Enis DİKİCİER, Fatih ALTINTOPRAK, Mustafa Yener UZUNOĞLU, Yusuf ARSLAN, Kıyasettin ASİL, İsmail ZENGİN

Pilonidal Sinüs Nedeni ile Opere Edilen Hastalarda Flep Kalınlığının Ultrasonografik Değerlendirmesi

Amaç: Pilonidal sünis nedeni ile opere edilen hastalarda nüksün pek çok nedeni vardır. Bu çalışmanın amacı pilonidal sinüs nedeni ile limberg flep uygulanan hastalarda, flep kalınlığının hastalık tekrarına etkisini araştırmaktır.Materyal ve Metot: Ocak 2008 ve Ocak 2014 yılları arasında pilonidal sinüs nedeni ile opere edilen 98 hastanın verileri retrospektif olarak incelendi. Flep kalınlığı deri ile sakrum arasındaki en yakın ve en uzak mesafeler ultrasonografik olarak ölçülerek değerlendirildi. Bulgular Limberg flep uygulanan 46 hasta (%46.9) ve rezeksiyon ve primer kapama uygulanan 52 hasta (%53.1) sonuçları geriye dönük değerlendirildi. Ortalama flep kalınlığı primer onarım grubu ve limberg flep grubunda sırası ile,17.2 mm (3.9 - 36.4 mm) ve 20.5 mm (4 -42.3 mm) olarak bulundu. Nüks oranı primer kapama grubunda %10.8 limberg flep grubunda % 3.8 olarak saptandı. Olguların ortalama takip süresi 27.1 ay (12-54 ay) olarak bulundu. Sonuçlar: Subkutan doku kalınlığı Limberg flep uygulanan hastalarda primer kapama grubuna göre belirgin olarak fazlaydı. Flep kalınlığı pilonidal sinüs nedenli opere edilen hastalarda nüksü azaltmada önemli bir parametre olarak kullanılabilir.

Anahtar Kelimeler:

Pilonidal sinüs, cerrahi, limberg

Ultrasonographic Evaluation of Flap Thickness In Patients With Pilonidal Sinus - Original Article

Background and Objective: Various risk factors have been defined for recurrence in pilonidal disease. This study was designed to investigate the local subcutaneous tissue thickness in patients who were operated on for sacrococcygeal pilonidal disease.Materials and Methods: Ninety-eight patients who had been operated on with the diagnosis of pilonidal sinus were retrospectively evaluated between January 2008 and January 2014. In evaluation of the flap thickness, the nearest and farthest margins were measured by ultrasonography between the skin and sacrum.Results: Resection and primary closure and Limberg flap transposition were performed in 46 (46.9%) and 52 (53.1%) patients, respectively. Mean flap thickness was found to be 17.2 mm (range: 3.9 - 36.4) and 20.5 mm (range: 4.0 - 42.3) in the primary repair group and the Limberg group, respectively. The recurrence rate was 10.8% in the primary repair group, 3.8% in the Limberg group at a mean of 27.1 months (range: 12-54 months) of follow-up. Conclusion: Subcutaneous tissue thickness in the place of surgery was greater in patients with the Limberg flap procedure compared to the patients with primary closure in pilonidal sinus disease. Flap thickness may be a parameter that can be used to predict the possibilty of recurrence.

Keywords:

Pilonidal sinus, Surgery, Limberg,

PDF

___

Sharma PP. Multiple Z-plasty in pilonidal sinus--a new technique under local anesthesia. World J Surg 2006;30(12):2261-5.
Harlak A, Mentes O, Kilic S, Coskun K, Duman K, Yilmaz F. Sacrococcygeal pilonidal disease: analysis of previously proposed risk factors. Clinics (Sao Paulo) 2010;65(2):125-31.
Akinci OF, Bozer M, Uzunkoy A, Duzgun SA, Coskun A. Incidence and aetiological factors in pilonidal sinus among Turkish soldiers. Eur J Surg 1999;165(4):339-42.
Karydakis GE. Easy and successful treatment of pilonidal sinus after explanation of its causative process. Aust N Z J Surg 1992;62(5):385-9.
Page BH. The entry of hair into a pilonidal sinus. Br J Surg 1969;56(1):32.
Akinci OF, Coskun A, Uzunköy A. Simple and effective surgical treatment of pilonidal sinus: asymmetric excision and primary closure using suction drain and subcuticular skin closure. Dis Colon Rectum 2000;43(5):701-6.
Ertan T, Koc M, Gocmen E, Aslar AK, Keskek M, Kilic M. Does technique alter quality of life after pilonidal sinus surgery? Am J Surg 2005;190(3):388-92.
Urhan M, Kücükel F, Topgül K, Ozer I, Sari S. Rhomboid excision and Limberg flap for managing pilonidal sinus: results of 102 cases. Dis Colon Rectum 2002;45(5):656-9.
Holm J, Hulten L. Simple primary closure for pilonidal disease. Acta Chir Scand 1970;136(6):537-40.
Karydakis GE. New approach to the problem of pilonidal sinus. Lancet 1973; 2(7843):1414-5.
Bascom J. Pilonidal disease: origin from follicles of hairs and results of follicle removal as treatment. Surgery 1980;87(5):567-72.
Doll D, Petersen S. Multiple Z-plasty in pilonidal sinus--a new technique under local anesthesia. World J Surg 2006;30(12):2261-5.
Toubanakis G. Treatment of pilonidal sinus disease with the Z-plasty procedure (modified). Am Surg 1986;52(11):611-2.
Roth RF, Moorman WL. Treatment of pilonidal sinus and cyst by conservative excision and W-plasty closure. Plast Reconstr Surg 1977;60(3):412-5.
el-Khadrawy O, Hashish M, Ismail K, Shalaby H. Outcome of the rhomboid flap for recurrent pilonidal disease. World J Surg 2009;33(5):1064-8.
Topgul K, Ozdemir E, Kilic K, Gokbayir H, Ferahkose Z. Long-term results of limberg flap procedure for treatment of pilonidal sinus: a report of 200 cases. Dis Colon Rectum 2003;46(11):1545-8.
Petersen S, Koch R, Stelzner S, Wendlandt TP, Ludwig K. Primary closure techniques in chronic pilonidal sinus: a survey of the results of different surgical approaches. Dis Colon Rectum 2002;45(11):1458-67.
Arda IS, Güney LH, Sevmiş S, Hiçsönmez A. High body mass index as a possible risk factor for pilonidal sinus disease in adolescents. World J Surg 2005;29(4):469-71.
Cubukçu A, Gönüllü NN, Paksoy M, Alponat A, Kuru M, Ozbay O. The role of obesity on the recurrence of pilonidal sinus disease in patients, who were treated by excision and Limberg flap transposition. Int J Colorectal Dis 2000;15(3):173-5.
Balik O, Balik AA, Polat KY, Aydinli B, Kantarci M, Aliagaoglu C, Akcay MN . The importance of local subcutaneous fat thickness in pilonidal disease. Dis Colon Rectum 2006;49(11):1755-7.