Pilonidal Cyst Case Presentation: Update Course 2015
After 2-3 recurrences of pilonidal cyst, definitive surgery is indicated rather than repeat I&D.
opinion0:30 ↗
The Bascom technique involves excising 1-millimeter pits at skin level under local anesthesia, allowing secondary healing, with 70% not recurring by their data (though no control group exists).
clinical0:54 ↗
For large draining sinuses or recurrence after pit excision, formal OR excision of the entire affected area with off-midline layered closure and drain placement is performed.
clinical1:28 ↗
Physical exam findings including deep gluteal fold and heavy hair burden are high-risk factors for pilonidal disease recurrence.
clinical2:25 ↗
For severely infected pilonidal disease, open excision with wet-to-dry dressing changes or wound VAC is an option.
clinical2:50 ↗
The Karydakis flap is superior to excision only and comparable to the modified Limberg flap for pilonidal disease.
Host summaryThe host summarizing the discussion — not the host's own clinical position3:10 ↗
The modified elliptical rotation flap has short-term results comparable to Limberg and Karydakis flaps, though less data exists.
Host summaryThe host summarizing the discussion — not the host's own clinical position3:10 ↗
Post-operative management with prone positioning until wound healing is critical for preventing recurrence; pilonidal disease is fundamentally a wound healing problem.
opinion3:43 ↗
Plastic surgery consultation for flap reconstruction with strict prone post-operative positioning is used for multiply recurrent pilonidal disease.
clinical3:54 ↗
One patient reported laser hair removal as the most painful procedure they had experienced, completing only half a session and refusing further treatment.
clinical4:28 ↗
Laser hair removal for pilonidal disease is expensive and insurance reimbursement has not been successful.
clinical4:46 ↗
Journal of Pediatric Surgery Article Review: July 2023, PAPS Issue
The cryoanalgesia study compared patients from 2011 to 2021, with 29 patients receiving cryoanalgesia and 15 not receiving it.
Host summaryCecilia Gigena summarizing the discussion — not the host's own clinical position1:39 ↗
Patients who received cryoanalgesia had shorter hospital stays: 3.0 days versus 5.4 days for those without cryoanalgesia.
Host summaryCecilia Gigena summarizing the discussion — not the host's own clinical position1:48 ↗
Hospital costs were slightly lower (less than $1000 difference) in patients who received cryoanalgesia despite the expensive equipment.
Host summaryCecilia Gigena summarizing the discussion — not the host's own clinical position2:00 ↗
Cryoanalgesia was associated with a 70% decrease in complication rates, from approximately 33% down to 17%.
Host summaryMary Brindle summarizing the discussion — not the host's own clinical position2:31 ↗
The chest tube study included 130 lung resections performed between 2013 and 2022.
Host summaryMary Brindle summarizing the discussion — not the host's own clinical position3:48 ↗
Of the 130 procedures, 59 were lobectomies (group 1), 19 were diagnostic wedge resections (group 2), and 52 were excisional wedge resections (group 3).
Host summaryEm Gootee summarizing the discussion — not the host's own clinical position3:55 ↗
In lobectomy patients (group 1), 75% had no air leak and median chest tube duration was 2 days.
Host summaryJamie Schnuck summarizing the discussion — not the host's own clinical position4:12 ↗
In diagnostic wedge resection patients (group 2), nearly 90% had no air leak and median chest tube duration was 1 day.
Host summaryEm Gootee summarizing the discussion — not the host's own clinical position4:30 ↗
In excisional wedge resection patients (group 3), 80% had no air leak and median chest tube duration was 1 day.
Host summaryEm Gootee summarizing the discussion — not the host's own clinical position4:39 ↗
Most chest tubes were removed on the first day after surgery and a majority of patients did not have an air leak.
Host summaryJamie Schnuck summarizing the discussion — not the host's own clinical position4:48 ↗
The pilonidal disease study included 198 patients presenting between 2019 and 2022, with data prospectively gathered in a retrospective study design.
Host summaryMary Brindle summarizing the discussion — not the host's own clinical position6:37 ↗
The pilonidal disease cohort included 21 patients with skin types 1-2, 156 with skin types 3-4, and 21 with skin types 5-6, with approximately 151 having dark colored hair.
Host summaryCecilia Gigena summarizing the discussion — not the host's own clinical position6:51 ↗
To reach 75% hair reduction requires a mean of 4.8 to 6.8 laser ablation sessions depending on skin and hair characteristics.
Host summaryCecilia Gigena summarizing the discussion — not the host's own clinical position7:34 ↗
Dark hair and skin types 5-6 were associated with higher recurrence rates in pilonidal disease after laser hair reduction.
Host summaryCecilia Gigena summarizing the discussion — not the host's own clinical position7:47 ↗
The overall recurrence rate for pilonidal disease after laser hair reduction was 6%.
Host summaryCecilia Gigena summarizing the discussion — not the host's own clinical position7:47 ↗
Insurance coverage for laser hair reduction varies, with some agencies covering it while in Canada advocacy to health systems is needed, making effectiveness data important for coverage decisions.
opinionMary Brindle8:12 ↗
All three articles were chosen as PAPS Award winners at the annual conference.
clinicalMary Brindle8:55 ↗
The three studies represent evolutionary (rather than revolutionary) advances important for day-to-day pediatric surgical care management.
opinionMary Brindle9:01 ↗
Update Course Rewind: Pilonidal Disease 2019
The patient presented with two previous abscess drainages (I&Ds) in the emergency department within the past 6 months
clinicalSteven Lee2:17 ↗