TRICK OF THE TRADE Loop drainage after debridement (LDAD): minimally invasive treatment for pilonidal cyst I. Qayyum 1 • D. Bai 1 • S. S. Tsoraides 1 Received: 13 January 2016 / Accepted: 29 March 2016 Ó Springer-Verlag Italia Srl 2016 Introduction Pilonidal disease is a subcutaneous infection occurring in the upper half of the gluteal cleft. Often, pilonidal disease presents as acute pilonidal abscess and requires treatment accordingly with an incision and drainage procedure. The principles of the Bascom-type treatments, such as the cleft lift, rely on the premise that pathogenesis originates at the epidermal level of the midline pit that harbors embedded hair follicles [1]. Definitive management of pilonidal cyst remains a challenge and often requires morbid wounds [2]. More complex techniques do not obviate the risk of failure or recurrence. As a result, less invasive and less complex techniques are desirable as the first-line management of pilonidal cyst. With this in mind, we invoke the principles of loop drainage of abscesses as described by Tsoraides et al. [3] in the pediatric population. Maintaining the principles of addressing the inciting epidermal insult, the above-mentioned strategy for managing abscesses, and the overarching principle of employing least invasive techniques, we describe an easy to perform, minimally invasive approach for the treatment of pilonidal disease that is effective and minimizes com- plexity of care for the surgeon and patient. Methods This is an IRB-approved retrospective review of patients treated for pilonidal disease within a single practice from 8/2011 to 7/2014. Patients were identified using ICD-9 codes related to pilonidal disease. All patients treated for codes related to pilonidal cyst and all employed techniques were included for review. Patients were selected for LDAD based on single surgeon preference. Technique Skin is cleared of hair. Midline pit(s) is cored out. Counter incision(s) of 1 cm or less are made at farthest extent of cyst cavity (Fig. 1). Number of incisions is tailored to size and shape of cavity. Residual hair debris is removed (Fig. 2). Aggressive curettage and debridement are performed through the small incisions to disrupt the walls of the cyst cavity and promote scarring (Fig. 3). Irrigation with diluted hydrogen peroxide is followed by saline rinse (Fig. 4). Vessel loops are passed from the midline pit(s) to the counter incision(s) and secured as a loop with silk suture (Fig. 5). An absorbent dressing is applied to cover and seal the top and sides of the wound. Dressing is changed daily. Patients are instructed to shower and/or bathe daily and keep the entire area clean, shaved, and covered until one week after the drains are removed and the incisions are healed. Results A total of 102 patients were treated for pilonidal disease. Eighty-five underwent traditional procedures by multiple surgeons including drainage, unroofing, open debridement, & I. Qayyum [email protected]1 University of Illinois College of Medicine at Peoria, Peoria, IL, USA 123 Tech Coloproctol DOI 10.1007/s10151-016-1469-8
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Loop drainage after debridement ... - Peoria Surgical Groupof loop drainage of abscesses as described by Tsoraides et al. [3] in the pediatric population. Maintaining the principles
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TRICK OF THE TRADE
Loop drainage after debridement (LDAD): minimally invasivetreatment for pilonidal cyst
I. Qayyum1• D. Bai1 • S. S. Tsoraides1
Received: 13 January 2016 / Accepted: 29 March 2016
� Springer-Verlag Italia Srl 2016
Introduction
Pilonidal disease is a subcutaneous infection occurring in
the upper half of the gluteal cleft. Often, pilonidal disease
presents as acute pilonidal abscess and requires treatment
accordingly with an incision and drainage procedure. The
principles of the Bascom-type treatments, such as the cleft
lift, rely on the premise that pathogenesis originates at the
epidermal level of the midline pit that harbors embedded
hair follicles [1]. Definitive management of pilonidal cyst
remains a challenge and often requires morbid wounds [2].
More complex techniques do not obviate the risk of failure
or recurrence. As a result, less invasive and less complex
techniques are desirable as the first-line management of
pilonidal cyst. With this in mind, we invoke the principles
of loop drainage of abscesses as described by Tsoraides
et al. [3] in the pediatric population.
Maintaining the principles of addressing the inciting
epidermal insult, the above-mentioned strategy for
managing abscesses, and the overarching principle of
employing least invasive techniques, we describe an easy
to perform, minimally invasive approach for the treatment
of pilonidal disease that is effective and minimizes com-
plexity of care for the surgeon and patient.
Methods
This is an IRB-approved retrospective review of patients
treated for pilonidal disease within a single practice from
8/2011 to 7/2014. Patients were identified using ICD-9
codes related to pilonidal disease. All patients treated for
codes related to pilonidal cyst and all employed techniques
were included for review. Patients were selected for LDAD
based on single surgeon preference.
Technique
Skin is cleared of hair. Midline pit(s) is cored out. Counter
incision(s) of 1 cm or less are made at farthest extent of cyst
cavity (Fig. 1). Number of incisions is tailored to size and
shape of cavity. Residual hair debris is removed (Fig. 2).
Aggressive curettage and debridement are performed
through the small incisions to disrupt the walls of the cyst
cavity and promote scarring (Fig. 3). Irrigation with diluted
hydrogen peroxide is followed by saline rinse (Fig. 4).
Vessel loops are passed from themidline pit(s) to the counter
incision(s) and secured as a loop with silk suture (Fig. 5). An
absorbent dressing is applied to cover and seal the top and
sides of the wound. Dressing is changed daily. Patients are
instructed to shower and/or bathe daily and keep the entire
area clean, shaved, and covered until one week after the
drains are removed and the incisions are healed.
Results
A total of 102 patients were treated for pilonidal disease.
Eighty-five underwent traditional procedures by multiple
surgeons including drainage, unroofing, open debridement,