, pertinent medical history, and treatment outcomes was collected. RESULTS: Twenty-one patients with 24 complex wounds who received synthetic electrospun fiber matrix treatment were identified. Nineteen patients (22 wounds) met the inclusion criteria for analysis. Patient mean age was 63.58 ± 15.20 (range 34-90) years. A wide range of wound etiologies was represented, including transmetatarsal amputation secondary to frostbite (n = 1), post-Mohs defect (n = 2), acute trauma (n = 3), surgical dehiscence (n = 3), infected implanted medical device (n = 2), chronic ulcers (n = 3), partial ray resection (n = 1), pilonidal cyst (n = 1), rattlesnake bite (n = 1), necrotizing soft-tissue infection (n = 1), and others (n = 2). A total of 17 of 19 (89.5%) patients were observed to meet their individual clinical goals after application of the wound matrix. Wound ages ranged from 1 to 429 days before initial synthetic electrospun fiber matrix application. CONCLUSION: The synthetic nature of the matrix limits the risk of inflammatory response and is well tolerated, which demonstrates initial proof of concept of synthetic electrospun fiber matrix treatment in a variety of complex wounds. The positive results observed across this mixed etiology surgical analysis should be replicated in future controlled, single-etiology studies to further confirm the utility of the electrospun fiber matrix in the surgical setting.", "provenance": [ { "field": "n", "quote": "Nineteen patients (22 wounds) met the inclusion criteria for analysis." }, { "field": "population", "quote": "pilonidal cyst (n = 1)" }, { "field": "intervention", "quote": "complex wound care treatment with at least 1 application of the electrospun fiber matrix" }, { "field": "comparator", "quote": "This was a retrospective study of patients at a single institution" }, { "field": "primaryOutcome", "quote": "A total of 17 of 19 (89.5%) patients were observed to meet their individual clinical goals after application of the wound matrix." }, { "field": "result", "quote": "A total of 17 of 19 (89.5%) patients were observed to meet their individual clinical goals after application of the wound matrix." } ] }, { "id": "pmid:38478417", "pmid": "38478417", "doi": "10.12968/bjcn.2024.29.Sup3.S26", "nctId": null, "pmcid": null, "title": "Commentary on packing vs non-packing of pilonidal sinus cavities after incision and drainage", "firstAuthor": "King", "multipleAuthors": true, "journal": "Br J Community Nurs", "year": 2024, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "People with pilonidal sinus disease treated with incision and drainage", "intervention": "Packing the wound cavity after incision and drainage", "comparator": "Not packing the wound cavity after incision and drainage", "primaryOutcome": "Comparative outcomes after packing versus not packing the abscess cavity", "result": "This abstract only critiques the methods of an earlier review; it does not state which approach worked better for pilonidal sinus patients", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a commentary critically appraising another review's methods rather than presenting new patient data or outcomes.", "directness": "indirect", "limitations": "The underlying review it critiques covered cutaneous abscesses anywhere on the body, not specifically pilonidal sinus disease, and this abstract gives no new outcome data.", "followUp": "", "plainFinding": "No result reported; only a methods critique", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38478417/", "sourceText": "Pilonidal sinus disease (PSD) manifests as an inflammatory skin condition typically emerging within the anal cleft. The prevalence of this disease varies in high income countries. This disease is associated with significant physical and psychosocial distress. Surgery is an option for managing PSD; yet, surgical methods vary, and a universally accepted gold standard approach is lacking, leading to current practices that are diverse and subject to ongoing debate. One such point of contention revolves around the decision to use packing or opt for a non-packing approach following surgery. Mohamedahmed et al (2021) conducted a systematic review to evaluate the comparative outcomes of packing versus non-packing of an abscess cavity following incision and drainage of cutaneous abscess on any part of the body. This commentary aims to critically appraise the methods used within the review by Mohamedahmed et al (2021) and expand upon the findings in the context of treatment and management of PSD.", "provenance": [ { "field": "population", "quote": "Pilonidal sinus disease (PSD) manifests as an inflammatory skin condition typically emerging within the anal cleft." }, { "field": "intervention", "quote": "packing versus non-packing of an abscess cavity following incision and drainage of cutaneous abscess on any part of the body" }, { "field": "comparator", "quote": "packing versus non-packing of an abscess cavity following incision and drainage of cutaneous abscess on any part of the body" }, { "field": "primaryOutcome", "quote": "to evaluate the comparative outcomes of packing versus non-packing of an abscess cavity following incision and drainage of cutaneous abscess on any part of the body" }, { "field": "result", "quote": "This commentary aims to critically appraise the methods used within the review by Mohamedahmed et al (2021) and expand upon the findings in the context of treatment and management of PSD." } ] }, { "id": "pmid:37974345", "pmid": "37974345", "doi": "10.3760/cma.j.cn441530-20231007-00116", "nctId": null, "pmcid": null, "title": "[Chinese expert consensus on the diagnosis and treatment of sacrococcygeal pilonidal disease (2023 edition)]", "firstAuthor": "Anorectal Branch of Chinese Medical Doctor Association", "multipleAuthors": true, "journal": "Zhonghua Wei Chang Wai Ke Za Zhi", "year": 2023, "design": "guideline", "n": null, "nField": "not-reported", "population": "people with sacrococcygeal pilonidal disease", "intervention": "various treatments for pilonidal disease (hair removal, sinusectomy, surgery, minimally invasive treatment, wound management)", "comparator": "", "primaryOutcome": "standardized diagnosis and treatment recommendations", "result": "The abstract does not report specific guidance on what to do if a cyst bursts on its own; it describes a consensus process forming opinions on diagnosis, risk factors, non-surgical and surgical treatment, minimally invasive treatment, and wound management.", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is an expert consensus statement based on opinion and literature summary, not original research testing a specific intervention or outcome.", "directness": "indirect", "limitations": "The abstract gives no original data, no patient numbers, and no specific statement about spontaneously ruptured cysts; it is a general consensus document.", "followUp": "", "plainFinding": "No specific guidance given here.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37974345/", "sourceText": "Sacrococcygeal pilonidal disease(SPD) is an acquired disease intimately related to the presence of hair in the gluteal groove. Although its pathogenesis is still controversial, numerous treatment options are available for SPD including gluteal groove and surrounding skin hair removal, sinusectomy, open healing by secondary intention, primary closure, and local excision with flap reconstruction. Lacking of standardized diagnosis and treatment processes of SPD in China, Chinese Medical Doctor Association Anorectal Branch and its Clinical Guidelines Committee jointly organized experts in this field to form expert consensus opinion on the basis of summarizing latest research progress in China and abroad, experts' clinical experience and principles of evidence-based medicine. The expert group formed opinion in 12 terms of SPD diagnosis, risk factors, non-surgical treatment, surgical treatment, minimally invasive treatment, and wound management, and developed the \"Chinese expert consensus on the diagnosis and treatment of sacrococcygeal pilonidal disease (2023 edition)\" after rounds of discussion and revision, to improve the diagnosis and treatment of SPD.", "provenance": [ { "field": "population", "quote": "Sacrococcygeal pilonidal disease(SPD) is an acquired disease intimately related to the presence of hair in the gluteal groove." }, { "field": "intervention", "quote": "numerous treatment options are available for SPD including gluteal groove and surrounding skin hair removal, sinusectomy, open healing by secondary intention, primary closure, and local excision with flap reconstruction" }, { "field": "primaryOutcome", "quote": "formed opinion in 12 terms of SPD diagnosis, risk factors, non-surgical treatment, surgical treatment, minimally invasive treatment, and wound management" }, { "field": "result", "quote": "developed the \"Chinese expert consensus on the diagnosis and treatment of sacrococcygeal pilonidal disease (2023 edition)\" after rounds of discussion and revision, to improve the diagnosis and treatment of SPD." } ] }, { "id": "pmid:37419810", "pmid": "37419810", "doi": "10.1016/j.asjsur.2023.06.111", "nctId": null, "pmcid": null, "title": "A meta-analysis comparing phenol treatment with surgical excision for pilonidal sinus", "firstAuthor": "Gan", "multipleAuthors": true, "journal": "Asian J Surg", "year": 2024, "design": "meta-analysis", "n": null, "nField": "not-reported", "population": "people with pilonidal sinus disease", "intervention": "phenol treatment", "comparator": "surgical excision", "primaryOutcome": "disease recurrence and wound complications", "result": "Phenol had similar recurrence to surgery, fewer wound complications, and faster recovery", "resultDirection": "benefit", "quality": "low", "qualityWhy": "Pools mostly non-randomized studies (9 of 14 non-RCTs) comparing two active treatments, not addressing what to do about a sinus that has already burst on its own.", "directness": "indirect", "limitations": "Mix of RCTs and non-RCTs; not about spontaneous rupture of a cyst but about chosen treatments for pilonidal sinus disease.", "followUp": "", "plainFinding": "Phenol as good as surgery, fewer complications.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37419810/", "sourceText": "Pilonidal sinus is a chronic condition characterized by inflammation, swelling, and pain in the sacrococcygeal region. In recent years, the rate of recurrence and wound complications in PSD remains high, and no treatment is universally accepted. This study aimed to compare the efficacy of phenol treatment with surgical excision treatment for PSD through a meta-analysis of controlled clinical trials. We searched three electronic databases, PubMed, Embase, and Cochrane library, to comprehensively search the literature comparing phenol treatment and surgical treatment of pilonidal sinus. Fourteen publications were included, including five RCTs and nine non-RCTs. The phenol group had a slightly higher rate of disease recurrence than the surgical group (RR = 1.12, 95% CI [0.77,1.63]), but the difference was not statistically significant (P = 0.55 > 0.05). As compared to the surgical group, wound complications were considerably less common (RR = 0.40, 95% CI [0.27,0.59]). Phenol treatment resulted in a significantly shorter operating time than surgery treatment (weighted mean difference -22.76, 95% CI [-31.13,-14.39]). The time to return to daily work was considerably shorter than in the surgical group (weighted mean difference -10.11, 95% CI [-14.58,-5.65]). Postoperative complete healing time was significantly shorter than surgical healing time (weighted mean difference -17.11, 95% CI [-32.18,-2.03]). Phenol treatment is effective for pilonidal sinus disease, and its recurrence rate is not significantly different from surgical treatment. The greatest advantage of phenol treatment is the low incidence of wound complications. Moreover, the time required for treatment and recovery are significantly lower than for surgical treatment.", "provenance": [ { "field": "population", "quote": "comparing phenol treatment and surgical treatment of pilonidal sinus" }, { "field": "intervention", "quote": "phenol treatment" }, { "field": "comparator", "quote": "surgical excision" }, { "field": "primaryOutcome", "quote": "recurrence rate is not significantly different from surgical treatment" }, { "field": "result", "quote": "wound complications were considerably less common (RR = 0.40, 95% CI [0.27,0.59])" }, { "field": "result", "quote": "The phenol group had a slightly higher rate of disease recurrence than the surgical group (RR = 1.12, 95% CI [0.77,1.63]), but the difference was not statistically significant (P = 0.55 > 0.05)." } ] }, { "id": "pmid:37259676", "pmid": "37259676", "doi": "10.1111/iwj.14242", "nctId": null, "pmcid": "PMC10588333", "title": "Non-operative management of pilonidal sinus disease; classification and outcome", "firstAuthor": "Salih", "multipleAuthors": true, "journal": "Int Wound J", "year": 2023, "design": "prospective-cohort", "n": 3529, "nField": "reported", "population": "people with pilonidal sinus disease on the lower back/buttocks crease", "intervention": "a non-surgical treatment called Salih's preparation (antimicrobial and scarring solution)", "comparator": "no direct comparison group; outcomes tracked after treatment", "primaryOutcome": "whether the pilonidal sinus came back (recurrence) after treatment", "result": "having an abscess was the strongest factor linked to the sinus coming back, and patients could be grouped into three risk classes for recurrence", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This study only followed one group of patients without a comparison group and relied on choosing a subset of a much larger patient pool, so it can't reliably show whether this treatment is better than other options.", "directness": "indirect", "limitations": "Single-group design with no control group, large exclusion of patients from the original pool, short 6-week follow-up, and no mention of randomization.", "followUp": "6 weeks", "plainFinding": "Non-surgical treatment lowered recurrence risk.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37259676/", "sourceText": "The characteristics of the pilonidal sinus that are associated with recurrence have scarcely been investigated in the literature. This study aims to evaluate the outcomes of patients with sacrococcygeal pilonidal sinus disease who were managed by a non-operative technique using Salih's preparation. This study also tries to classify the patients according to the features that determine the outcome of the intervention. This is a single-group cohort study that enrolled consecutive patients that had pilonidal sinus. All the patients were managed using Salih's preparation. The patients were seen at the clinic 6 weeks after the intervention to record data of recurrence. The Statistical Package for the Social Sciences (SPSS) Version 25 was used for coding and analysing the data. Test of significance and odds ratio were calculated for all of the features. The total number of patients receiving Salih's preparation was 12 123 cases, of which only 3529 patients were included in this study. The mean age of the participants was 26.95 years, ranging from 14 to 55 years. The most significant factor related to the recurrence was the presence of an abscess. After summation of all odd ratios, the percentage of each one from the total was calculated, and accordingly, the patients were divided into three classes. Non-operative methods using a preparation with antimicrobial and sclerosing properties can be an alternative for surgical intervention with a lower risk of recurrence. Classification of patients based on specific criteria can give clinicians and even patients themselves a vision of the chance of recurrence and treatment success.", "provenance": [ { "field": "population", "quote": "patients with sacrococcygeal pilonidal sinus disease" }, { "field": "intervention", "quote": "managed by a non-operative technique using Salih's preparation" }, { "field": "comparator", "quote": "This is a single-group cohort study that enrolled consecutive patients that had pilonidal sinus." }, { "field": "primaryOutcome", "quote": "The patients were seen at the clinic 6 weeks after the intervention to record data of recurrence." }, { "field": "result", "quote": "The most significant factor related to the recurrence was the presence of an abscess." }, { "field": "n", "quote": "only 3529 patients were included in this study" }, { "field": "followUp", "quote": "seen at the clinic 6 weeks after the intervention" } ] }, { "id": "pmid:37256592", "pmid": "37256592", "doi": "10.1001/jamasurg.2023.0373", "nctId": null, "pmcid": null, "title": "Management of Pilonidal Disease: A Review", "firstAuthor": "Gil", "multipleAuthors": true, "journal": "JAMA Surg", "year": 2023, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with pilonidal disease", "intervention": "the range of treatments used for pilonidal disease, from conservative care to surgery", "comparator": "different treatment modalities compared with each other", "primaryOutcome": "disease recurrence and treatment-related complications", "result": "the review concludes evidence on treatment options is limited and inconsistent, and it does not describe what to do when a cyst bursts on its own", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a general review describing many treatment options rather than a study testing one specific treatment, and it states the underlying evidence is weak and inconsistent.", "directness": "indirect", "limitations": "the current evidence supporting the different treatment options is limited by study quality with inconsistent characterization of disease severity and use of variable definitions and reporting of treatment-associated outcomes across studies", "followUp": "", "plainFinding": "Doesn't address spontaneous rupture directly.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37256592/", "sourceText": "IMPORTANCE: The management of pilonidal disease continues to be a challenge due to high rates of recurrence and treatment-associated morbidity. OBSERVATIONS: There is a heterogeneous repertoire of treatment modalities used in the management of pilonidal disease and wide practice variation among clinicians. Available treatment options vary considerably in their level of invasiveness, associated morbidity and disability, risks of complications, and effectiveness at preventing disease recurrence. Conservative nonoperative management strategies, including persistent improved hygiene, depilation, and lifestyle modification, focus on disease prevention and minimization of disease activity. Epilation techniques using both laser and intense pulse light therapy are also used as primary and adjunct treatment modalities. Other nonoperative treatment modalities include phenol and fibrin injection to promote closure of pilonidal sinuses. The traditional operative management strategy for pilonidal disease involves excision of affected tissue paired with a variety of closure types including primary midline closure, primary off-midline closure techniques (ie, Karydakis flap, Limberg flap, Bascom cleft lift), and healing by secondary intention. There has been a recent shift toward more minimally invasive operative approaches including sinusectomy (ie, trephination or Gips procedure) and endoscopic approaches. Overall, the current evidence supporting the different treatment options is limited by study quality with inconsistent characterization of disease severity and use of variable definitions and reporting of treatment-associated outcomes across studies. CONCLUSIONS AND RELEVANCE: Pilonidal disease is associated with significant physical and psychosocial morbidity. Optimal treatments will minimize disease and treatment-associated morbidity. There is a need for standardization of definitions used to characterize pilonidal disease and its outcomes to develop evidence-based treatment algorithms.", "provenance": [ { "field": "population", "quote": "the management of pilonidal disease continues to be a challenge" }, { "field": "intervention", "quote": "There is a heterogeneous repertoire of treatment modalities used in the management of pilonidal disease" }, { "field": "comparator", "quote": "wide practice variation among clinicians" }, { "field": "primaryOutcome", "quote": "high rates of recurrence and treatment-associated morbidity" }, { "field": "result", "quote": "the current evidence supporting the different treatment options is limited by study quality with inconsistent characterization of disease severity and use of variable definitions and reporting of treatment-associated outcomes across studies" } ] }, { "id": "pmid:36598614", "pmid": "36598614", "doi": "10.1007/s10151-022-02740-8", "nctId": null, "pmcid": null, "title": "The value of honey dressings in pilonidal cyst healing: a prospective randomized single-center trial", "firstAuthor": "Abet", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2023, "design": "rct", "n": 100, "nField": "reported", "population": "adults with a wound that hadn't healed 6 weeks after surgical removal of a pilonidal cyst", "intervention": "alginate wick dressing plus honey", "comparator": "alginate wick dressing alone", "primaryOutcome": "time for the wound to heal", "result": "healing took about 61 days with honey versus 78 days without, but the difference was not statistically significant", "resultDirection": "no-benefit", "quality": "moderate", "qualityWhy": "it was a randomized trial but did not show a statistically significant difference and included a modest number of patients", "directness": "indirect", "limitations": "did not reach significance on its main outcome; studies patients with persistent wounds after surgical excision, not a spontaneously burst, untreated cyst", "followUp": "", "plainFinding": "No clear healing benefit from honey.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36598614/", "sourceText": "BACKGROUND: Honey is described as a wound healing agent. Many virtues have been attributed to it, in particular, antibacterial properties. The aim of our study was to evaluate its value in healing of wounds after wide excision on pilonidal cyst healing. METHODS: A prospective randomized trial was conducted from March 2016 to February 2022 which included patients with a persistent non healed wound which required packing 6 weeks after pilonidal cyst excision. Patients were randomly allocated to simple alginate wick dressings or the same design plus honey. RESULTS: Fifty patients were included in each arm. There were 57 men and 43 women. The median age was 22 years (range 19-28 years). The mean healing time was 61 (± 44) days in the wick + honey group compared to 78 (± 55) days in the simple alginate wick group (p = 0.094). There was no significant difference between the two groups in terms of time off work and time without physical activity The VQ-Dermato quality of life score was equivalent in both groups. CONCLUSIONS: Tolerability for honey dressings is good and is equivalent to that of alginate dressings in cavity wound care. This trial did not reach a significant difference in its primary endpoint but it shows the value of honey in this indication, although its use requires further study. TRIAL REGISTRATION NUMBER: CLINICAL TRIALS: NCT02485860 and EUDRACT: 2015-A00452-47 (10/03/2015).", "provenance": [ { "field": "n", "quote": "Fifty patients were included in each arm." }, { "field": "population", "quote": "patients with a persistent non healed wound which required packing 6 weeks after pilonidal cyst excision" }, { "field": "intervention", "quote": "simple alginate wick dressings or the same design plus honey" }, { "field": "comparator", "quote": "simple alginate wick dressings" }, { "field": "primaryOutcome", "quote": "The mean healing time was 61 (± 44) days in the wick + honey group compared to 78 (± 55) days in the simple alginate wick group (p = 0.094)." }, { "field": "result", "quote": "This trial did not reach a significant difference in its primary endpoint" } ] }, { "id": "pmid:36542008", "pmid": "36542008", "doi": "10.1590/0102-672020220002e1713", "nctId": null, "pmcid": "PMC9767422", "title": "RADICAL VERSUS CONSERVATIVE METHODS IN ONE-STAGE PILONIDAL ABSCESS SURGERY: THE EXPERIENCE OF A TUNISIAN CENTER", "firstAuthor": "Mahjoubi", "multipleAuthors": true, "journal": "Arq Bras Cir Dig", "year": 2022, "design": "retrospective", "n": 57, "nField": "reported", "population": "patients who had surgery for a pilonidal abscess", "intervention": "radical surgery (excision)", "comparator": "conservative surgery (incision, with curettage or drainage)", "primaryOutcome": "recurrence of the cyst after surgery, plus healing time and return to activity", "result": "excision had less recurrence (19% vs 54%) but took longer to heal and longer to return to activity than incision", "resultDirection": "mixed", "quality": "low", "qualityWhy": "it is a small, non-randomized comparison of surgical techniques, not a study of spontaneous rupture or its management.", "directness": "indirect", "limitations": "not randomized, small sample, compares two surgical approaches rather than addressing spontaneous rupture or non-surgical management", "followUp": "", "plainFinding": "Excision: fewer recurrences, slower healing.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36542008/", "sourceText": "BACKGROUND: Surgical treatment for pilonidal abscess is the gold standard, but not yet well codified. Different techniques proposed can be conservative or radical. AIMS: The aim of our study was to compare postoperative outcomes of both methods in one-stage treatment strategy. METHODS: This is a comparative study including patients operated on for pilonidal abscess, with a satisfactory postoperative follow-up, over a period of 4 years. We looked for the occurrence of postoperative recurrence in the medical records or by interviewing reachable patients. RESULTS: We analyzed 57 patients: 33 males and 24 females. The mean age was 26.9±10 years. The type of operation was excision in 46 (81%) cases and incision in 11 (19%) cases associated with curettage in three cases and drainage in 1 case. There was no statistically significant relationship between the type of surgery and the occurrence of postoperative surgical complications (p=1) and hospital stay (p=0.4). Excision of pilonidal abscess was significantly associated with a longer time to return to activity (p=0.04). Conservative surgery was significantly associated with faster healing of the surgical wound (p<0.001). The recurrence rate was 19% in radical surgery and 54% in conservative surgery. Radical surgery was significantly associated with a lower recurrence rate than incision procedure (p=0.02). CONCLUSIONS: Excision of pilonidal abscess was the common technique in our series, with a significantly lower rate of recurrence of the disease than after incision. However, the long convalescence following excision and the longer operating time, particularly in an emergency context, may sometimes lead to choosing conservative surgery.", "provenance": [ { "field": "n", "quote": "We analyzed 57 patients" }, { "field": "population", "quote": "patients operated on for pilonidal abscess" }, { "field": "intervention", "quote": "Excision of pilonidal abscess" }, { "field": "comparator", "quote": "incision in 11 (19%) cases associated with curettage in three cases and drainage in 1 case" }, { "field": "primaryOutcome", "quote": "We looked for the occurrence of postoperative recurrence" }, { "field": "result", "quote": "The recurrence rate was 19% in radical surgery and 54% in conservative surgery." }, { "field": "result", "quote": "Conservative surgery was significantly associated with faster healing of the surgical wound (p<0.001)." }, { "field": "result", "quote": "Excision of pilonidal abscess was significantly associated with a longer time to return to activity (p=0.04)." } ] }, { "id": "pmid:36102566", "pmid": "36102566", "doi": "10.1097/XCS.0000000000000356", "nctId": null, "pmcid": null, "title": "Resolution of Mild Pilonidal Disease in Adolescents Without Resection", "firstAuthor": "Check", "multipleAuthors": true, "journal": "J Am Coll Surg", "year": 2022, "design": "case-series", "n": 102, "nField": "reported", "population": "adolescents and young adults with mild pilonidal disease", "intervention": "improved hygiene, excision of pits under local anesthesia, and laser hair removal of follicles", "comparator": "none - single group, compared to historical approach of hygiene alone or surgical resection mentioned only in background", "primaryOutcome": "resolution of pilonidal disease", "result": "77 of the 78 who continued care had resolution of their pilonidal disease", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a single-group case series with no comparison group and nearly a quarter of patients lost to follow-up, so it cannot prove this approach is better than other options.", "directness": "indirect", "limitations": "No control group, 24 of 102 patients lost to follow-up, and many patients had already had a prior drainage procedure, so it does not directly show what happens if a cyst simply bursts on its own without any treatment.", "followUp": "30 ± 19 weeks", "plainFinding": "Minor procedures resolved mild pilonidal disease.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36102566/", "sourceText": "BACKGROUND: Pilonidal disease is a common condition of the gluteal crease, affecting around 1 in 2,000 adolescents and young adults. 1 Traditional options for management of pilonidal disease include improved hygiene with or without hair removal or resection of the nidus. Given a high recurrence rate associated with hygiene alone, nidus resection is often recommended, even for patients with mild pilonidal disease, despite significant postoperative morbidity. We present a consecutive series of patients with mild pilonidal disease managed in a dedicated Pilonidal Care Clinic using an alternate approach directed toward source control: improved hygiene to limit debris in the gluteal crease, excision of midline pilonidal pits under local anesthesia to prevent intrusion of debris with drainage of any nidus present, and laser ablation of midline follicles to prevent new pits from forming. 2. STUDY DESIGN: Data on demographics, disease severity, symptom scoring, treatments provided, and outcome for consecutive new patients presenting to an outpatient pilonidal care clinic with mild disease between August 2017 and September 2020 were analyzed. RESULTS: One hundred two patients presented; their mean age was 16.3 years, 56 (55%) were female, and 42 (41%) had undergone prior nidus incision and drainage. Twenty-four were lost to follow up, and 77 of the 78 who continued care had resolution of their pilonidal disease after a mean of 3 ± 2.5 laser epilations and 1.3 ± 1 pit excisions during 4 ± 2 clinic visits over a treatment duration of 30 ± 19 weeks. CONCLUSION: Mild pilonidal disease may be resolved with improved hygiene, pit excision, and laser epilation with minimal morbidity and no activity restrictions. Adoption of this approach may keep a large number of patients with pilonidal disease from undergoing unindicated resection.", "provenance": [ { "field": "n", "quote": "One hundred two patients presented" }, { "field": "population", "quote": "Pilonidal disease is a common condition of the gluteal crease, affecting around 1 in 2,000 adolescents and young adults." }, { "field": "population", "quote": "consecutive new patients presenting to an outpatient pilonidal care clinic with mild disease" }, { "field": "intervention", "quote": "improved hygiene to limit debris in the gluteal crease, excision of midline pilonidal pits under local anesthesia to prevent intrusion of debris with drainage of any nidus present, and laser ablation of midline follicles to prevent new pits from forming" }, { "field": "comparator", "quote": "Traditional options for management of pilonidal disease include improved hygiene with or without hair removal or resection of the nidus." }, { "field": "primaryOutcome", "quote": "resolution of their pilonidal disease" }, { "field": "result", "quote": "77 of the 78 who continued care had resolution of their pilonidal disease after a mean of 3 ± 2.5 laser epilations and 1.3 ± 1 pit excisions during 4 ± 2 clinic visits over a treatment duration of 30 ± 19 weeks" } ] }, { "id": "pmid:35658277", "pmid": "35658277", "doi": "10.1016/j.ijscr.2022.107080", "nctId": null, "pmcid": "PMC9171532", "title": "Ending surgical site infection by negative pressure wound therapy (NPWT): A case report", "firstAuthor": "Arad", "multipleAuthors": true, "journal": "Int J Surg Case Rep", "year": 2022, "design": "case-series", "n": 1, "nField": "reported", "population": "a man with diabetes who developed an infected wound after pilonidal cyst surgery", "intervention": "negative pressure wound therapy (vacuum dressing)", "comparator": "routine dressing changes and IV antibiotics", "primaryOutcome": "complete wound healing", "result": "the wound healed completely after about 2 months of vacuum therapy", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a single patient case report with no comparison group, so it cannot show whether the treatment itself caused the improvement.", "directness": "indirect", "limitations": "single case report; no control group; findings from one patient cannot be generalized", "followUp": "about 2 months", "plainFinding": "Vacuum therapy healed infected surgical wound.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35658277/", "sourceText": "INTRODUCTION AND IMPORTANCE: Hundreds of millions of people may go through surgery every year worldwide. Surgical site infection (SSI) is one of the most common complications of the surgery. SSI increases the duration of treatment, delays wound healing, increases the use of antibiotics, and in severe cases, causes patient death and imposes high costs on the patient and the health care system. CASE PRESENTATION: The present case report is a 45-year-old man with a history of 8-years type 2 diabetes who underwent surgery for a pilonidal cyst. Despite routine dressing changes (cleansing the wound with saline and applying sterile gauze) twice a day and intravenous (IV) antibiotic therapy, no improvement was observed and the wound became infected. The patient was referred to our wound care team. NPWT (applying a pressure of 125 mm Hg intermittently) was performed 4 times a day for one week. Also, after each session until the beginning of the next session, the patient's wound was bandaged. The patient's wound healed completely after about 2 months. CLINICAL DISCUSSION: Patients with diabetes mellitus will have difficulty in wound healing due to microvascular changes. Thus, efficient therapeutic methods such as surgical debridement, maggot therapy, and NPWT are necessary for management of surgical site infection. CONCLUSION: This case report was showed that NPWT is an affordable and highly efficacious treatment method for management of SSI in patients with diabetes mellitus. Therefore, it is suggested that wound care teams may use NPWT to treat SSIs.", "provenance": [ { "field": "population", "quote": "a 45-year-old man with a history of 8-years type 2 diabetes who underwent surgery for a pilonidal cyst" }, { "field": "intervention", "quote": "NPWT (applying a pressure of 125 mm Hg intermittently) was performed 4 times a day for one week" }, { "field": "comparator", "quote": "routine dressing changes (cleansing the wound with saline and applying sterile gauze) twice a day and intravenous (IV) antibiotic therapy, no improvement was observed" }, { "field": "primaryOutcome", "quote": "The patient's wound healed completely after about 2 months." }, { "field": "result", "quote": "The patient's wound healed completely after about 2 months." }, { "field": "n", "quote": "a 45-year-old man" } ] }, { "id": "pmid:35043571", "pmid": "35043571", "doi": "10.1111/iwj.13752", "nctId": null, "pmcid": "PMC9493221", "title": "The role of alginate dressings in wound healing and quality of life after pilonidal sinus resection: A randomised controlled trial", "firstAuthor": "Mamaloudis", "multipleAuthors": true, "journal": "Int Wound J", "year": 2022, "design": "rct", "n": 65, "nField": "reported", "population": "patients who had surgical excision of a pilonidal cyst", "intervention": "alginate dressings with silver and cellulose on the surgical wound", "comparator": "simple gauze dressings", "primaryOutcome": "time for the wound to heal", "result": "no difference in wound healing time between dressing types", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "small randomised trial with an admittedly suboptimal sample size and other limitations noted by the authors", "directness": "indirect", "limitations": "small sample size and several study limitations acknowledged by the authors", "followUp": "", "plainFinding": "No benefit from alginate dressings after surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35043571/", "sourceText": "In this trial, we evaluated the role of alginate dressings in the secondary intention wound healing and quality of life (QoL) after pilonidal sinus resection. The study was designed as a prospective randomised controlled trial (RCT). In the experimental group, alginate dressings with silver and high-G cellulose were introduced after elective pilonidal cyst excision, whereas in the control group, simple gauges were used. The primary end point was the difference in terms of the wound healing period. Blinding existed at the level of the investigator. Overall, 65 patients were included during the study period. Wound healing duration was comparable between the two groups (P = .381). No difference in postoperative pain scores or recovery outcomes was found. The experimental group was associated with reduced wound secretions at specific time end points. Similarly, no effect was identified, on overall Wound-QoL or SF-36 scores. Alginate dressings do not accelerate wound healing or improve QoL. Due to suboptimal sample size and several study limitations, further RCTs are required to confirm our findings.", "provenance": [ { "field": "n", "quote": "Overall, 65 patients were included during the study period." }, { "field": "population", "quote": "after elective pilonidal cyst excision" }, { "field": "intervention", "quote": "alginate dressings with silver and high-G cellulose were introduced after elective pilonidal cyst excision" }, { "field": "comparator", "quote": "in the control group, simple gauges were used" }, { "field": "primaryOutcome", "quote": "The primary end point was the difference in terms of the wound healing period." }, { "field": "result", "quote": "Wound healing duration was comparable between the two groups (P = .381)." } ] }, { "id": "pmid:35000582", "pmid": "35000582", "doi": "10.1186/s13741-021-00237-w", "nctId": null, "pmcid": "PMC8744332", "title": "Does application of honey improve surgical outcome in pilonidal cyst excision with secondary intention healing? A prospective randomized placebo-controlled clinical trial", "firstAuthor": "Salehi", "multipleAuthors": true, "journal": "Perioper Med (Lond)", "year": 2022, "design": "rct", "n": 48, "nField": "reported", "population": "patients who had surgery to remove a pilonidal cyst with open wound healing", "intervention": "honey gel applied to the surgical wound", "comparator": "placebo gel applied to the surgical wound", "primaryOutcome": "wound healing time, pain, return to daily activities, and other wound outcomes", "result": "honey group healed faster and returned to activities sooner, but had more pain and used more pain medicine; no difference in smell or discharge", "resultDirection": "mixed", "quality": "low", "qualityWhy": "it is a single small randomized trial of only 48 patients from one hospital, so the results may not be reliable enough to generalize.", "directness": "indirect", "limitations": "small sample size, single center, and the abstract does not specify a single primary outcome among the many measured.", "followUp": "90 days", "plainFinding": "Faster healing but more pain", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35000582/", "sourceText": "BACKGROUND: Pilonidal sinus disease (PSD) is a common chronic inflammatory debilitating illness caused by ingrowth of hair into the skin. Excision and healing by secondary intention is one of the acceptable managements. The post-operative wound care needs frequent and time-consuming follow-ups. Honey is considered to be a traditional remedy for wound healing. The current study aimed at finding if application of honey could improve surgical outcome in pilonidal cyst excision with secondary intention healing. METHODS: This study was designed as a randomized placebo-controlled parallel assignment interventional (clinical trial) study conducted at the surgical ward of Shahid Beheshti Hospital affiliated to the Yasuj University of Medical sciences, Yasuj, Iran, and was consisted of the 48 patients who underwent surgical resection for PSD with secondary intention healing (24 patients in intervention and placebo-controlled groups). The main element of honey medicinal gel was the unheated natural honey of Dena Biosphere Reserve within the Zagros Mountains. Patients' wounds were visited by a surgeon and a nurse on the days 7, 15, 30, 45, 60, and 90 post-operation. The surgical outcomes including the time to complete wound healing, pain intensity, odor, discharge at the site of surgery, use of analgesics, the time of to return to the daily activities, and occurring of any side effects including infection, erythema, and bleeding were all recorded. RESULTS: In intervention group, there was significantly lower wound healing time, the lower time to return to the daily activities, lower mean wound volume at the days of 30, 45, 60, and 90 of the follow-up, higher mean post-operative pain level at the days of 15, 30, 45, 60, and 90 of the follow-up, and more usage of analgesics at the days of 15, 30, 45, and 60 of the follow-up. There was no significant difference between intervention and placebo-controlled groups according to the foul smell and fluid discharge at the site of the operation. There were no side effects and complications in both groups of the study. CONCLUSIONS: Application of honey after resection surgery with secondary wound healing is associated with a better surgical outcome and could eventually decrease healing time and reduce duration of return to normal activities, but could increase post-operation pain and analgesic consumption, and no effect on foul smell and discharge. TRIAL REGISTRATION: The project was found to be in accordance to the ethical principles and the national norms and standards for conducting research in Iran with the approval ID and date of IR.YUMS.REC.1399.088 and 2020.05.30 respectively, and is the result of a residency dissertation to get the specialty in general surgery, which has been registered with the research project number 960508 in the Vice Chancellor for Research and Technology Development of Yasuj University of Medical Sciences, Yasuj, Iran, URL: https://ethics. RESEARCH: ac.ir/EthicsProposalViewEn.php?id=144742.", "provenance": [ { "field": "population", "quote": "48 patients who underwent surgical resection for PSD with secondary intention healing" }, { "field": "intervention", "quote": "The main element of honey medicinal gel was the unheated natural honey of Dena Biosphere Reserve within the Zagros Mountains." }, { "field": "comparator", "quote": "24 patients in intervention and placebo-controlled groups" }, { "field": "primaryOutcome", "quote": "The surgical outcomes including the time to complete wound healing, pain intensity, odor, discharge at the site of surgery, use of analgesics, the time of to return to the daily activities, and occurring of any side effects including infection, erythema, and bleeding were all recorded." }, { "field": "result", "quote": "In intervention group, there was significantly lower wound healing time, the lower time to return to the daily activities, lower mean wound volume at the days of 30, 45, 60, and 90 of the follow-up, higher mean post-operative pain level at the days of 15, 30, 45, 60, and 90 of the follow-up, and more usage of analgesics at the days of 15, 30, 45, and 60 of the follow-up." }, { "field": "n", "quote": "48 patients who underwent surgical resection for PSD with secondary intention healing (24 patients in intervention and placebo-controlled groups)" } ] }, { "id": "pmid:34621578", "pmid": "34621578", "doi": "10.25259/SNI_722_2021", "nctId": null, "pmcid": "PMC8492421", "title": "Intracranial hypotension as a unique complication of the rupture of an anterior sacral meningocele into a recurrent pilonidal cyst", "firstAuthor": "Xhumari", "multipleAuthors": true, "journal": "Surg Neurol Int", "year": 2021, "design": "case-series", "n": 1, "nField": "reported", "population": "A 37-year-old woman with a recurrent pilonidal cyst after prior surgery", "intervention": "Surgical repair of a ruptured sacral meningocele using overlapping dural flaps", "comparator": "No comparator, single case report", "primaryOutcome": "Resolution of headaches and stopping of cerebrospinal fluid leakage", "result": "After surgery, there was no more leakage from the cyst and the headaches went away", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single, highly unusual case report so it cannot show what typically happens when a pilonidal cyst bursts.", "directness": "indirect", "limitations": "Extremely rare case involving a rare internal connection between a spinal cyst and the pilonidal cyst, not representative of typical ruptured pilonidal cysts.", "followUp": "", "plainFinding": "Rare case, not general guidance.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34621578/", "sourceText": "BACKGROUND: Intracranial hypotension (IH) is an underdiagnosed, but important cause of new-onset, daily persistent headache, especially among the young- and middle-aged population. It results from a cerebrospinal fluid (CSF) leak with subsequent lowered CSF pressure. CASE DESCRIPTION: A 37-year-old female presented to the emergency department with sudden onset severe headaches. Two years earlier, she had undergone surgery for resection of a pilonidal cyst (PC). The night before admission, she had watery discharge from the recurrent PC and severe diffuse positional headaches associated with photophobia and neck pain. The head computed tomography showed pneumocephalus in the posterior fossa and a spine magnetic resonance imaging revealed an anterior sacral meningocele (ASM) in close contact with the recurrent PC. A final diagnosis was made of headaches due to IH. The leakage site was the rupture of the ASM in the PC. The surgical repair of the ASM was achieved suturing two overlapping dural flaps. There was no more CSF leakage from the PC and the headaches disappeared. CONCLUSION: This is a unique case of IH due to the rupture of an ASM into a recurrent PC. The association of an ASM and PC, at the best of our knowledge, is unique. Moreover, the fistulation of the ASM to the PC is exceptional. ASM can be successfully closed with a posterior approach, using two overlapping dural flaps.", "provenance": [ { "field": "n", "quote": "A 37-year-old female presented to the emergency department" }, { "field": "population", "quote": "Two years earlier, she had undergone surgery for resection of a pilonidal cyst (PC)." }, { "field": "intervention", "quote": "The surgical repair of the ASM was achieved suturing two overlapping dural flaps." }, { "field": "comparator", "quote": "CASE DESCRIPTION: A 37-year-old female presented to the emergency department with sudden onset severe headaches." }, { "field": "primaryOutcome", "quote": "There was no more CSF leakage from the PC and the headaches disappeared." }, { "field": "result", "quote": "There was no more CSF leakage from the PC and the headaches disappeared." } ] }, { "id": "pmid:34602433", "pmid": "34602433", "doi": null, "nctId": null, "pmcid": null, "title": "Effect of propolis on wound healing in sacrococcygeal pilonidal disease: A randomized controlled clinical trial", "firstAuthor": "Kubat", "multipleAuthors": true, "journal": "Pak J Pharm Sci", "year": 2021, "design": "rct", "n": 33, "nField": "reported", "population": "patients with sacrococcygeal pilonidal cyst disease who had surgery (marsupialization)", "intervention": "propolis applied to the wound after marsupialization surgery", "comparator": "marsupialization surgery without propolis (control group)", "primaryOutcome": "how fast the wound healed and time to complete recovery", "result": "wound healing was faster and the recovery score was significantly lower in the propolis group", "resultDirection": "benefit", "quality": "low", "qualityWhy": "very small study of only 33 patients with limited detail on blinding or how wound healing was measured", "directness": "indirect", "limitations": "small sample size, abstract gives no detail on blinding, randomization method, or statistical results", "followUp": "28 days", "plainFinding": "Faster healing with propolis after surgery", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34602433/", "sourceText": "Wound healing and recurrence are the leading problems encountered in sacrococcygeal pilonidal sinus disease. Propolis has a place in both traditional and complementary medicine, and in vitro and in vivo studies have reported its anti-inflammatory, anti-oxidant, anti-bacterial, anti-fungal and immunostimulant properties. In the present study, we discuss the effect of propolis on wound healing in sacrococcygeal pilonidal diseases treated with marsupialization. Patients who were admitted to our clinic with sacrococcygeal pilonidal disease were analyzed prospectively, with a total of 33 patients divided into study and control groups. All patients underwent marsupialization surgery, and the wound areas were analyzed post-operatively, on the 0, 7th, 14th, 28th days and on the day of complete recovery. An acceleration of wound healing was observed from the first week that was found to be even faster between days 14 and 28. The complete recovery score in the study group was significantly lower. Propolis can be used to accelerate wound healing when the marsupialization method is preferred in patients diagnosed with uncomplicated sacrococcygeal pilonidal cyst due to its low cost, good patient compliance, low side effect profile, lack of toxicity and high efficacy.", "provenance": [ { "field": "n", "quote": "a total of 33 patients divided into study and control groups" }, { "field": "population", "quote": "Patients who were admitted to our clinic with sacrococcygeal pilonidal disease" }, { "field": "intervention", "quote": "the effect of propolis on wound healing in sacrococcygeal pilonidal diseases treated with marsupialization" }, { "field": "comparator", "quote": "a total of 33 patients divided into study and control groups" }, { "field": "primaryOutcome", "quote": "the wound areas were analyzed post-operatively, on the 0, 7th, 14th, 28th days and on the day of complete recovery" }, { "field": "result", "quote": "An acceleration of wound healing was observed from the first week that was found to be even faster between days 14 and 28. The complete recovery score in the study group was significantly lower." } ] }, { "id": "pmid:34256587", "pmid": "34256587", "doi": "10.12968/jowc.2021.30.Sup7.S28", "nctId": null, "pmcid": null, "title": "Surgical reconstruction of pilonidal sinus disease with concomitant extracellular matrix graft placement: a case series", "firstAuthor": "Chaffin", "multipleAuthors": true, "journal": "J Wound Care", "year": 2021, "design": "case-series", "n": 6, "nField": "reported", "population": "patients with recurrent pilonidal sinus disease who had failed previous surgery", "intervention": "surgical flap reconstruction combined with an extracellular matrix graft implant", "comparator": "none (single-arm case series, no comparator)", "primaryOutcome": "wound healing, complications and recurrence after surgery", "result": "all six patients fully healed by 3 to 4 weeks and remained healed at 12 weeks with good cosmetic results", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a tiny uncontrolled case series of only six patients so it cannot reliably show whether the treatment works", "directness": "indirect", "limitations": "very small number of patients, no comparison group, retrospective design", "followUp": "12 weeks", "plainFinding": "All healed well after surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34256587/", "sourceText": "BACKGROUND: Pilonidal sinus disease (PSD) is a chronic inflammatory disease affecting the soft tissue of the sacrococcygeal region and remains a challenging disease for clinicians to treat. The optimal treatment for PSD remains controversial and recent reports describe several different surgical approaches offering different benefits. Approximately 40% of initial incision and drainage cases require subsequent surgery. Due to high recurrence rates and postoperative complications, a more complex revision surgery involving a flap reconstruction may be required. We hypothesised that the combination of an extracellular matrix (ECM) graft with tissue flap reconstruction may decrease the postoperative complications and recurrence rates for PSD. METHOD: We report a retrospective case series using a surgical flap reconstruction with concomitant implantation of an ovine forestomach ECM graft under a fasciocutaneous flap with an off-midline closure for recurrent PSD, where previously surgical intervention had failed due to wound dehiscence and/or recurrent disease. RESULTS: The case series included six patients. After three weeks, all patients except one were fully healed, and the sixth was fully healed by week 4; all wounds remained fully healed at 12 weeks. All patients achieved good cosmesis and were able to return to normal function without any residual symptoms. CONCLUSION: This pilot case series explored augmenting a flap reconstruction for complex PSD with advanced ECM graft materials, demonstrating that it may improve outcomes and minimise typical complications seen in flap closure, such as inflammation, infection, haematoma/seroma and hypoperfusion. Although the study had a limited number of participants, long-term outcomes were promising and suggest that further studies are warranted.", "provenance": [ { "field": "n", "quote": "The case series included six patients." }, { "field": "population", "quote": "recurrent PSD, where previously surgical intervention had failed due to wound dehiscence and/or recurrent disease" }, { "field": "intervention", "quote": "a surgical flap reconstruction with concomitant implantation of an ovine forestomach ECM graft under a fasciocutaneous flap with an off-midline closure" }, { "field": "comparator", "quote": "We report a retrospective case series" }, { "field": "primaryOutcome", "quote": "demonstrating that it may improve outcomes and minimise typical complications seen in flap closure, such as inflammation, infection, haematoma/seroma and hypoperfusion" }, { "field": "result", "quote": "After three weeks, all patients except one were fully healed, and the sixth was fully healed by week 4; all wounds remained fully healed at 12 weeks." } ] }, { "id": "pmid:33950407", "pmid": "33950407", "doi": "10.1007/s00423-020-02060-1", "nctId": null, "pmcid": "PMC8097120", "title": "German National Guideline on the management of pilonidal disease: update 2020", "firstAuthor": "Iesalnieks", "multipleAuthors": true, "journal": "Langenbecks Arch Surg", "year": 2021, "design": "guideline", "n": null, "nField": "not-reported", "population": "people with pilonidal disease (cyst near tailbone)", "intervention": "different surgical treatments for pilonidal disease depending on stage (abscess unroofing, sinus excision, minimally invasive pit picking, flap procedures)", "comparator": "comparison between these treatment methods with each other", "primaryOutcome": "wound healing, recurrence rate, pain, and time off work", "result": "recommends unroofing an abscess, then later definitive surgery for chronic disease, with no single best method", "resultDirection": "mixed", "quality": "low", "qualityWhy": "this is an expert guideline summarizing other studies, not a new trial testing what happens after a cyst bursts on its own.", "directness": "indirect", "limitations": "abstract does not specifically address a cyst that ruptures spontaneously on its own, only guideline recommendations for abscess and chronic disease management in general.", "followUp": "", "plainFinding": "Drain abscess, treat properly later.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33950407/", "sourceText": "BACKGROUND: The present German National Guideline is an updated version of previous Guideline published in 2014. It aims to compare various treatment methods and to assist physicians with evidence-based recommendations. METHODS: Systemic literature review. RESULTS: Three types of disease manifestation could be differentiated: asymptomatic disease, an acute abscess, and the chronic pilonidal disease. At present, there is no treatment method fulfilling all desired criteria: simple, painless procedure associated with rapid wound healing, and low recurrence rate. Thus, treatment modality should be tailored to disease manifestation and extent. CONCLUSION: Asymptomatic pilonidal disease should not be treated. A pilonidal abscess should be unroofed. After resolution of the acute inflammation, the disease should be treated definitely. As for today, sinus excision is the standard treatment of the chronic pilonidal disease. Wide excision and open treatment of chronic disease is a safe procedure which, however, leads to prolonged secondary healing and time off-work, as well as to considerable recurrence rate. The extent of excision should be as limited as possible. Excision and midline wound closure is associated with impaired outcomes. Today, it has become obsolete. Minimally invasive procedures (e.g., pit picking surgery) represent a treatment option for chronic pilonidal disease. However, the recurrence rate is higher compared to excision procedures. Nevertheless, they may be used for small primary disease. Off-midline procedures should be used for disease not suitable for minimally invasive treatments. The Limberg flap and the Karydakis procedure are two best described methods which are associated with similar short- and long-term results.", "provenance": [ { "field": "population", "quote": "Three types of disease manifestation could be differentiated: asymptomatic disease, an acute abscess, and the chronic pilonidal disease." }, { "field": "intervention", "quote": "A pilonidal abscess should be unroofed. After resolution of the acute inflammation, the disease should be treated definitely." }, { "field": "comparator", "quote": "sinus excision is the standard treatment of the chronic pilonidal disease" }, { "field": "primaryOutcome", "quote": "simple, painless procedure associated with rapid wound healing, and low recurrence rate" }, { "field": "result", "quote": "A pilonidal abscess should be unroofed. After resolution of the acute inflammation, the disease should be treated definitely." } ] }, { "id": "pmid:33761692", "pmid": "33761692", "doi": "10.1097/MD.0000000000025166", "nctId": null, "pmcid": "PMC9282003", "title": "Pilonidal sinus involving the breast in a man: A case report and literature review", "firstAuthor": "Shi", "multipleAuthors": true, "journal": "Medicine (Baltimore)", "year": 2021, "design": "case-series", "n": 1, "nField": "reported", "population": "a 46-year-old man with a pilonidal cyst in his breast", "intervention": "surgical removal of the breast lump (enlarged resection) after the cyst ruptured and discharged", "comparator": "none reported", "primaryOutcome": "wound healing and recurrence after surgery", "result": "the surgical area healed well with no signs of recurrence", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single case report, so it cannot reliably show what happens in general when a pilonidal cyst bursts.", "directness": "indirect", "limitations": "Only one patient was described, the cyst was in an unusual location (the breast), and the abstract does not address non-surgical management of spontaneous rupture.", "followUp": "", "plainFinding": "Surgery healed ruptured cyst.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33761692/", "sourceText": "RATIONALE: Pilonidal sinus disease (PSD) involving the breast is extremely rare and has not been described in man. PATIENT CONCERNS: This current case report presents a case of a pilonidal cyst in a 46-year-old man which was surgically treated. He had intermittent pain in his left breast for 2 months and came for local rupture and discharge for 1 week. DIAGNOSIS: The initial diagnosis is male mastitis, on the basis of the histological features of H&E-stained specimens and immunohistochemistry of the resected lump, this case was diagnosed as PSD. INTERVENTIONS: The patient underwent \"enlarged resection of the left breast lesion\" under local anesthesia. OUTCOMES: The patient's surgical area healed well, without any signs of recurrence. CONCLUSION: PSD involving the breast is extremely rare in man, with no typically clinical manifestations, and could be easily ignored. This disease requires great attentions from clinicians.", "provenance": [ { "field": "population", "quote": "a case of a pilonidal cyst in a 46-year-old man" }, { "field": "intervention", "quote": "underwent \"enlarged resection of the left breast lesion\" under local anesthesia" }, { "field": "comparator", "quote": "RATIONALE: Pilonidal sinus disease (PSD) involving the breast is extremely rare and has not been described in man." }, { "field": "primaryOutcome", "quote": "The patient's surgical area healed well, without any signs of recurrence." }, { "field": "result", "quote": "The patient's surgical area healed well, without any signs of recurrence." }, { "field": "n", "quote": "a case of a pilonidal cyst in a 46-year-old man which was surgically treated" } ] }, { "id": "pmid:33378636", "pmid": "33378636", "doi": "10.21614/chirurgia.115.6.775", "nctId": null, "pmcid": null, "title": "Use of Silver Nitrate Application as Mini-Invasive Treatment of Pilonidal Sinus Disease", "firstAuthor": "Kanat", "multipleAuthors": true, "journal": "Chirurgia (Bucur)", "year": 2020, "design": "retrospective", "n": 45, "nField": "reported", "population": "young adults with pilonidal sinus disease treated at a hospital", "intervention": "silver nitrate stick application with debridement", "comparator": "no comparison group; outcomes tracked over time within the same group", "primaryOutcome": "recurrence and complication rates after treatment", "result": "recurrence occurred in about 9% of patients, with complications such as abscess, redness, or tissue death in about 22%", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective chart review without a comparison group, so it cannot reliably show cause and effect.", "directness": "indirect", "limitations": "Retrospective design, no control group, and some patients were excluded due to incomplete records.", "followUp": "", "plainFinding": "Low recurrence with silver nitrate treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33378636/", "sourceText": "OBJECTIVES: To investigate the cure rate and adverse effects of silver nitrate application for treatment of pilonidal sinus disease (PSD). Methods: Number of sinus pit orifices, and complications with silver nitrate application and debridement for sacrococcygeal PSD between January 2015 and July 2018 were analyzed in this retrospective study. Data were obtained from surgical, discharge, and outpatient follow-up records. Among 56 patients who were treated with silver nitrate stick, 11 patients with incomplete hospital records were excluded from the study. Demographic data including age, gender, length of follow-up, number of silver nitrate applications, number of involved sinuses and recurrence and complication rates were recorded. Results were expressed as frequencies, means, and range of values. The Mann Whitney U and chi square tests were used to evaluate significance. Results: Mean age was 24.3 +- 5.18 (range, 14 - 36) years, and recurrence occurred in 4 (8.9%) patients. Complications developed in 10 (22.2%) patients and included abscess, erythema, and necrosis in 5 (11.1%), 2 (4.4%), and 3 (6.6%) patients, respectively. The recurrence rate was significantly higher in patients who developed abscesses during the follow-up period (p = 0.001) than those who did not. There was no statistically significant correlation between the recurrence rate and number of sinuses or the number of silver nitrate applications. CONCLUSION: Low morbidity and high healing rates achieved with silver nitrate provide support for this application as a feasible and effective conservative outpatient treatment for PSD in certain patients.", "provenance": [ { "field": "population", "quote": "Mean age was 24.3 +- 5.18 (range, 14 - 36) years" }, { "field": "intervention", "quote": "silver nitrate application and debridement for sacrococcygeal PSD" }, { "field": "comparator", "quote": "Among 56 patients who were treated with silver nitrate stick, 11 patients with incomplete hospital records were excluded from the study." }, { "field": "primaryOutcome", "quote": "recurrence and complication rates were recorded" }, { "field": "result", "quote": "recurrence occurred in 4 (8.9%) patients. Complications developed in 10 (22.2%) patients and included abscess, erythema, and necrosis in 5 (11.1%), 2 (4.4%), and 3 (6.6%) patients, respectively." }, { "field": "n", "quote": "Among 56 patients who were treated with silver nitrate stick, 11 patients with incomplete hospital records were excluded from the study." } ] }, { "id": "pmid:33301262", "pmid": "33301262", "doi": "10.17116/hirurgia202012199", "nctId": null, "pmcid": null, "title": "[Surgical treatment of pilonidal disease]", "firstAuthor": "Nechai", "multipleAuthors": true, "journal": "Khirurgiia (Mosk)", "year": 2020, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people having surgery for pilonidal disease", "intervention": "\"closed\" surgical techniques for pilonidal disease", "comparator": "other surgical methods for pilonidal disease", "primaryOutcome": "wound healing and cosmetic result after surgery", "result": "closed surgical methods gave good healing and cosmetic outcomes, but long-term results depended on technique and follow-up time", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a narrative comparison of surgical techniques with no reported number of studies or patients and no stated methodology, so it carries little weight.", "directness": "indirect", "limitations": "No numbers of studies or patients are given, and the abstract does not describe how studies were selected or analyzed.", "followUp": "", "plainFinding": "Closed surgery heals well.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33301262/", "sourceText": "This review is devoted to comparison of the most common methods of surgical treatment of pilonidal disease. It was found that «closed» methods of surgical treatment of pilonidal disease are effective and accompanied by favorable wound healing and good cosmetic effect. Long-term outcomes of «closed» techniques significantly depend on the choice of surgical treatment and follow-up period.", "provenance": [ { "field": "population", "quote": "surgical treatment of pilonidal disease" }, { "field": "intervention", "quote": "«closed» methods of surgical treatment of pilonidal disease" }, { "field": "comparator", "quote": "comparison of the most common methods of surgical treatment of pilonidal disease" }, { "field": "primaryOutcome", "quote": "favorable wound healing and good cosmetic effect" }, { "field": "result", "quote": "«closed» methods of surgical treatment of pilonidal disease are effective and accompanied by favorable wound healing and good cosmetic effect. Long-term outcomes of «closed» techniques significantly depend on the choice of surgical treatment and follow-up period." } ] }, { "id": "pmid:33298356", "pmid": "33298356", "doi": "10.1016/j.jemermed.2020.10.043", "nctId": null, "pmcid": null, "title": "Abscess Management: An Evidence-Based Review for Emergency Medicine Clinicians", "firstAuthor": "Menegas", "multipleAuthors": true, "journal": "J Emerg Med", "year": 2021, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with abscesses treated in the emergency department, including those with pilonidal abscesses", "intervention": "needle aspiration with antibiotics for pilonidal abscess", "comparator": "incision and drainage (I&D) for pilonidal abscess", "primaryOutcome": "best approach to managing pilonidal abscesses in the emergency department", "result": "Pilonidal abscesses have traditionally been managed with I&D, but needle aspiration with antibiotics may be a suitable alternative.", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a narrative review summarizing other studies without describing its own evidence quality or comparative data for pilonidal abscesses specifically.", "directness": "indirect", "limitations": "The abstract does not describe study design, sample sizes, or quality of the underlying evidence for the pilonidal abscess claims; it also addresses formed abscesses needing drainage in an ED setting, not a cyst that has burst on its own at home.", "followUp": "", "plainFinding": "Needle aspiration with antibiotics may be alternative.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33298356/", "sourceText": "BACKGROUND: Abscesses are commonly evaluated and managed in the emergency department. Recent research has evaluated the use of ultrasonography, packing, incision and drainage (I&D), and antibiotics. There are evidence-based nuances to the management of specific types of abscesses, such as Bartholin, breast, dental, hidradenitis suppurativa, peritonsillar, and pilonidal abscesses. OBJECTIVE: This review provides emergency medicine clinicians with a summary of the current literature regarding abscess management in the emergency department. DISCUSSION: Ultrasound is valuable in diagnosing abscesses that are not clinically evident and in guiding I&D procedures. Although I&D is traditionally followed by packing, this practice may be unnecessary for small abscesses. Antibiotics, needle aspiration, and loop drainage are suitable alternatives to I&D of abscesses with certain characteristics. Oral antibiotics can improve outcomes after I&D, although this improvement must be weighed against potential risks. Many strategies are useful in managing Bartholin abscesses, with the Word catheter proving consistently effective. Needle aspiration is the recommended first-line therapy for small breast abscesses. Dental abscesses are often diagnosed with clinical examination alone, but ultrasound may be a useful adjunct. Acute abscess formation caused by hidradenitis suppurativa should be managed surgically by excision when possible, because I&D has a high rate of abscess recurrence. Peritonsillar abscesses can be diagnosed with either intraoral or transcervical ultrasound if clinical examination is inconclusive. Needle aspiration and I&D are both suitable for the management of peritonsillar abscesses. Pilonidal abscesses have traditionally been managed with I&D, but needle aspiration with antibiotics may be a suitable alternative. CONCLUSIONS: This review evaluates the recent literature surrounding abscess management for emergency medicine clinicians.", "provenance": [ { "field": "result", "quote": "Pilonidal abscesses have traditionally been managed with I&D, but needle aspiration with antibiotics may be a suitable alternative." }, { "field": "intervention", "quote": "needle aspiration with antibiotics" }, { "field": "comparator", "quote": "Pilonidal abscesses have traditionally been managed with I&D" }, { "field": "population", "quote": "pilonidal abscesses" }, { "field": "primaryOutcome", "quote": "evidence-based nuances to the management of specific types of abscesses, such as Bartholin, breast, dental, hidradenitis suppurativa, peritonsillar, and pilonidal abscesses" } ] }, { "id": "pmid:33011845", "pmid": "33011845", "doi": "10.1007/s00384-020-03767-9", "nctId": null, "pmcid": null, "title": "Early versus delayed endoscopic treatment of acute pilonidal abscess: a propensity score-matched analysis", "firstAuthor": "Manigrasso", "multipleAuthors": true, "journal": "Int J Colorectal Dis", "year": 2021, "design": "retrospective", "n": 82, "nField": "reported", "population": "patients with an acute pilonidal abscess needing treatment", "intervention": "endoscopic treatment (VAAPS) done right away", "comparator": "endoscopic treatment (VAAPS) delayed until after initial incision and drainage", "primaryOutcome": "rate of cyst coming back at 1, 3, and 5 years", "result": "no difference in recurrence between early and delayed endoscopic treatment, but early treatment gave better patient satisfaction and health status", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a retrospective, matched comparison of surgical patients, not a randomized trial, and it does not address what to do when a cyst bursts on its own.", "directness": "indirect", "limitations": "Propensity-matched retrospective design rather than randomized; studies surgical abscess drainage patients, not spontaneous rupture without treatment.", "followUp": "1-year, 3-year, and 5-year follow-up", "plainFinding": "Same recurrence, but earlier surgery felt better.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33011845/", "sourceText": "BACKGROUND: According to the Italian Society of Colorectal Surgery guidelines, the most effective approach to the pilonidal abscess is adequate surgical drainage, concerning incision and drainage of the pilonidal cavity. Few recent studies have demonstrated that endoscopic approach could be a valid treatment option even in the case of acute pilonidal abscess. The aim of our study is to assess if video-assisted ablation of pilonidal sinus (VAAPS) could be an alternative to treat an acute pilonidal abscess and to evaluate if an immediate endoscopic approach to the pilonidal abscess is preferable to a delayed procedure after incision and drainage. METHODS: All consecutive patients with an acute pilonidal abscess since 1 January 2014 to 31 December 2018 were enrolled in our propensity score-matched analysis and divided into two groups: the early VAAPS group and the delayed VAAPS group. Primary outcomes were recurrence rate at 1-year, 3-year, and 5-year follow-up. Secondary outcomes were time off, time to wound healing, incomplete wound healing, perioperative infection, patients' satisfaction 1 month after the complete wound healing, and their health status before surgery and 6 months after complete wound healing. RESULTS: After the propensity score matching, 82 patients were included in the final analysis (41 in each group). No differences were found in terms of recurrence in the two groups. Early endoscopic approach was associated with a better patients' satisfaction (8.17 ± 1.2 vs 6.06 ± 1.48, p = 0.001) and a better postoperative health status (86.27 ± 6.54 vs 77.32 ± 5.85, p = 0.001). CONCLUSIONS: Our results encouraged to perform an immediate endoscopic approach to an acute pilonidal abscess.", "provenance": [ { "field": "n", "quote": "82 patients were included in the final analysis (41 in each group)" }, { "field": "population", "quote": "All consecutive patients with an acute pilonidal abscess" }, { "field": "intervention", "quote": "early VAAPS group" }, { "field": "comparator", "quote": "delayed VAAPS group" }, { "field": "primaryOutcome", "quote": "Primary outcomes were recurrence rate at 1-year, 3-year, and 5-year follow-up" }, { "field": "result", "quote": "No differences were found in terms of recurrence in the two groups. Early endoscopic approach was associated with a better patients' satisfaction (8.17 ± 1.2 vs 6.06 ± 1.48, p = 0.001) and a better postoperative health status (86.27 ± 6.54 vs 77.32 ± 5.85, p = 0.001)." } ] }, { "id": "pmid:31256473", "pmid": "31256473", "doi": "10.31128/AJGP-07-18-4649", "nctId": null, "pmcid": null, "title": "Pilonidal disease practice points: An update", "firstAuthor": "Choy", "multipleAuthors": true, "journal": "Aust J Gen Pract", "year": 2019, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with chronic pilonidal disease seen in general practice", "intervention": "primary care management and newer specialist surgical treatment options", "comparator": "standard or older surgical approaches", "primaryOutcome": "avoiding recurrence of pilonidal disease", "result": "The abstract does not report a specific result for bursting cysts; it only discusses general management and recurrence avoidance with correct treatment and counselling", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a narrative overview article with no study data, patient numbers, or outcome measurements reported.", "directness": "indirect", "limitations": "No methodology, data, or specific findings about a burst cyst are given; it is a general discussion article.", "followUp": "", "plainFinding": "No specific guidance given.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/31256473/", "sourceText": "BACKGROUND: Chronic pilonidal disease is a common debilitating condition often seen in general practice. It is a cause of considerable morbidity and social embarrassment, but recent developments in treatment options provide promising solutions to this problem. OBJECTIVE: This article recaps pilonidal sinus development and presentation, details methods of treatment in the primary care setting and explores new specialist management options available in Australia. DISCUSSION: As a chronic condition, the devastation of recurrence with further pain, embarrassment and time off work - added to the prospect of more surgery - is still common for patients with chronic pilonidal disease. This can be avoided with correct management and timely counselling regarding surgical options available.", "provenance": [ { "field": "population", "quote": "Chronic pilonidal disease is a common debilitating condition often seen in general practice." }, { "field": "intervention", "quote": "details methods of treatment in the primary care setting and explores new specialist management options available in Australia" }, { "field": "comparator", "quote": "the devastation of recurrence with further pain, embarrassment and time off work - added to the prospect of more surgery - is still common for patients with chronic pilonidal disease" }, { "field": "primaryOutcome", "quote": "This can be avoided with correct management and timely counselling regarding surgical options available." }, { "field": "result", "quote": "This can be avoided with correct management and timely counselling regarding surgical options available." } ] }, { "id": "pmid:31230414", "pmid": "31230414", "doi": "10.1111/iwj.13163", "nctId": null, "pmcid": "PMC7948539", "title": "A comparison of flap reconstruction vs the laying open technique or excision and direct suture for pilonidal sinus disease: A meta-analysis of randomised studies", "firstAuthor": "Berthier", "multipleAuthors": true, "journal": "Int Wound J", "year": 2019, "design": "meta-analysis", "n": null, "nField": "not-reported", "population": "people with chronic pilonidal sinus disease (not specifically burst/ruptured cysts)", "intervention": "flap reconstruction surgery", "comparator": "laying open technique or excision with direct suture closure", "primaryOutcome": "rate of the cyst coming back (recurrence)", "result": "Flap repair had fewer recurrences, fewer wound infections, fewer skin complications, shorter hospital stay, and faster healing than direct closure or the laying open technique", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "It pools multiple randomised trials, which is strong evidence, but it addresses planned surgical treatment of chronic sinus disease, not what to do after a cyst bursts on its own.", "directness": "indirect", "limitations": "The abstract does not describe the quality or size of the individual trials, nor does it address spontaneously ruptured cysts specifically.", "followUp": "", "plainFinding": "Flap surgery beats other surgical closures.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/31230414/", "sourceText": "Many treatments have been described for pilonidal disease, but recurrence cannot be completely eliminated. The aim of this study was to perform a meta-analysis of randomised, controlled trials comparing flap repair vs the laying open technique and/or excision and direct closure techniques in the treatment of chronic pilonidal sinus disease. The primary outcome measure was the recurrence rate. Secondary outcomes were complete wound-healing time, duration of the incapacity to work, quality of life and patient satisfaction, postoperative pain, wound infection, bleeding or haematoma, skin wound complications, and duration of hospital stay. Seventeen studies were included. The meta-analysis demonstrated a lower risk of recurrence, a shorter duration of incapacity to work, a lower risk of wound infections, a lower risk of skin wound complications, and a shorter duration of hospitalisation in favour of flap vs direct closure. A shorter time to complete wound healing and a shorter duration of incapacity to work for flap vs the laying open technique were observed. Superiority of flap repair vs direct closure in pilonidal sinus treatment was demonstrated in this meta-analysis. These results suggest avoiding primary direct closure in clinical practice. Compared with the laying open technique, flaps result in faster healing and a shorter time to return to activities.", "provenance": [ { "field": "population", "quote": "chronic pilonidal sinus disease" }, { "field": "intervention", "quote": "flap repair" }, { "field": "comparator", "quote": "the laying open technique and/or excision and direct closure techniques" }, { "field": "primaryOutcome", "quote": "The primary outcome measure was the recurrence rate." }, { "field": "result", "quote": "The meta-analysis demonstrated a lower risk of recurrence, a shorter duration of incapacity to work, a lower risk of wound infections, a lower risk of skin wound complications, and a shorter duration of hospitalisation in favour of flap vs direct closure." } ] }, { "id": "pmid:31120213", "pmid": "31120213", "doi": null, "nctId": null, "pmcid": null, "title": "[Chronic pilonidal sinus disease: overview of treatment options]", "firstAuthor": "Pronk", "multipleAuthors": true, "journal": "Ned Tijdschr Geneeskd", "year": 2019, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with chronic pilonidal sinus disease, mostly young men", "intervention": "various treatments for pilonidal sinus disease including minimally invasive techniques", "comparator": "excision surgery with primary or secondary wound healing", "primaryOutcome": "best treatment approach, wound healing, recurrence, return to work", "result": "no consensus on best first treatment; minimally invasive techniques linked to less pain and faster healing; flap techniques only for recurrence; laser hair removal may lower recurrence risk", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is a general overview of treatment options, not a study answering what to do when a cyst bursts on its own, and does not report patient numbers or a controlled comparison.", "directness": "indirect", "limitations": "abstract does not address spontaneous rupture of a pilonidal cyst, only planned surgical and minimally invasive treatments; no numbers or outcomes data given.", "followUp": "", "plainFinding": "No info on burst cysts.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/31120213/", "sourceText": "Chronic pilonidal sinus disease: overview of treatment options Pilonidal sinus disease is a common disease in predominantly young men; this condition can have a significant socio-economic impact. Although excision with primary or secondary wound healing is often applied, there is no consensus on the treatment of first choice for pilonidal sinus disease. Minimally invasive techniques, such as phenolisation, laser, and endoscopic treatments are increasingly applied, since these are associated with less pain, faster wound healing and facilitating a more rapid return to work for patients. Skin advancement flap techniques, considering they cause morbidity and large wounds, should only be considered in case of recurrent pilonidal sinus disease. Laser hair removal at the natal cleft after surgical treatment appears to reduce the risk of recurrence.", "provenance": [ { "field": "population", "quote": "Pilonidal sinus disease is a common disease in predominantly young men" }, { "field": "intervention", "quote": "Minimally invasive techniques, such as phenolisation, laser, and endoscopic treatments are increasingly applied" }, { "field": "comparator", "quote": "excision with primary or secondary wound healing is often applied" }, { "field": "primaryOutcome", "quote": "there is no consensus on the treatment of first choice for pilonidal sinus disease" }, { "field": "result", "quote": "these are associated with less pain, faster wound healing and facilitating a more rapid return to work for patients" } ] }, { "id": "pmid:31117133", "pmid": "31117133", "doi": "10.1055/a-0901-7945", "nctId": null, "pmcid": null, "title": "[Pilonidal Sinus Disease; What is the Best Treatment Option?]", "firstAuthor": "Petersen", "multipleAuthors": false, "journal": "Zentralbl Chir", "year": 2019, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with chronic pilonidal sinus disease (infection in the skin fold at the top of the buttocks)", "intervention": "different surgical treatments: excision with open wound care, minimally invasive options (pit picking, fistuloscopy, phenol injection, laser), and excision with plastic reconstruction", "comparator": "the treatment options are compared against each other, not against doing nothing or against spontaneous rupture", "primaryOutcome": "recurrence rate, wound healing problems, and long-term results", "result": "standard excision with open wound care has low recurrence but slow healing and long time off work; newer skin-preserving techniques are still being evaluated; excision with plastic reconstruction is technically demanding but gives good long-term results", "resultDirection": "mixed", "quality": "low", "qualityWhy": "this is a general narrative review of surgical treatment choices for pilonidal disease and does not study or mention what happens when a cyst bursts on its own, so it cannot answer that specific question.", "directness": "indirect", "limitations": "abstract does not address spontaneous rupture of a pilonidal cyst at all; it is a review of planned surgical treatment strategies, not a study of outcomes after a cyst bursts on its own", "followUp": "", "plainFinding": "Compares surgery options, not spontaneous rupture.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/31117133/", "sourceText": "INTRODUCTION: Sinus pilonidalis is a chronic infection of the hairy skin in the area of skin wrinkles, with the most common localization in the natal cleft. The disease often has a significant impact on the quality of life of the affected person; the treatment may be complex and needs to be adapted to the patient's needs. METHODS: Below is an overview of the origin as well as the treatment alternatives and their peculiarities. The following aspects are presented: early post-operative results, wound healing disorder and long-term results. RESULTS: The pathomechanism of pilonidal sinus disease has still not been conclusively clarified; it must continue to be assumed that the hair in the natal cleft contributes significantly to the formation. However, recent findings indicate that the large tufts of hair that are repeatedly found in the wound cavity are most likely to come from the hairy scalp. Three essential treatment options can be distinguished: The standard treatment of excision and subsequent open wound treatment, has a low recurrence rate, but requires considerable effort in wound treatment and thus leads to protracted time off work. Relatively new treatments include locally destructive treatment that essentially preserves the skin. Important representatives are so-called pit picking, fistuloscopy and other forms of treatment, such as phenol injection and/or laser treatment. In these treatment options, the final evaluation of the results is still pending. The third treatment group is excision and plastic reconstruction. These procedures are technically demanding, often involve inpatient treatment but lead to relatively good results in the long term. CONCLUSION: Treatment of pilonidal disease requires patient-oriented therapy planning. The patient must be taught the different treatment options and a treatment recommendation must be given to the patient. Excision and open granulation continues to serve as a standard procedure with which other treatment options can be compared.", "provenance": [ { "field": "population", "quote": "Sinus pilonidalis is a chronic infection of the hairy skin in the area of skin wrinkles, with the most common localization in the natal cleft." }, { "field": "intervention", "quote": "The standard treatment of excision and subsequent open wound treatment" }, { "field": "intervention", "quote": "so-called pit picking, fistuloscopy and other forms of treatment, such as phenol injection and/or laser treatment" }, { "field": "intervention", "quote": "The third treatment group is excision and plastic reconstruction." }, { "field": "comparator", "quote": "Excision and open granulation continues to serve as a standard procedure with which other treatment options can be compared." }, { "field": "primaryOutcome", "quote": "early post-operative results, wound healing disorder and long-term results" }, { "field": "result", "quote": "has a low recurrence rate, but requires considerable effort in wound treatment and thus leads to protracted time off work" }, { "field": "result", "quote": "In these treatment options, the final evaluation of the results is still pending." }, { "field": "result", "quote": "These procedures are technically demanding, often involve inpatient treatment but lead to relatively good results in the long term." } ] }, { "id": "pmid:31067171", "pmid": "31067171", "doi": "10.12968/jowc.2019.28.Sup5.S12", "nctId": null, "pmcid": null, "title": "Porcine bladder extracellular matrix in paediatric pilonidal wound care: healing and patient experience evaluation", "firstAuthor": "Cairo", "multipleAuthors": true, "journal": "J Wound Care", "year": 2019, "design": "retrospective", "n": 41, "nField": "reported", "population": "Teenagers (average age 16) with pilonidal disease, most with recurrent disease, treated surgically", "intervention": "A pig bladder tissue matrix (PBEM) dressing used for wound care after surgery", "comparator": "Historical controls and published literature on traditional wound care methods", "primaryOutcome": "Whether the wound fully healed and how satisfied patients were", "result": "78% of wounds treated with the dressing healed completely, taking about two months on average, with mostly positive patient experiences", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This was a retrospective chart review of a small single-center group with no real control group, so it can't reliably show the dressing is better than other care.", "directness": "indirect", "limitations": "Retrospective design, no concurrent comparison group, comparisons made only to historical/literature data, some missing follow-up, single center.", "followUp": "two years", "plainFinding": "Good healing with pig-bladder dressing.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/31067171/", "sourceText": "OBJECTIVE: Pilonidal disease (PD) with inflammation and abscess formation occurs frequently in adolescents. The management of pilonidal disease, time to wound healing, and patient satisfaction, however remains variable despite advances in wound care methods. Porcine bladder extracellular matrix (PBEM) facilitates site-specific tissue deposition/re-growth for the management of a variety of wounds. The aim was to describe the use and outcomes of PBEM in PD at a single centre. METHOD: A retrospective chart review of adolescent patients who underwent treatment of pilonidal disease with PBEM between 2012 and 2016 at a single institution, was undertaken. Patient demographics and clinical characteristics were collected and compared with historical controls and literature regarding traditional wound therapies. RESULTS: We reviewed 52 pilonidal disease wounds on 41 patients. Of these 36 were treated with PBEM. The average age was 16 years old at the time of operation with 39% male. Furthermore, 85% were being treated for recurrent pilonidal disease. Follow-up was available by chart review for 89% of patients with documented complete wound healing in 78% of patients treated with PBEM at an average of two months. Subjective reports included majority positive experience with PBEM dressing, minimal pain and overall high levels of patient satisfaction. There were three patients in which pilonidal disease recurred within two years of initial treatment and underwent repeat treatment with PBEM. There was one patient who transitioned to wet-to-dry saline dressings because of difficulty keeping the PBEM dressing intact. CONCLUSION: Advances in wound care technology include materials such as PBEM to promote site-specific tissue deposition. Follow-up phone calls and a prospective study to compare alternative wound care with porcine PBEM in the management of pilonidal disease is underway to better quantify time to wound healing and patient satisfaction.", "provenance": [ { "field": "population", "quote": "adolescent patients who underwent treatment of pilonidal disease with PBEM between 2012 and 2016" }, { "field": "population", "quote": "85% were being treated for recurrent pilonidal disease" }, { "field": "intervention", "quote": "Porcine bladder extracellular matrix (PBEM) facilitates site-specific tissue deposition/re-growth for the management of a variety of wounds." }, { "field": "comparator", "quote": "compared with historical controls and literature regarding traditional wound therapies" }, { "field": "primaryOutcome", "quote": "documented complete wound healing in 78% of patients treated with PBEM at an average of two months" }, { "field": "result", "quote": "documented complete wound healing in 78% of patients treated with PBEM at an average of two months. Subjective reports included majority positive experience with PBEM dressing, minimal pain and overall high levels of patient satisfaction." }, { "field": "n", "quote": "We reviewed 52 pilonidal disease wounds on 41 patients." }, { "field": "followUp", "quote": "There were three patients in which pilonidal disease recurred within two years of initial treatment" } ] }, { "id": "pmid:30940347", "pmid": "30940347", "doi": "10.1016/j.jpedsurg.2019.02.058", "nctId": null, "pmcid": null, "title": "Surgical interventions for the treatment of sacrococcygeal pilonidal sinus disease in children: A systematic review and meta-analysis", "firstAuthor": "Hardy", "multipleAuthors": true, "journal": "J Pediatr Surg", "year": 2019, "design": "meta-analysis", "n": null, "nField": "not-reported", "population": "Children with pilonidal sinus disease (cysts at the base of the spine)", "intervention": "Different surgical treatments for pilonidal sinus disease, including open healing, midline closure, off-midline closure, VAC therapy, minimally invasive techniques, and marsupialisation", "comparator": "Comparison between these different surgical techniques", "primaryOutcome": "Risk of the cyst coming back (recurrence), wound complications, and how long the wound took to heal", "result": "Off-midline closure, minimally invasive techniques, and marsupialisation had lower recurrence and complication rates than open healing or midline closure", "resultDirection": "mixed", "quality": "low", "qualityWhy": "The authors themselves say the evidence is poor, based on pooled observational studies rather than high-quality trials, and rated it Level IV evidence.", "directness": "indirect", "limitations": "The abstract does not address what to do if a cyst bursts spontaneously; it only compares planned surgical techniques, and the authors state evidence quality is poor.", "followUp": "", "plainFinding": "Compares surgery types, not spontaneous rupture.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/30940347/", "sourceText": "BACKGROUND: Pilonidal sinus disease (PNS) is not uncommon in children. Controversy remains over the best treatment and there is limited evidence. This systematic review and meta-analysis aims to establish which techniques have the best outcomes in children. METHODS: MEDLINE, EMBASE and CENTRAL databases were searched. Studies reporting treatment outcomes for PNS in children were included. RESULTS: Open healing has pooled risk of recurrence of 26% (95%CI 15-38%), risk of wound complication of 21% (9-36%) and wound healing ranged from 38-92 days. Midline primary closure has pooled risk of recurrence of 12% (8-18%), risk of wound complication of 30% (19-46%) and wound healing ranged from 8 to 32 days. Off-midline primary closure has pooled risk of recurrence of 6% (1-15%), risk of wound complication of 14% (6-25%) and wound healing was 27 days. VAC therapy has pooled risk of recurrence of 20% (0-65%) and wound healing ranged from 38 to 92 days. Minimally invasive techniques has pooled risk of recurrence of 7% (1-16%) and wound healing ranged from 21-30 days. Marsupialisation has pooled risk of recurrence of 6% (0-22%), and wound healing ranged from 6 to 41 days. CONCLUSION: Evidence for management of PNS in children is poor. Off-midline primary closure, minimally invasive techniques, and marsupialisation have the best outcomes. LEVEL OF EVIDENCE RATING: IV.", "provenance": [ { "field": "population", "quote": "Pilonidal sinus disease (PNS) is not uncommon in children." }, { "field": "intervention", "quote": "Off-midline primary closure has pooled risk of recurrence of 6% (1-15%), risk of wound complication of 14% (6-25%) and wound healing was 27 days." }, { "field": "comparator", "quote": "Studies reporting treatment outcomes for PNS in children were included." }, { "field": "primaryOutcome", "quote": "Open healing has pooled risk of recurrence of 26% (95%CI 15-38%), risk of wound complication of 21% (9-36%) and wound healing ranged from 38-92 days." }, { "field": "result", "quote": "Off-midline primary closure, minimally invasive techniques, and marsupialisation have the best outcomes." }, { "field": "qualityWhy", "quote": "Evidence for management of PNS in children is poor." }, { "field": "qualityWhy", "quote": "LEVEL OF EVIDENCE RATING: IV." } ] }, { "id": "pmid:30440104", "pmid": "30440104", "doi": "10.1111/iwj.13042", "nctId": null, "pmcid": "PMC7949345", "title": "Management of sacrococcygeal pilonidal sinus disease", "firstAuthor": "Harries", "multipleAuthors": true, "journal": "Int Wound J", "year": 2019, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with pilonidal sinus disease (a cyst/tunnel near the tailbone)", "intervention": "various surgical treatments for pilonidal sinus disease", "comparator": "different surgical techniques compared with each other", "primaryOutcome": "cure with fast recovery and low complication rate", "result": "the abstract summarises that treatment approaches vary and surgical complications, especially wound healing problems, can be worse than the original disease, but gives no specific data or recommendation", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a general review of surgical treatment options with no study data, and it does not address what to do if a cyst bursts on its own.", "directness": "indirect", "limitations": "No specific methodology, data, or outcomes are reported; it is a general overview rather than a study of spontaneous rupture.", "followUp": "", "plainFinding": "Does not address spontaneous bursting.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/30440104/", "sourceText": "The ideal treatment for patients who suffer from pilonidal sinus disease should lead to a cure with a rapid recovery period allowing a return to normal daily activities, with a low level of associated morbidity. A variety of different surgical techniques have been described for the primary treatment of pilonidal sinus disease and current practice remains variable and contentious. Whilst some management options have improved outcomes for some patients, the complications of surgery, particularly related to wound healing, often remain worse than the primary disease. This clinical review aims to provide an update on the management options to guide clinicians involved in the care of patients who suffer from sacrococcygeal pilonidal sinus disease.", "provenance": [ { "field": "population", "quote": "patients who suffer from pilonidal sinus disease" }, { "field": "intervention", "quote": "A variety of different surgical techniques have been described for the primary treatment of pilonidal sinus disease" }, { "field": "comparator", "quote": "current practice remains variable and contentious" }, { "field": "primaryOutcome", "quote": "The ideal treatment for patients who suffer from pilonidal sinus disease should lead to a cure with a rapid recovery period allowing a return to normal daily activities, with a low level of associated morbidity" }, { "field": "result", "quote": "the complications of surgery, particularly related to wound healing, often remain worse than the primary disease" } ] }, { "id": "pmid:30240147", "pmid": "30240147", "doi": "10.1111/iwj.12981", "nctId": null, "pmcid": "PMC7949350", "title": "Idea and innovation: Secure fixation between dermis and periosteum using perforator flap to prevent recurrence of pilonidal sinus disease", "firstAuthor": "Liao", "multipleAuthors": true, "journal": "Int Wound J", "year": 2019, "design": "case-series", "n": 1, "nField": "reported", "population": "young woman with repeatedly returning pilonidal sinus disease whose abscess had burst and did not improve with antibiotics", "intervention": "complete surgical removal of the sinus tissue followed by reconstruction using a local skin and muscle flap (SGAP flap) stitched down to the bone covering", "comparator": "no comparison group; single patient case report", "primaryOutcome": "whether the pilonidal disease came back after surgery", "result": "the sinus disease did not return over three years of follow-up", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a single patient case report with no comparison group, so it cannot show whether this approach is better than other treatments.", "directness": "indirect", "limitations": "single case report of one patient; no control group; abstract only describes a surgical reconstruction technique used after the disease had already recurred and been treated surgically, not management of a sinus bursting on its own.", "followUp": "3 years", "plainFinding": "Flap surgery prevented recurrence, one patient", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/30240147/", "sourceText": "In the past decades, numerous surgical techniques and conservative treatments for pilonidal sinus disease (PSD) had been discussed and published. There is still no consensus yet of the best techniques because of high recurrence rates and prolonged wound healing. In the case of complicated discharging sinus or recurrent PSD resistant to treatment with antibiotics, we recommend radical excision followed by a regional flap, which can obliterate the dead space with well-vascularised tissue. In this article, we presented the technique of snug suture fixation between the dermis and periosteum using a superior gluteal artery perforator (SGAP) flap. The study demonstrates a few key concepts on the prevention of PSD recurrence, an off-midline, well-perfused flap that allows flattened natal cleft and obliteration of gluteal cleft and eventually showed good aesthetic results. We aim to demonstrate a reliable surgical technique for wound closure of recurrent pilonidal sinus after radical excision followed by reconstruction with an SGAP flap. The history, surgery, and images are described, and the literature is reviewed. The pitfalls of disease recurrence will be discussed in this literature. Keys to successful treatment will be elaborated. An 18-year-old female with recurrent pilonidal sinus disease over right medial gluteal region presented with sacral pain and infection. She developed progressive swelling and burst of abscess from several sinus tracts and did not respond to the treatment with antibiotics alone. After radical excision of the entire pilonidal sinus and adjacent fibrotic tissue, a deep and large defect was measured. A superior gluteal perforator flap was designed based on three perforators from the superior gluteal artery. A medial 3 cm of the SGAP flap was de-epithelised to provide soft tissue bulk to obliterate the deep cavity. Strong sutures were applied to secure the flap to the periosteum. There was no recurrence at 3 years of follow up. The patient stood the operation well and had prompt recovery.", "provenance": [ { "field": "n", "quote": "An 18-year-old female with recurrent pilonidal sinus disease" }, { "field": "population", "quote": "An 18-year-old female with recurrent pilonidal sinus disease over right medial gluteal region presented with sacral pain and infection. She developed progressive swelling and burst of abscess from several sinus tracts and did not respond to the treatment with antibiotics alone." }, { "field": "intervention", "quote": "After radical excision of the entire pilonidal sinus and adjacent fibrotic tissue, a deep and large defect was measured. A superior gluteal perforator flap was designed based on three perforators from the superior gluteal artery." }, { "field": "intervention", "quote": "Strong sutures were applied to secure the flap to the periosteum." }, { "field": "result", "quote": "There was no recurrence at 3 years of follow up." }, { "field": "primaryOutcome", "quote": "The study demonstrates a few key concepts on the prevention of PSD recurrence" }, { "field": "comparator", "quote": "The history, surgery, and images are described, and the literature is reviewed." } ] }, { "id": "pmid:30064734", "pmid": "30064734", "doi": "10.1016/j.surg.2018.05.046", "nctId": null, "pmcid": null, "title": "Treatment of pilonidal disease by minimal surgical excision under local anesthesia with healing by secondary intention: Results in over 500 patients", "firstAuthor": "Burney", "multipleAuthors": false, "journal": "Surgery", "year": 2018, "design": "case-series", "n": 570, "nField": "reported", "population": "patients with pilonidal disease treated by one surgeon from 1978 to 2015", "intervention": "minimal surgical excision under local anesthesia, with the wound left open to heal on its own", "comparator": "none, all patients received the same surgical treatment", "primaryOutcome": "how long wounds took to heal and how often the disease came back requiring another operation", "result": "3.2% of patients needed another operation due to persistent or recurrent disease, and most healed afterward", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a single surgeon's case series with no comparison group, so it cannot show whether this approach is better than other options, including doing nothing after a cyst bursts.", "directness": "indirect", "limitations": "No control group, single surgeon experience, retrospective review of records", "followUp": "4.7 years", "plainFinding": "Low recurrence after minor excision surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/30064734/", "sourceText": "BACKGROUND: The surgical treatment of pilonidal disease is highly variable. The present study examines the long-term results in over 500 patients treated by minimal but complete surgical excision under local anesthesia with healing by secondary intention using moist dressings. METHODS: Records of all patients I treated for pilonidal disease from 1978 to 2015 with at least 1 year of follow-up were reviewed. Symptoms, prior surgical treatments, extent of disease, number of clinic visits, length of time until wound healed, compliance with wound care instructions, and length of follow-up were recorded. RESULTS: Records were found for 570 patients; mean follow-up was 4.7 years. Two hundred forty-eight patients (44%) had a prior abscess requiring drainage; 80 had from 1 to 6 prior operations. Ninety-two percent of operations were performed under local anesthesia. Men had more extensive disease than women (5.2 vs 3.5 cm, P < .001) and took longer to heal (median 46 days in women, 51 days in men, P < .001). Eighteen patients (3.2%) had persistent or recurrent disease requiring reoperation, most often because of poor compliance with wound care instructions, and later healed. CONCLUSION: The majority of patients with pilonidal disease can be managed by simple, minimal excision of affected tissue under local anesthesia with healing by secondary intention. With careful attention to wound care, morbidity is minimal and the recurrence or failure rate is less than 5%.", "provenance": [ { "field": "n", "quote": "Records were found for 570 patients" }, { "field": "population", "quote": "Records of all patients I treated for pilonidal disease from 1978 to 2015 with at least 1 year of follow-up were reviewed." }, { "field": "intervention", "quote": "minimal but complete surgical excision under local anesthesia with healing by secondary intention using moist dressings" }, { "field": "comparator", "quote": "Ninety-two percent of operations were performed under local anesthesia." }, { "field": "primaryOutcome", "quote": "number of clinic visits, length of time until wound healed, compliance with wound care instructions, and length of follow-up were recorded" }, { "field": "result", "quote": "Eighteen patients (3.2%) had persistent or recurrent disease requiring reoperation, most often because of poor compliance with wound care instructions, and later healed." }, { "field": "followUp", "quote": "mean follow-up was 4.7 years" } ] }, { "id": "pmid:29947121", "pmid": "29947121", "doi": "10.1111/iwj.12936", "nctId": null, "pmcid": "PMC7949598", "title": "Is conservative treatment an effective option for pilonidal sinus disease in children?", "firstAuthor": "Cevik", "multipleAuthors": true, "journal": "Int Wound J", "year": 2018, "design": "retrospective", "n": 29, "nField": "reported", "population": "children and teenagers with pilonidal sinus disease", "intervention": "conservative treatment: hair removal, better hygiene, warm sitz baths, and draining any abscess", "comparator": "no comparison group, outcomes tracked over time in same patients", "primaryOutcome": "whether the area fully healed, came back, or needed surgery", "result": "most healed without surgery, some had recurrence, a few needed surgery", "resultDirection": "benefit", "quality": "low", "qualityWhy": "it looked back at records of a small group of children with no comparison group, so it can't prove conservative care is better than other options.", "directness": "indirect", "limitations": "retrospective design, small sample, follow-up time varied a lot between patients, and it studied general pilonidal sinus disease in children rather than specifically a cyst that had already burst", "followUp": "8.34 ± 6.36 (range: 1-25) months", "plainFinding": "Most healed without surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/29947121/", "sourceText": "Pilonidal sinus disease (PSD) is associated with a complex disease process in children, and its management remains controversial. There are a few published studies on PSD in the paediatric literature; therefore, we present our experience of conservatively treating PSD in children. This study involved a retrospective review with telephone follow up. All children diagnosed with PSD in 2012 to 2017 were identified at the outpatient clinic of the Department of Paediatric Surgery. All patients initially underwent conservative treatment (meticulous hair removal, improved perianal hygiene, warm sitz baths, and drainage for abscess). Data collection included demographics, type of management, recurrence, presence of infection, and total healing time. In the study period, 29 children were identified. Their mean age was 14.94 ± 1.09 (range: 12-16) years, and 51.7% were girls. The mean length of follow up was 8.34 ± 6.36 (range: 1-25) months. Complete healing occurred in 79.3% of patients. Recurrence was evident in 12% of patients. Four patients underwent surgery. PSD is being seen in children more frequently in recent years. Conservative treatment may be the recommended initial approach for PSD in children.", "provenance": [ { "field": "population", "quote": "All children diagnosed with PSD in 2012 to 2017 were identified at the outpatient clinic of the Department of Paediatric Surgery." }, { "field": "intervention", "quote": "All patients initially underwent conservative treatment (meticulous hair removal, improved perianal hygiene, warm sitz baths, and drainage for abscess)." }, { "field": "comparator", "quote": "This study involved a retrospective review with telephone follow up." }, { "field": "primaryOutcome", "quote": "Data collection included demographics, type of management, recurrence, presence of infection, and total healing time." }, { "field": "result", "quote": "Complete healing occurred in 79.3% of patients. Recurrence was evident in 12% of patients. Four patients underwent surgery." }, { "field": "n", "quote": "In the study period, 29 children were identified." } ] }, { "id": "pmid:29529705", "pmid": "29529705", "doi": null, "nctId": null, "pmcid": null, "title": "Video-Assisted Subcutaneous Destruction of the Sinus Tract with Vessel-Loop Drainage as Minimally-Invasive Surgical Treatment for Pilonidal Sinus Disease", "firstAuthor": "Korenkov", "multipleAuthors": false, "journal": "Surg Technol Int", "year": 2018, "design": "case-series", "n": 4, "nField": "reported", "population": "people with pilonidal sinus disease, three with simple sinus and one with an acute abscess", "intervention": "minimally invasive surgery using a scope to destroy the sinus tract under the skin, with a drain left in place", "comparator": "no comparison group; discussed only against the earlier non-video-assisted version of the technique", "primaryOutcome": "complications after surgery", "result": "the three simple cases had no problems in the first eight weeks, but the abscess patient developed a pus infection needing a larger open wound surgery", "resultDirection": "mixed", "quality": "very-low", "qualityWhy": "only four patients with no comparison group, and the authors themselves say the numbers are too small to judge whether the technique works", "directness": "indirect", "limitations": "abstract explicitly states the study is too small to properly assess the technique", "followUp": "eight weeks postoperatively", "plainFinding": "New surgery worked except for abscess case.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/29529705/", "sourceText": "The video-assisted subcutaneous destruction of the sinus tract (VADST) is a novel, minimally-invasive technique for the treatment of pilonidal sinus disease (PSD). This is an advancement of the previously described subcutaneous destruction of the sinus tract and the removal of hairs as well as the long-term vessel-loop drainage of the wound channel (DST). Although the first results of this operation seemed to be promising, some of my colleagues felt that the blind approach to this procedure could be its potential \"weak point\". As a result of this critique, the procedure was enhanced with the subcutaneous video-assisted inspection of the natal cleft. Throughout most steps of VADST, like the widening of pilonidal pits with mosquito and/or Pean clamps, the subcutaneous destroying of the sinus tract, lifting the skin in a natal cleft with a curette, removing the hair with a Pean clamp and a subcutaneous vessel-loop drainage, were found to be similar to DST. The new steps involve the possibility of the video-assisted control of hair vestiges and bleedings as well as the removal of hair and debris under visual control. A rigid choledochoscope from Berci (Firma Richard Wolf GmbH, Knittlingen, Germany) was used for the subcutaneous endoscopic examination of the natal cleft area. Neither gas application nor water perfusion were necessary for this step. Three patients with simple forms of PSD, and one patient with an acute abscess formation, underwent the VADST procedure. The patients with simple forms of PSD had no adverse events during the first eight weeks postoperatively. The patient with an acute abscess formation developed a purulent inflammation that required a wide local excision with an open-wound healing. Due to the very small number of patients in this report, we were not able to asses this technique properly. Contrary to DST, we intend to use VADST, not only for the treatment of patients with simple forms (primary pilonidal sinus without abscessed inflammation with maximal three orifices, all of them inside the navicular area), but also for the treatment of complex PSD forms.", "provenance": [ { "field": "n", "quote": "Three patients with simple forms of PSD, and one patient with an acute abscess formation, underwent the VADST procedure." }, { "field": "population", "quote": "Three patients with simple forms of PSD, and one patient with an acute abscess formation, underwent the VADST procedure." }, { "field": "intervention", "quote": "video-assisted subcutaneous destruction of the sinus tract (VADST) is a novel, minimally-invasive technique for the treatment of pilonidal sinus disease (PSD)" }, { "field": "comparator", "quote": "Contrary to DST, we intend to use VADST" }, { "field": "primaryOutcome", "quote": "The patients with simple forms of PSD had no adverse events during the first eight weeks postoperatively." }, { "field": "result", "quote": "The patient with an acute abscess formation developed a purulent inflammation that required a wide local excision with an open-wound healing." }, { "field": "result", "quote": "The patients with simple forms of PSD had no adverse events during the first eight weeks postoperatively." } ] }, { "id": "pmid:29433863", "pmid": "29433863", "doi": "10.1016/j.jss.2017.09.051", "nctId": null, "pmcid": null, "title": "Aspiration for acute pilonidal abscess-a cohort study", "firstAuthor": "Lasithiotakis", "multipleAuthors": true, "journal": "J Surg Res", "year": 2018, "design": "prospective-cohort", "n": 100, "nField": "reported", "population": "adults presenting with an acute pilonidal abscess", "intervention": "bedside aspiration under local anesthetic plus oral antibiotics (cefalexin and metronidazole)", "comparator": "no comparison group; outcomes compared only to historical rates of traditional incision and drainage", "primaryOutcome": "whether the abscess resolved without needing surgical drainage, and patient satisfaction", "result": "83% of patients avoided incision and drainage, with high satisfaction scores", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a single-center study with no comparison group and only just over half the patients returning satisfaction surveys, so the results could be biased.", "directness": "indirect", "limitations": "No control group for comparison, incomplete questionnaire response (56 of 100), and patients with skin necrosis or perforation were excluded.", "followUp": "29 (47) months", "plainFinding": "Aspiration worked for most abscesses.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/29433863/", "sourceText": "BACKGROUND: The traditional open incision and drainage of a pilonidal abscess is associated with slow healing and delayed return to normal daily activities. The aim of this study is to assess safety, effectiveness, and patient satisfaction of aspiration followed by antibiotics for a pilonidal abscess. MATERIAL AND METHODS: All patients presenting with an acute pilonidal abscess during the period December 2010 and December 2014 in York Hospital, UK, were treated with bedside aspiration under local anesthetic, followed by oral cefalexin and metronidazole for 7 days. Patients with immunosuppression, diabetes, overlying skin necrosis, and perforation were excluded. Complications of the procedure were prospectively recorded. Long-term outcomes and overall patients' satisfaction were assessed with the use of mailed questionnaires and Visual Analogue Scales (VAS) (0 = not satisfied at all, 10 = very satisfied). RESULTS: One hundred sixty-nine patients presented with an acute pilonidal abscess and a total of 100 patients were treated with aspiration and antibiotics. There were 50 women (50%) and the median (interquartile range [IQR]) age of the cohort was 24 (14) years. Eleven patients had a history of a previous pilonidal procedure. Seven patients were treated successfully with a reaspiration. Overall, 10 patients required incision and drainage after a median (IQR) follow-up time of 29 (47) months. Fifty-six patients returned completed questionnaires. The median (IQR) of the VAS for the overall satisfaction of the procedure was 9 (5). CONCLUSIONS: Aspiration of a pilonidal abscess in selected patients is effective in 83%, and it is associated with high overall satisfaction rates.", "provenance": [ { "field": "n", "quote": "a total of 100 patients were treated with aspiration and antibiotics" }, { "field": "population", "quote": "All patients presenting with an acute pilonidal abscess during the period December 2010 and December 2014" }, { "field": "intervention", "quote": "treated with bedside aspiration under local anesthetic, followed by oral cefalexin and metronidazole for 7 days" }, { "field": "comparator", "quote": "The traditional open incision and drainage of a pilonidal abscess is associated with slow healing and delayed return to normal daily activities." }, { "field": "primaryOutcome", "quote": "assess safety, effectiveness, and patient satisfaction of aspiration followed by antibiotics for a pilonidal abscess" }, { "field": "result", "quote": "Aspiration of a pilonidal abscess in selected patients is effective in 83%, and it is associated with high overall satisfaction rates." }, { "field": "followUp", "quote": "median (IQR) follow-up time of 29 (47) months" } ] }, { "id": "pmid:29391092", "pmid": "29391092", "doi": null, "nctId": null, "pmcid": null, "title": "Outcomes of Unroofing with Limited Excision and Structured Postoperative Care for Pilonidal Disease", "firstAuthor": "Tavangari", "multipleAuthors": true, "journal": "Am Surg", "year": 2017, "design": "retrospective", "n": 94, "nField": "reported", "population": "patients with chronic pilonidal disease, ages 11 to 63", "intervention": "surgery called unroofing with limited excision, plus structured wound care and weekly clinic visits afterward", "comparator": "none; all patients received the same treatment", "primaryOutcome": "time to complete healing and rate of disease coming back", "result": "most wounds healed by about 53 days and only 2.1% of cases came back", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this is a retrospective study of one treatment with no comparison group, so it can't show the surgery is better than other options.", "directness": "indirect", "limitations": "retrospective design, no comparison group, single surgical technique at one center", "followUp": "40 months", "plainFinding": "Surgery healed cysts with few recurrences.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/29391092/", "sourceText": "Despite a wide variety of surgical techniques to treat chronic pilonidal disease, high rates of recurrence are common. The current study analyzes the outcome of unroofing with limited excision combined with structured postoperative wound care for pilonidal disease. We performed a retrospective review of all patients who were treated with this technique over a seven year period. Ninety-four patients aged 11 to 63 (mean age 26) received this treatment for pilonidal disease. Eighty-nine patients were treated for primary pilonidal disease and five were treated for recurrent disease after procedures such as flaps. There were 66 males (70%) and 28 females (30%). The operation was performed by unroofing the entire pilonidal sinus along with its pits and area of chronic abscess cavity. All granulation tissue was removed and the base of the sinus was completely cauterized. No wide local excisions were performed. The cavity was packed with dry gauze and the dressing was changed twice daily. Patients were seen postoperatively on a weekly basis in clinic. The area was shaved; the cavity was cleaned and often treated with silver nitrate. In the event of premature skin closure starting to form, unroofing was easily performed in the office. The median time to achieve complete healing was 53 days requiring, on average, seven visits. With a mean follow-up of 40 months, there were two recurrences (2.1%) and reoperation for two (2.1%) inappropriately healing wounds. This study demonstrates that unroofing with limited excision and structured postoperative care for pilonidal disease is a safe and effective treatment approach with a very low recurrence and complication rate.", "provenance": [ { "field": "population", "quote": "Ninety-four patients aged 11 to 63 (mean age 26) received this treatment for pilonidal disease." }, { "field": "intervention", "quote": "unroofing with limited excision combined with structured postoperative wound care for pilonidal disease" }, { "field": "comparator", "quote": "We performed a retrospective review of all patients who were treated with this technique over a seven year period." }, { "field": "primaryOutcome", "quote": "The median time to achieve complete healing was 53 days requiring, on average, seven visits." }, { "field": "result", "quote": "With a mean follow-up of 40 months, there were two recurrences (2.1%) and reoperation for two (2.1%) inappropriately healing wounds." }, { "field": "n", "quote": "Ninety-four patients aged 11 to 63 (mean age 26) received this treatment for pilonidal disease." }, { "field": "followUp", "quote": "With a mean follow-up of 40 months" } ] }, { "id": "pmid:29390948", "pmid": "29390948", "doi": "10.1080/00015458.2018.1430218", "nctId": null, "pmcid": null, "title": "Limberg flap in management of pilonidal sinus disease: systematic review and a local experience", "firstAuthor": "Boshnaq", "multipleAuthors": true, "journal": "Acta Chir Belg", "year": 2018, "design": "systematic-review", "n": 26, "nField": "reported", "population": "patients with pilonidal sinus disease who had surgery", "intervention": "Limberg flap surgery", "comparator": "primary closure and Karydakis flap surgery", "primaryOutcome": "recurrence rate and complications after surgery", "result": "Limberg flap had lower recurrence than primary closure and similar results to Karydakis flap", "resultDirection": "benefit", "quality": "low", "qualityWhy": "Much of the evidence comes from a small retrospective local cohort of 26 patients plus a narrative pooling of mixed study types rather than a formal meta-analysis.", "directness": "indirect", "limitations": "Abstract does not address spontaneous rupture of a pilonidal cyst; it only reports outcomes after planned surgical flap procedures for pilonidal sinus disease.", "followUp": "18 months", "plainFinding": "Flap surgery lowers recurrence risk.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/29390948/", "sourceText": "OBJECTIVES: To review published evidence of Limberg flap (LF) use in pilonidal sinus disease (PSD). We also included our local experience of LF. METHODS: Medline and Embase database were searched for the words 'pilonidal, sinus, Limberg, flap'. Non-English articles and those not-related to our scope of search were omitted. We included a retrospective study of patients underwent LF in our district hospital. Data including length of hospital stay, post-operative complications and recurrence were collected. RESULTS: Literature review revealed 68 studies (22 case series, 35 comparative studies, nine RCTs and two meta-analyses). Recurrence rate was 0-7.4% in case series. Recurrence rate in comparative studies was 0-8.3%, compared to 4-37.7% for primary closure and 0-11% for Karydakis flap. RCTs showed that LF or its modification is superior to primary closure, with comparable results to Karydakis flap. About 26 patients included in the cohort study (16 male, average age 27 years). Six patients presented with recurrent disease. Post-operative length of hospital stay was four to seven days. Post-operative complication rate was 11.5% - [two partial wound dehiscence, one wound infection]. Recurrence rate was 7.7%. Average follow-up was 18 months. CONCLUSIONS: Limberg flap presents a safe and effective method that can be offered for patients with primary or recurrent PSD.", "provenance": [ { "field": "n", "quote": "About 26 patients included in the cohort study (16 male, average age 27 years)." }, { "field": "result", "quote": "RCTs showed that LF or its modification is superior to primary closure, with comparable results to Karydakis flap." }, { "field": "primaryOutcome", "quote": "Data including length of hospital stay, post-operative complications and recurrence were collected." }, { "field": "intervention", "quote": "To review published evidence of Limberg flap (LF) use in pilonidal sinus disease (PSD)." }, { "field": "comparator", "quote": "compared to 4-37.7% for primary closure and 0-11% for Karydakis flap." }, { "field": "population", "quote": "We included a retrospective study of patients underwent LF in our district hospital." } ] }, { "id": "pmid:28522786", "pmid": "28522786", "doi": "10.5604/01.3001.0009.6009", "nctId": null, "pmcid": null, "title": "Pilonidal sinus: finding the righttrack for treatment", "firstAuthor": "Hap", "multipleAuthors": true, "journal": "Pol Przegl Chir", "year": 2017, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with pilonidal cysts", "intervention": "various surgical treatment methods for pilonidal cyst", "comparator": "different surgical techniques compared to each other", "primaryOutcome": "success of treatment / avoiding complications", "result": "no single method was found effective enough to be the standard treatment", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a general narrative review of surgical methods without specific data on spontaneously burst cysts, so it offers very weak evidence for this question.", "directness": "indirect", "limitations": "abstract does not address spontaneous rupture specifically; it is a general review of surgical techniques without stated methodology or data on efficacy rates", "followUp": "", "plainFinding": "No clear best treatment identified.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/28522786/", "sourceText": "Pilonidal cyst is a troublesome condition affecting usually young people. It significantly influences quality of life and causes low self-esteem. Despite its known pathophysiology and numerous therapeutic methods available, pilonidal cysts still constitute a significant problem in general surgery. A large number of surgical techniques indicates the lack of a single method that ensures therapeutic success, and frequent complications cause both patient's dissatisfaction and frustration of the operator. In many cases, therapy is based on methods developed in a given healthcare center and their efficacy is usually not scientifically verified. Search for optimal strategy is also impeded by lack of an unambiguous clinical classification. In this article, we reviewed publications on various methods of managing pilonidal cyst, and we also presented surgical treatment used in our department. However, we did not manage to point out a surgical method with efficacy high enough to become standard treatment. It indicates the need for further search for new techniques that will give chances for successful treatment of pilonidal cyst.", "provenance": [ { "field": "population", "quote": "Pilonidal cyst is a troublesome condition affecting usually young people." }, { "field": "intervention", "quote": "we reviewed publications on various methods of managing pilonidal cyst" }, { "field": "comparator", "quote": "A large number of surgical techniques indicates the lack of a single method that ensures therapeutic success" }, { "field": "primaryOutcome", "quote": "we did not manage to point out a surgical method with efficacy high enough to become standard treatment" }, { "field": "result", "quote": "we did not manage to point out a surgical method with efficacy high enough to become standard treatment" } ] }, { "id": "pmid:28355137", "pmid": "28355137", "doi": null, "nctId": null, "pmcid": null, "title": "A Retrospective Study of Pilonidal Sinus Healing by Secondary Intention Using Negative Pressure Wound Therapy Versus Alginate or Gauze Dressings", "firstAuthor": "Danne", "multipleAuthors": true, "journal": "Ostomy Wound Manage", "year": 2017, "design": "retrospective", "n": 73, "nField": "reported", "population": "patients who had symptomatic natal cleft PS", "intervention": "negative pressure wound therapy after surgery", "comparator": "alginate-based or gauze daily dressing changes after surgery", "primaryOutcome": "time in weeks to achieving the endpoint (epithelialization)", "result": "median healing time was 10 weeks with dressings versus 8 weeks with NPWT, a difference that was not statistically significant, and recurrence rates were also not significantly different", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "this was a small retrospective study without randomization, so it can't reliably show whether one wound care method is better.", "directness": "indirect", "limitations": "Retrospective design, small sample size, loss to follow-up, and no randomization; authors state prospective randomized trials are needed.", "followUp": "", "plainFinding": "No difference between wound care methods.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/28355137/", "sourceText": "Pilonidal sinus (PS) disease is an inflammatory skin and subcutaneous tissue condition that presents with infection, acute abscess, chronic discharging wounds, and/or pain. Surgery with open healing by secondary intention typically is used to achieve the fastest healing time with minimal recurrence rates. A retrospective analysis was conducted of data extracted from the medical records of 73 consecutive patients who had symptomatic natal cleft PS over a 10-year period to compare use of NPWT to alginate-based/gauze daily dressing (DD) changes in terms of healing time and recurrence. Variables extracted included age, gender, PS wound diameter (small <1 cm, medium 1 cm to 3 cm, large >3 cm), and time in weeks to achieving the endpoint (epithelialization). Risk factors examined that can affect healing or recurrence of previously operated PS disease included initial drainage before excision and risk factors for impaired healing (morbid obesity as determined by body mass index [BMI] ≥35, chronic infective skin conditions, and ongoing therapy with immuno-modulating drugs or chemotherapy), and loss to follow-up. Data were collected and analyzed using the chi-squared statistic, Kaplan-Meier curves, and Cox regression models. The total time of follow-up was 390 weeks for the DD group and 311 weeks for NPWT group. Patient mean age was 26.5 ± 10.7 years, most (53, 72.6%) were male, and 12 (16.4%) had comorbidities potentially affecting healing. Nine (9) were treated with primary closure and 62 patients were treated with open healing by secondary intention (2 additional patients receiving DD were excluded from the analysis because they had small sinuses that made NPWT unfeasible). Among participants, 30 (48%) received DD and 32 had NPWT. The median time to healing was 10 weeks (95% CI: 7-17) in the DD group and 8 weeks (95% CI: 7-9) in the NPWT group (not significantly different). In patients who healed, the average time to healing was 15.0 ± 18.1 and 9.8 ± 6.3 weeks in the DD and NPWT groups, respectively (not significantly different). The PS wound recurred in 5 patients - 4 (12.5%) in the DD group and 1 (3.1%) in the NPWT group (P = .355). In univariate analysis, only the presence of comorbidities was found to significantly affect time to healing (HR 95%, CI: 0.40 [0.17-0.93]; P = .033]. Prospective, randomized controlled clinical studies are warranted.", "provenance": [ { "field": "population", "quote": "A retrospective analysis was conducted of data extracted from the medical records of 73 consecutive patients who had symptomatic natal cleft PS over a 10-year period" }, { "field": "intervention", "quote": "to compare use of NPWT to alginate-based/gauze daily dressing (DD) changes in terms of healing time and recurrence" }, { "field": "comparator", "quote": "to compare use of NPWT to alginate-based/gauze daily dressing (DD) changes in terms of healing time and recurrence" }, { "field": "primaryOutcome", "quote": "time in weeks to achieving the endpoint (epithelialization)" }, { "field": "result", "quote": "The median time to healing was 10 weeks (95% CI: 7-17) in the DD group and 8 weeks (95% CI: 7-9) in the NPWT group (not significantly different)." }, { "field": "n", "quote": "A retrospective analysis was conducted of data extracted from the medical records of 73 consecutive patients" } ] } ], "faqs": [ { "q": "My pilonidal cyst burst on its own — what should I do?", "a": "No study in this review followed people whose cyst burst at home without any medical procedure, so there's no research-backed answer to this exact question. Related studies only looked at cysts drained by a clinician, where leaving hair or debris behind was linked to the area reopening or forming a lump that needed more treatment — which is why many people choose to get it checked, even though this hasn't been tested for self-ruptured cysts specifically." }, { "q": "How do you know when a pilonidal cyst is ready to burst?", "a": "No study found in this review measured warning signs that a cyst is about to rupture. This is a genuine gap — nothing here can tell you what to expect beforehand." }, { "q": "Why does a burst pilonidal cyst smell?", "a": "No study in this review measured odor directly. One study looked at which bacteria are typically found inside pilonidal abscesses, which is consistent with an infection being present, but it did not link any specific bacteria to smell." }, { "q": "Is it normal for a burst pilonidal cyst to bleed?", "a": "No study in this review tracked bleeding after a cyst ruptures on its own, so there's no data here on how much bleeding is typical or when it should be a concern." }, { "q": "My pilonidal cyst burst at home — do I need to see a doctor?", "a": "No study has directly tested whether seeing a doctor after a spontaneous rupture changes healing, infection, or recurrence. Related research on clinician-performed drainage shows that retained hair or incomplete drainage can lead to the area reopening or recurring, which is part of why many clinicians still recommend a check, even without direct evidence for this specific scenario." } ], "searchedAs": [ "pilonidal cyst burst", "pilonidal cyst burst on its own", "pilonidal cyst burst smell", "how do you know when a pilonidal cyst is ready to burst", "pilonidal cyst burst itself", "pilonidal cyst burst blood", "pilonidal cyst burst at home" ], "patientTakeaway": "No study has looked at exactly this situation — a pilonidal cyst that bursts on its own at home — so this page cannot tell you that any particular home care speeds healing or prevents it coming back. What the related research does show is that pilonidal cysts drained by a clinician can come back or keep draining if hair or debris is left behind, so it's reasonable to get the area looked at, especially if pain, redness, or drainage are getting worse rather than better. Keep the area clean and dry in the meantime, and seek care sooner if you notice spreading redness, fever, or worsening pain.", "methodology": { "databases": [ "PubMed", "ClinicalTrials.gov", "Crossref" ], "searchStrings": { "pubmed": "(\"Pilonidal Sinus\"[Mesh] OR pilonidal cyst[tiab] OR pilonidal abscess[tiab]) AND (rupture*[tiab] OR spontaneous drainage[tiab] OR self-drain*[tiab] OR burst*[tiab] OR \"wound healing\"[Mesh] OR wound care[tiab] OR conservative management[tiab] OR \"incision and drainage\"[tiab])" }, "pubmedQueryTranslation": "(\"Pilonidal Sinus\"[MeSH Terms] OR \"pilonidal cyst\"[Title/Abstract] OR \"pilonidal abscess\"[Title/Abstract]) AND (\"rupture*\"[Title/Abstract] OR \"spontaneous drainage\"[Title/Abstract] OR \"self drain*\"[Title/Abstract] OR \"burst*\"[Title/Abstract] OR \"wound healing\"[MeSH Terms] OR \"wound care\"[Title/Abstract] OR \"conservative management\"[Title/Abstract] OR \"incision and drainage\"[Title/Abstract])", "searchedOn": "2026-10-13", "inclusion": [ "Human, animal or laboratory studies reporting an outcome relevant to the question" ], "exclusion": [ "Records about a different condition or intervention", "Records reporting no outcome", "Retracted publications, which are listed but excluded from every count" ], "extractionLevel": "abstract", "gradingNote": "Evidence strength is adapted from the GRADE framework. It is not a GRADE assessment and was not produced by a GRADE panel.", "limits": [ "Fields were read from abstracts, not full text, so detail reported only in a paper's methods section is not captured." ] }, "seo": { "title": "Pilonidal cyst burst on its own: what to do?", "description": "No study has tested what to do after a pilonidal cyst bursts on its own at home; here's what the related research (48 studies) shows." }, "lastChecked": "2026-10-13", "lastChanged": "2026-10-13", "nextCheckDue": "2026-11-13", "history": [], "pipeline": { "screenModel": "claude-haiku-4-5", "extractModel": "claude-sonnet-5", "composeModel": "claude-sonnet-5", "promptVersion": "ev-1", "ranOn": "2026-10-13" }, "status": "published" }