Z-plasty For Treatment of Chronic, Refractory Pilonidal Disease
Pilonidal disease is inflammation with abscess formation and very often chronic drainage from the natal cleft at the tip of the coccyx. First line techniques such as drainage, excision, fibrin glue, and marsupialization are often unsatisfactory and do not provide definitive repair. One technique used by plastic surgeons and some general surgeons as a second line treatment when earlier attempts at treatment have failed is the Z-plasty.
Z-plasty is a surgical technique that is used widely in plastic surgery to close large wounds and to release contractures. In pilonidal disease, it has the advantage of eliminating the deep natal cleft and replacing the tissue defect with healthy, sinus free tissue from the lateral lower back.
Typically the pilonidal sinus is excised down to the presacral fascia (i.e., close to the sacral bone). Then two parallel incisions are made at the superior and inferion edges of the wound. The subcutaneous tissue (i.e., the fat layer beneath the skin) is raised to form skin flaps and the hook retractors are used to transpose the edges of the initial resection from the horizontal to the vertical.
The skin is then closed using nylon mattress sutures after a drain is placed. Generally, the patients tolerate the procedure well and have a fairly rapid recovery.
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