2005 May;13(2):215-30, v This phase of the wound healing process has 3 stages that operate in an overall and ongoing process: 1. 'D' excision for sacrococcygeal pilonidal sinus disease. The Turkish study (Cihan 2006) identified two participants with recurrence in the classical Limberg group (Peto OR 7.19. We were unable to trace one paper (Khalid 2001). Khawaja 1992; sekundre Wundheilung - English translation - Linguee Empirical evidence of bias in treatment effect estimates in controlled trials with different interventions and outcomes: metaepidemiological study, Healing by primary closure versus open healing after surgery for pilonidal sinus: systematic review and metaanalysis, The Cochrane Database of Systematic Reviews. #6 (pilonidal near/3 disease*) Reported that two participants opted for primary closure despite randomisation. Kazmers NH, Fragomen AT, Rozbruch SR. Prevention of pin site infection in external fixation: a review of the literature. Our systematic review found similar results for midline wound closure when SSI rates were aggregated, giving a pooled rate of 13% (35/270). The high heterogeneity between pooled data could be due to differences in the characteristics of participants at recruitment (e.g. Thompson SG, Rao 2001; All participants were operated under general or spinal anaesthesia. Median age 25.5 years (range 1649). Federal government websites often end in .gov or .mil. Time to return to work is a type of timetoevent data but has been inappropriately treated as continuous data (see discussion above in relation to time to healing). 120 participants, sex and age not reported. Kareem 2006), one used general or spinal anaesthesia (Jamal 2009), one study used spinal anaesthesia only (Karakayali 2009), and one did not specify type of anaesthesia (Mohamed 2005). Secondly, some studies used postal questionnaires or telephone interviewing to follow up participants, either as the only assessment method or in an attempt to follow up those who failed to attend outpatient clinics. Despite the potential economical impact of pilonidal sinus disease, there were no fully costed economic evaluation studies investigating either direct or indirect financial consequences. This way, your skin will be primed for effective healing. and transmitted securely. liegenden Wundrndern, in der Regel mglich bei chirurgisch gesetzten Wunden. Sakr 2006; Sheikh 2007). Sndenaa 1992; Second intention, also termed secondary healing, is the healing that occurs when a wound is left open to heal by granulation, contraction, and epithelialization. Doganay B, The authors would like to acknowledge the contribution of the peer referees, Wounds Group Editors (Nicky Cullum, Andrew Jull, Liz McInnes, Gill Worthy) and referees (Magnus Agren, Anne Marie Bagnall, Shirley Mankell, Nikki Stubbs). Health care professionals involved in the care of patients with these wounds face multiple, complex challenges . wenn eine eitrige Infektion die direkte Vereinigung der Wundrnder verhindert. zunehmend mit dem Kontakt von Medien wie Blut, Wasser oder Kochsalzlsung. Therefore, operative time could potentially be reduced by increasing surgical experience. Mohamed 2005; Gencosmanoglu 2005; The study by Abu Galala 1999 found that time to RTW took significantly longer after midline closure compared to offmidline (mean 23 days vs. 14 days respectively). Only two of nine studies (Gencosmanoglu 2005; Fazeli 2006; Recurrence of pilonidal sinus was the most commonly reported outcome by all the included studies. Testini 2001; alHassan 1990; Healing times were faster after offmidline closure (MD 5.4 days, 95% CI 2.3 to 8.5). The subcutaneous melolabial island flap for nasal alar reconstruction: a clinical review with nuances in technique. Ertan 2005 assessed quality of life using the SF36 questionnaire. States that complex recurrence cases excluded. Khawaja 1992; This site needs JavaScript to work properly. Methodology and interventions did not satisfy inclusion criteria, Fully translated: retrospective, not a clinical trial, Paper translated: participant group contained acute abscess, RCT stopped prior to endpoints being reached: 11 participants only: poor description of results and outcomes, Paper translated: retrospective cohort study, Interventions did not satisfy inclusion criteria, Translated: interventions did not satisfy inclusion criteria, Case series description without comparison group, Poor methodology: inadequate description of results: large losses to follow up, Not an RCT: interventions did not satisfy inclusion criteria, Large proportion of cases were pilonidal abscesses, Interventions did not appear to satisfy inclusion criteria: attempt to contact author: no reply. Cihan 2006; One study was at low risk of bias (Khawaja 1992) and five were at high risk of bias (alHassan 1990; Gencosmanoglu 2005; Jamal 2009; Quote: "Patients were randomly assigned". Stage 1: The Bleeding Stops 2 /13 In the first of four healing stages, your body swings into action to stop the flow of blood. Comparison of Primary and Secondary Closure of the Surgical Wound After sind bzw. sharing sensitive information, make sure youre on a federal All studies reporting time to healing as an outcome report data as continuous (except Mohamed 2005 who reported it in graphical form). indicates unclear risk of bias, and "" indicates high risk of bias. Frizelle FA. Kareem 2006; Most frequent English dictionary requests: Suggest as a translation of "sekundre Wundheilung". This way, your skin will be primed for effective healing. Ersoy 2009 reported that the median VAS pain score for participants treated with Karydakis technique was similar to the classical rhomboid flap group (median score 4 points in both groups). Six studies (510 participants) reported complication rate when open healing was compared with midline primary closure. Comparison of shortterm results after Limberg and Karydakis procedures. Nordon 2009; One study used a Verbal Rating System (VRS) to assess pain severity and presented graphical results, which were extracted and interpreted (Jamal 2009). Entwicklungen") fr noch zufriedenstellend. Ustunsoy B, No information on attrition or missing data. Participant satisfaction, cost, pain, QoL, wound healing rate and operative time. Examples of wounds healing by secondary intention include severe lacerations or massive . Any disagreements were resolved by discussion. This significant difference was more marked when open healing was compared with closed offmidline technique than when open healing was compared with closed midline technique. Limited information because restricted to oral abstract. No mention if they were opaque. This evidence was graded as being of moderate quality. SSI rate, recurrence, time of return to work, time to wound healing and other complications are reported in the 1992 paper and then recurrence only reported in the 1996 manuscript. Federal government websites often end in .gov or .mil. For this update, 8 additional trials were identified giving a total of 26 included studies (n=2530). Of the 16 potentially eligible trials, 8 new trials met the inclusion criteria (AlSalamah 2007; Ersoy 2009; Jamal 2009; Karakayali 2009; Kareem 2006; Nordon 2009; Sakr 2006; Sheikh 2007) and 8 studies were added to the Characteristics of excluded studies table. Repercussions for patients' family members can also be extremely detrimental, including financial pressures. Petersen S, Scottish Intercollegiate Guidelines Network (SIGN). Cihan 2006 reported a significantly longer LOS after classical Limberg flap compared to modified Limberg flap (5.71 vs 3.61 days; P<0.01) (Table 8) (Analysis 3.5). Although the mean scores for each of the eight SF36 domains were reported, summary scores for physical and mental components were not reported (Table 11). The review has been updated, a new search undertaken and an additional 8 studies have been included. ZPlasty: This is an offmidline surgical technique where the whole diseased area is removed. The determination of which wounds are to be allowed to heal secondarily requires knowledge of the biology of wound healing as well as the likely regional effects of wound contraction. Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Comparison 4 Closed other (Karydakis) vs. closed other (classic Limberg), Outcome 1 SSI rate. [1] In undamaged skin, the epidermis (surface, epithelial layer) and dermis (deeper, connective layer) form a protective barrier against the external environment. PMC Another explanation is that Testini 2001 carried out surgery as day cases whereas other studies admitted people as inpatients. Berkem 2005; The .gov means its official. 33 participants, sex and age not reported. One Turkish study (Akca 2005) reported a significant longer period to RTW after midline closure when compared to offmidline (rhomboid excision and Limberg flap) (median 19 vs. 9.5 days, respectively). Gocmen E, Element of selective under reporting. Closed wounds using offmidline methods (other) included descriptions such as: rhomboid flap (also known as Limberg flap) (Abu Galala 1999; Akca 2005; Cihan 2006; Ersoy 2009; Ertan 2005; Federal government websites often end in .gov or .mil. Karakayali 2009; Kareem 2006; Rao 2001; 3-4 Wochen dauert. Ruiz R, All studies implied that all participants returned to work therefore this 'time to event' variable was presented using mean (SD) days. A list of journals currently being handsearched by The Cochrane Collaboration is available at the US Cochrane Center Handsearch master list page: http://apps1.jhsph.edu/cochrane/masterlist.asp. Petersen 2002 had similar findings, as they reported a higher recurrence rate with midline closure in comparison to offmidline (9.4% compared with 1.5 to 2.4% depending on the type of the offmidline closure). If primary surgical closure was used, these interventions were assigned to the "closed" healing group. 355 men, 25 women. healing time, recurrence, RTW, other complications, operating time. M. Open excision with secondary healing versus rhomboid excision with Limberg transposition flap in the management of Sacrococcygeal Disease. Outpatient management of pilonidal disease. For example: assessment of randomisation process, study quality and analytical method. The first review retrieved 45 potential papers for full assessment, of which 18 studies were included and 26 studies were excluded. Wright 2001), Karydakis technique (Sakr 2006; Sheikh 2007) and zplasty (Fazeli 2006). Chalmers I, Reporting of attrition, exclusions and missing data was generally poor, with only five studies appropriately reporting these factors. official website and that any information you provide is encrypted Quote: "allocated by a system of sequentially numbered sealed envelopes". Bonavito G, This outcome was neglected by most pilonidal sinus studies, which warrants encouraging future trials to include patient preference and satisfaction with treatment. Sakr 2006) were at high risk of bias. Comparative study of three surgical techniques. Kareem 2006; Khawaja 1992; Kronborg 1985; Therefore one definitive recommendation from this systematic review is that where a decision has been made to close the sinus wound using stitches, this wound should not lie in the central area of the buttocks. All study participants were reported as achieving complete healing. et al. So there is a possibility that participants with macroscopic asymptomatic recurrence disease were not detected. The Karakayali 2009 study reported scores for different followup periods (Table 12). Was the study apparently free of other problems that could put it at a high risk of bias e.g. This makes the RTW outcome a very important factor in determining the optimal surgical procedure. Closed (offmidline) vs closed (offmidline). As mentioned above, the Norwegian group published two papers (Sndenaa 1992; Sndenaa 1996) on the same participant cohort with followup at one and four years. This disease is usually treated by surgery. Data are presented in Table 13. Copyright 2023 by The Journal of Bone and Joint Surgery, Incorporated. Studies looked at wounds after diabetic foot amputation, pilonidal sinus surgery, treatment of various types of abscess, surgery for haemorrhoids, complications after caesarean section and healing of openings created by operations such as colostomy. Quote: "patients who were categorized, using the closed method..". Based on the updated Cochrane Handbook, we adhered to recommendations in Chapter 8 and have altered the quality criteria accordingly. Moray G, The area from which the rhomboid flap was cut is closed in a straight line which can be achieved without difficulty as this skin is looser. Salinas A. Resection and primary closure vs simple curetage in the treatment of pilonidal sinus. Pflege von Granulationsgewebe und Wundrndern Das Vorhandensein bzw. Pictures of the Wound Healing Process - WebMD Quasi RCT with 3 comparisons. This study compared open healing with midline closure, where two (wide and limited excision) of the three arms were combined. Rapidly absorbable materials such as those. We would also like to thank the copy editors, Elizabeth Royle and Margaret Carver, and the contribution and advice of Sally BellSyer (Managing Editor) and Ali Baba Akbari Sari and Ruth Foxlee (Trial Search Coordinators). Quote: "Randomly allocated". A formal sensitivity analysis was not performed across all outcomes (e.g. Surgical techniques were assigned to the open healing group if the wound was allowed to heal either fully or partially by secondary intention. Akca 2005; Doll D, Irrespective of the mode of presentation, the painful nature of the condition causes significant morbidity and, although many tolerate symptoms for up to one year before seeking treatment, there is often a protracted loss of normal activity for these patients. Sperlongano P, Sndenaa 1992; Not enough information provided to incorporate time to wound healing data. A group of wound healing experts developed the TIME acronym as a method for promoting consistency in the evaluation and treatment of wound healing before closure, or for second intention healing. This process helps the cut edges heal together and is called 'healing by primary intention'. 2 pilonidal$.tw. Oksuz E, 59 participants. This review is a systematic review of the surgical treatment options available for pilonidal sinus disease. Seven studies (798 participants) (AlSalamah 2007; Hameed 2001; Jamal 2009; Karabulut Z, This study was at unclear risk of bias. The review also found that if a decision had been made to close the wound with stitches, then the best way to reduce the risk of the disease coming back and reduce other complications (such as infection), was to use a wound technique where the line of stitches was moved away from between the buttocks. Operative time was significantly shorter after an open approach compared with closed surgery. There was no significant difference in the rate of SSI between the two treatments (RR 1.31, 95% CI 0.93 to 1.85) (Analysis 1.1). Sakr 2006). central randomisation, or sequentially numbered, opaque, sealed envelopes? Estimated means of wound healing rate for the first and second wound for each family were obtained by fitting a linear model [lm command from base R stats package (R Core team 2020)]. To determine the relative effects of open surgical techniques compared with closed techniques for the management of pilonidal sinus disease on the outcomes of healing time, infection and rate of recurrence. Two review authors (AA and IM) had independently developed and piloted the forms using three RCTs. Are reports of the study free from suggestion of selective outcome reporting? alHassan 1990; Accessibility New and recurrence presentation. Many, but not all patients are hirsute, and an excess incidence has been reported in those who are moderately obese (Notaro 2003). eines Sekrets zur Folge hat, und ca. Participants lost to follow up (n=9) were not included in the study analysis. Only data for 50 participants included. Harding KG, Fazeli 2006; Two studies were at high risk of bias (alHassan 1990Sndenaa 1992) and the rest were at unclear risk of bias. 118 men, 22 women. Kaufman HD. Key outcome events included: time to healing; treatment type; infection; hospital re-admission and further procedures; health-related quality of life and pain. Only 5 studies (459 participants) compared open with closed offmidline closure (zplasty, Karydakis flap, rhomboid excision and Limberg flap); no significant difference was demonstrated (RR 0.69, 95% CI 0.37 to 1.30, I2=2%) (Fazeli 2006; Healthrelated QoL was underreported, with only 2 of 26 studies assessing postoperative QoL. Hautarzt. However, a minority of surgical wounds are not closed in this way. Due to the high heterogeneity between the two studies reporting mean values (Abu Galala 1999; Ertan 2005) (I2 = 95.6%) the data were not pooled (Table 7) (Analysis 2.4). This ad is displayed using third party content and we do not control its accessibility features. Jamal A, Sakr 2006). Eser M, Factors in pin tract infections. S8 TI natal cleft or AB natal cleft PPI= Present Pain Intensity; PRI= Pain Rating Index, VAS = Visual Analogue Scale. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. Jamal 2009; Sndenaa 1992; Participants were followed in outpatient clinic. Akca T, Healing by primary versus secondary intention after surgical treatment Clipboard, Search History, and several other advanced features are temporarily unavailable. The primary outcome was pin-site infection. A randomised trial of knife versus diathermy in pilonidal disease, Annals of the Royal College of Surgeons of England, Pilonidal sinus disease: comparison among various methods of treatment and a survey of 160 patients, A randomized study between excision and marsupialization and radiofrequency sinus excision in sacrococcygeal pilonidal disease, Radiofrequency sinus excision: better alternative to marsupialization technique in sacrococcygeal pilonidal sinus disease, Journal of the National Medical Association, Pilonidal disorder (pilonidal cyst) and its treatment, A comparative study between Zplasty and incision and drainage or excision with marsupialization for pilonidal sinuses. An attempt was made to contact authors for data but no reply was received (Mohamed 2005). Sakr 2006). Nordon 2009). Hegarty DM, Mohamed 2005). The model included family and wound order as fixed variables, and seedling initial basal diameter (mm, measured on day 1 after seedlings were transplanted in pots . Karakayali 2009; National Library of Medicine Patients' perceptions and experiences of living with a surgical wound Cihan 2006 reported significantly higher postoperative complication rate after classical Limberg flap: authors reported that there were 16 participants with maceration and 8 with wound dehiscence although it is unclear whether some had both events (24/35; 69%). Ertan 2005; Another point worth considering is that the low recurrence rate found in this systematic review may represent an underestimate of the true recurrence. Lefebvre C, Piccinni G, 2007 Jul;21(7):714-7. The event rate in participants having modified Limberg flap was (3/33, 10%) (Analysis 3.4). However, management of chronic pilonidal disease is variable, contentious and problematic. "..randomly allocated to two groups according to the initial letter of their surname (AM, group A; NZ, group B)". Hollingworth J, One study was at low risk of bias (Akca 2005), and two were at high risk of bias (Abu Galala 1999; The pathology of healing and repair - ScienceDirect Christensen K, No. See Instructions for Authors for a complete description of levels of evidence. Schrank S, This was not statistically significant. Wound care is one of the most common concerns faced by nurses and care givers today. 7 (pilonidal adj3 abscess$).mp. Karakayali 2009; Unauthorized use of these marks is strictly prohibited. Duesel W. Timeline of recurrence after primary and secondary pilonidal sinus surgery. New sinus presentation. Midline closure (simple excision with closure) vs open healing (simple excision without closure). Karakayali 2009; Age and sex details not reported. When closure of pilonidal sinuses is the desired surgical option, offmidline closure should be the standard management. This key item was recorded as: yes, no, or unclear. As recommended by Zubritsky, simply clean the wound with antibacterial or gentle soap, then cover it with a fragrance-free healing ointment followed by a bandage. In one study by Karakayali 2009, pain levels were significantly lower after open healing compared with closed (offmidline) surgery at 1 week, however this difference diminished at 3 months. 2013 Aug;64(8):567-76. doi: 10.1007/s00105-013-2540-2. Postoperative pain was reported by six studies (Jamal 2009; There was moderate quality evidence that more Dermacym-treated post-operative foot wounds in people with diabetes healed compared to those treated with iodine (RR 0.61, 95% CI 0.40 to 0.93). Unable to load your collection due to an error, Unable to load your delegates due to an error. When the space left by the flap is closed the sutures form a Y shape. 2020 Feb 19;21(1):205. doi: 10.1186/s13063-020-4087-8. Koronare Herzerkrankungen durch erhhten Cholesterinspiegel, Krebs, Diabetes, Adipositas (Fettsucht), Multiple Sklerose, Hautkrankheiten, Arthritis, geschwchtes Immunsystem, gestrte Sehkraft, gest. Incomplete outcome data essentially include: attrition, exclusions and missing data. Fzn 1994; Gencosmanoglu 2005; Even where wounds are not clearly infected, they usually have populations of micro-organisms present. Failure to address or report the main risk of bias criteria contributes to the potential uncertainty of the results generated by this review. 37 men, 9 women, Mean age 22.5 years. 168 men, 32 women. Sndenaa 1992). Khawaja 1992; Wound healing: cellular mechanisms and pathological outcomes Testini 2001 The most striking examples of progress in each of these priority areas include: the launch of an 'open season' procedure to. Ozel H, These chronic discharging wounds cause pain and impact upon quality of life. Surgeons agree that the area where the infection has developed should be completely incised and removed. Hannah Frye is the Assistant Beauty Editor at mindbodygreen. Altman DG. Sndenaa 1992 compared open healing with midline closure and reported identical pain rates of 10%. Unclear whether new or recurrence presentation. the contents by NLM or the National Institutes of Health. Healing by secondary intention - PubMed There is a risk of infection in open wounds, which may impact on wound healing, and antiseptic or antibiotic treatments may be used with the aim of preventing or treating such infections. No information about exclusion, attrition, or missing data. Primary closure should therefore be considered in patients treated with a temporary external fixator. Shah CM, Babb PE, McAndrew CM, Brimmo O, Badarudeen S, Tornetta P 3rd, Ricci WM, Gardner MJ. AlSalamah 2007). Der STADA-Vorstand hlt diese Umsatzentwicklung vor dem Hintergrund eines in verschiedenen nationalen Mrkten, insbesondere in Deutschland. Wound healing is a complex, dynamic process supported by a myriad of cellular events that must be tightly coordinated to efficiently repair damaged tissue. PMK conceived the study & advised on clinical aspects. Jamal 2009; Oncel M, S7 TI pilonidal N3 abscess* or AB pilonidal N3 abscess* Quote: "computer generated table of random numbers, we randomly assigned participants..". S3 TI pilonidal N3 sinus* or AB pilonidal N3 sinus* It aims to present current evidence related to the use of antiseptics and antibiotics for surgical wounds healing by secondary intention (SWHSI). One study presented percentage data graphically therefore it was not possible to extract actual values for time to wound healing. No distinction was made between new (initial presentation of the disease) and recurrent presentation of pilonidal sinus disease. Kanik A, This study was at high risk of bias. One small study (n = 83; 3 arms) (Mohamed 2005) measured participant satisfaction as 'satisfied/not satisfied'. AlSalamah 2007; Fazeli 2006; In other centres, LOS was based on participant choice (Karakayali 2009). The study was at high risk of bias. A Peto OR was used to calculate the effect estimate due to a low event rate and specifically a high frequency of zero events in series. An example of an adequate method to address incomplete outcome data is the use of intention totreat analysis (ITT). 4.2 Wound Healing and Assessment - Clinical Procedures for Safer This is followed by reporting of subgroup analyses where data are available: open healing vs. closed wound (midline); open vs closed (other). One Pakistani study compared the cost of open versus closed midline repair (Hameed 2001). Quote: "participants were randomised . by taking a card from a sealed envelope". Berkem 2005; Complete follow up for at least one year; <80% drop out by 2 years. Pilonidal sinus is a disease that arises in the hair follicles of the natal cleft of the sacrococcygeal area (i.e. Testini 2001), of which six used midline closure (alHassan 1990; Quote: "Randomly allocated.Computer generated table of random numbers". Jamal 2009; Hameed 2001). Soylu M, Other complications and morbidity, participant satisfaction, cost, LOS, pain, QoL, and operative time. 110 participants. Comparison 3 Closed other (classic Limberg) vs. closed other (modified Limberg), Outcome 2 Recurrence rate. Several different types of wounds were included. Ragusa M, Studies that included participants presenting with an abscess were excluded except where data could be extracted and analysed separately for those with and without pilonidal abscess. The pilonidal sinus is excised with a surrounding area of normal tissue, the edges of the wound are then stitched closed together but not completely closed so that the resulting wound is smaller. Ribeiro CD. found that all the participants having Bascom cleft closure healed within 6 months compared with only 62% of participants in the simple Bascom group; no statistical tests were reported (Analysis 5.2). [Process, disturbances and improvements of wound healing]. Wendlandt TP, Patients with surgical wounds healing by secondary intention: A 5 (pilonidal adj3 cyst$).mp. The study was at unclear risk of bias. Healing is slow, which places the patient at risk for infection. The epidemiology, management and impact of surgical wounds healing by A Turkish study used a VAS to assess participant satisfaction (Ertan 2005) and an Egyptian study reported satisfaction rate as 'satisfied or not satisfied' (Mohamed 2005). Wright 2001; Krueger CM, Participants having the offmidline Limberg flap had better scores for general health and social functioning although had more pain, less energy and vitality at one year after surgery. There were no restrictions with respect to language, date of publication or study setting.