Less invasive treatment for the pilonidal sinus combined use of negative-pressure wound therapy

In treating pilonidal sinus of the sacral region, complete resection of the lesion and closure of the soft tissue defect/dead space resulting from fistulectomy is important. Insufficient closure of dead space frequently leads to a subsequent infection and wound dehiscence, with complications. We treated 4 patients with pilonidal sinus using negative-pressure wound therapy (NPWT) for closing the soft tissue defect after surgical resection and, by reducing the dead space in a short period, could close the wound by suturing in a second operation. The NPWT was continued for 14–21 (mean, 17.5) days, by which time satisfactory granulation was observed in the wound base, and closure by suturing was possible. In one patient, the NPWT was suspended until infection was controlled by lavage. The second operation was carried out 16–34 (mean, 24.5) days after the first operation. Primary healing was obtained in all patients. During a postoperative follow-up period of 12–18 (mean, 16) months, no recurrence was noted in any patient. This method is advantageous in that it is simple, reliable for closing the dead space, only slightly invasive, and leaves less obvious operative scars, although it required a two-stage operation. The procedure can also be indicated for complex infected lesions and a wide range of defects, and is useful for the treatment of pilonidal sinus.