藏毛窦切除术后切口开放、缝合或皮瓣转移的疗效回顾

Open Incision,Suturingv,or Flap Transposition after Removing Pilonidal Sinus

目的探讨藏毛窦手术3种不同切口处理方法的临床效果。方法 2005年5月～2009年10月施行藏毛窦手术62例,随访43例,其中单纯切除术12例(切口开放组),切除后缝合18例(切口缝合组),切除后行各种皮瓣转移术13例(皮瓣转移组,包括菱形皮瓣转移6例,椭圆形皮瓣转移5例,三角形皮瓣转移2例)。结果单纯切除组切口愈合时间(70.1±11.6)d,术后第1天疼痛VAS评分(3.7±0.9)分,愈合后切口不适、针刺样疼痛7例,其中2例瘢痕处反复脱皮,无复发。切口缝合组切口愈合时间(34.3±7.6)d,术后第1天疼痛VAS评分(3.7±1.1)分,术后切口渗出10例,裂开5例,皮肤及皮下组织坏死1例,切口不适、针刺样疼痛3例,无复发。皮瓣转移组切口愈合时间(21.2±6.1)d,术后第1天疼痛VAS评分(2.3±0.9)分,切口裂开2例,前8例中2例皮肤表皮层坏死,改善缝合方法后5例无皮肤坏死,切口不适1例,1例复发。结论藏毛窦手术后切口闭合愈合时间较短,不影响手术效果,择期行切口闭合手术应是较好选择。闭合方法的选择根据切口张力的大小而定,张力小时可直接缝合切口,张力大时采用皮瓣转移术。

Objective To investigate the clinical significance of the pilonidal sinus surgery with incision open,suturing,or flap transposition.Methods From May 2005 to October 2009,we performed pilonidal sinus surgery in 62 cases,43 of them recieved folloow-up.In the 43 patients,12 patients underwent resection alone（incision open group）,18 patients recieved incision saturing after the removal（incision sutured group）,and the other 13 cases skin flap transposition（flap transposition group,including the rhomboid-shaped flap in 6 cases,oval-shaped flap in 5 cases,and triangular flap in 2）.Results In the incision open group,the mean wound healing time was（70.1±11.6）days,and the mean VAS for incisional pain on the first postoperative day was 3.7 ± 0.9（7 patients complained of pruritus or prickling sensation,2 of them showed desquamation around the scar area）.In the incision sutured group,the mean healing time was（34.3 ± 7.6）days,and VAS on the first day after operation was 3.7 ± 1.1（10 patients had exudation from the incision,5 of them showed wound dehiscence and 1 developed skin and subcutaneous tissue necrosis;3 patients complained of incision discomfort and prickling sensation）.In the flap transposition group,the mean healing time was（21.2 ± 6.1）days,and the day 1 VAS was 2.3±0.9（2 patients developed wound dehiscence;in the first 8 cases,2 patients had skin and subcutaneous tissue necrosis after the procedure,afterwards,we modifed the suturing method,and then none of the latter 5 cases had the necorsis.Only one patient complained of incisional discomfort）.None of the patients in the incision open and incision sutured group had relapse,while one patient in the flap transposition group had relapse.Conclusions Patients with closed surgical incision after pilonidal sinus surgery have shorter healing time,and less effect from the operations.Therefore,selective operation with closed surgical incision is a better choice.The selection of wound closure methods depends on the incisional tension,suturing directly can the choice for incisions with lower tension,otherwise,skin flap transposition shall be used.