Mahan J, Seligson D, Henry SL, Hynes P, Dobbins J. Similarly, only five studies adequately addressed incomplete outcome data (Gencosmanoglu 2005; Comparison 1 Open vs. closed (all), Outcome 7 Wound healing rate. #6 (pilonidal near/3 disease*) Karakayali 2009; Healing time, recurrence pain, satisfaction, LOS. Mean age 28.4 (range 1743). Sabet B, and transmitted securely. Karakayali 2009; Wound healing: cellular mechanisms and pathological outcomes Frizelle FA. The treatment of a pilonidal sinusrelated acute abscess is well established and consists of immediate drainage of the abscess followed by the slow process of healing by granulation (formation of new tissue in the sinus void). Fzn M, 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. The symbol "+" indicates low risk of bias, "?" In surgical RCTs, blinding of participants, surgeons and outcome assessors can be difficult, and in many circumstances impossible. Many, but not all patients are hirsute, and an excess incidence has been reported in those who are moderately obese (Notaro 2003). Of the 13 studies incorporating 1421 participants reporting time to wound healing, 9 studies reported significantly faster (mean/median) time to wound healing after primary closure (Fazeli 2006; Higgins JPT, Which technique for treatment of pilonidal sinus open or closed? 2009 Apr;57(4):324-35 1 exp Pilonidal Sinus/ Pooling the data from the 16 studies, using a fixed effect model showed that open healing by secondary intention was associated with significantly lower rates of recurrence than closed (all) wounds healing (RR 0.65, 95% CI 0.46 to 0.93, I2 = 17%) (Analysis 1.2). One study (Mohamed 2005) had three trial arms and participants were assigned to subgroups, where one arm was midline closure, therefore they were categorised as midline closure group. Midline closure (excision and primary closure) vs. offmidline closure (rhomboid excision and Limberg flap). This was taken into consideration and random effects models were used where appropriate as detailed in analysis text and graphs. The open healing group included wounds that were left open to heal naturally by secondary intention. When these procedures were compared, offmidline procedures were found to be associated with significantly fewer recurrences (10.5% vs. 1.7%). This could be explained by the reduced tension that wound edges are put under when the suture line lies offmidline. Oncel M, However, studies published preCONSORT (Moher 2001) were less likely to have provided explicit details on study methodology or considered factors that may increase risk of bias. This was conducted using forest plots generated by the Cochrane RevMan software. Egger M, Two studies compared midline with offmidline closure, both at high risk of bias: one examined healing rate beyond 6 months (Abu Galala 1999), and favoured offmidline closure; the other examined healing rate within 6 months and found no difference between the two treatments (Sakr 2006). Akca 2005; wounds left open to heal: open wounds) for the treatment of noninfected pilonidal sinus disease were included. The study by Akca 2005 was at low risk of bias; the study by Ertan 2005 was at unclear risk of bias; and the study by Sakr 2006 was at high risk of bias. Here we describe a series of 22 patients after full thickness resection of basal cell carcinoma who underwent wound healing by secondary intention. The median value was used to summarize time to wound healing data in four of the 15 studies (Gencosmanoglu 2005; Six studies reported mean/median pain scores (Ertan 2005; The term pilonidal sinus, 'pilus' meaning hair and 'nidal' meaning nest, was first used by Hodges in 1880 to describe an abnormal chronic tract between the buttocks (Werkgartner 2004). AA, IM and JB extracted data and wrote the updated review. Avoid any infections and manage the wound with little stress. The Incidence of Pin Tract Infections and Septic Arthritis in Percutaneous Distal Femur Pinning. Any disagreements were resolved by discussion. Surgical techniques were assigned to closed (other) if the wound was closed by primary intention and the suture line lay off the midline of the natal cleft. This has been added postprotocol. Martolotta M, One study reported that sucralfate cream increased the likelihood of healing open wounds following haemorrhoidectomy compared to a petrolatum cream (RR: 1.50, 95% CI 1.13 to 1.99) over a three week period. Miocinovic 1999; Kareem 2006; Pilonidal disease was termed 'jeep disease' during World War II because many military drivers were found to have the condition (Chinn 2003). Complete follow up for at least one year; <80% drop out by 2 years. This outcome was neglected by most pilonidal sinus studies, which warrants encouraging future trials to include patient preference and satisfaction with treatment. Wound healing was significantly faster in the primary closure group (median of 2 versus 6 weeks, p = 0.013). A simple novel technique for closure of simple and complex pilonidal sinus with either simple (tongueshaped) or bilobed rotation flap. Akca 2005; Three of the 10 studies reported significantly longer hospital stay (mean/median) after open healing (Jamal 2009; Kareem 2006; AlSalamah 2007). The study was at high risk of bias. Quote: "patients were randomized according to their admission protocol number". Empirical studies investigating the impact of failure to address the three main risk of bias criteria (sequence generation, allocation concealment and reporting of incomplete data) have varied in their findings and failed to demonstrate consistent results (AlsNielsen 2004; Pildal 2007; Schultz 1995; Wood 2008). 1984 Jul-Sep;2(3):92-106 The remaining studies were graded as unclear risk of bias and thus of intermediate methodological quality. alHassan 1990 assessed participants within six months and found that 98% of closed wounds had healed compared with only 72% of open wounds, this difference was statistically significant (RR 0.74, 95% CI 0.62 to 0.88). eCollection 2019 Jul. Reduction of the excessive inflammatory reaction and subsequent edema of the burnt skin, and improved wound healing, may offer the first causal treatment option in order to prevent full skin damage and the subsequent need for skin transplantation after a second-degree burn lesion. We completed a risk of bias table for each eligible study. Epub 2012 May 7. Raniga S, What is primary intention, secondary intention and tertiary intention 144 participants. Fzn 1994; Khawaja 1992; akuten Wunde mit der Blutstillung und in der Folge mit der Freisetzung von Wachstumsfaktoren. Ashaal YI, 2013 Dec 3;2013(12):CD004551. Hameed 2001; Jamal 2009; Karakayali 2009; No information of exclusions, attrition and missing data. Considering the clinical heterogeneity of this outcome (different complications pooled as one outcome) studies were pooled using a random effects model. Kareem 2006) and the rest were at unclear risk of bias. In the event that the patient must perform their own wound care, several things should be mentioned. 37 men, 9 women, Mean age 22.5 years. ZimmermannNielsen C, 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. Sieron HL, Sommer F, Lindemann J, Scheithauer MO, Wagenmann M, Stupp F, Hoffmann TK. New presentation only. healing time, recurrence, RTW, other complications, operating time. Rao 2001;Sakr 2006; Sheikh 2007). 82 participants. Of all studies, three were at high risk of bias (alHassan 1990; Quote: "participants were randomised . by taking a card from a sealed envelope". 2002;160:219-24 Fzn 1994; Definition of Terms PHYSIOLOGY OF WOUND HEALING Wound healing occurs in four stages, haemostasis, inflammation, proliferation and remodelling, and the appearance of the wound will change as the wound heals. The review only included studies that recruited participants with new onset or recurrent pilonidal sinus disease and rejected those with an abscess at presentation. Kareem 2006; Sndenaa 1992). She previously interned for Almost 30, a top-rated health and wellness podcast. Kurt N, We also searched the bibliographies of all included studies and review papers to identify other potentially suitable studies. Are reports of the study free from suggestion of selective outcome reporting? Data on time to wound healing are presented in Table 6. Zur Kompressionstherapie, z. Mean age 26.6 years (range 1931). sind bzw. One small study (n = 83; 3 arms) (Mohamed 2005) measured participant satisfaction as 'satisfied/not satisfied'. Granulation Wound Care (Second Intent Wound Healing) Your wound will be left to heal in naturally or by second intention healing. New and recurrence presentation. All data were converted into units of days. wird, die tgliche Verffentlichung von Daten ber die Fernleitungskapazitt und die Gasflsse in der Region Nord-West, die Prfung von Mglichkeiten fr eine vermehrte Umkehr der Lastflsse in der Region SdSdost und der Abschluss von Vereinbarungen ber Kuppelstellen sowie von Vereinbarungen ber den operativen Ausgleich von Mengenabweichungen und die Umsetzung gemeinsamer Geschftspraktiken durch den Verband EASEE-Gas. Data were pooled using a random effects model and there was no significant difference in the wound healing rate between the two methods (RR 0.94, 95% CI 0.85 to 1.04, I2 =79%) (Analysis 1.7). The primary outcome was pin-site infection. http://www.sign.ac.uk/methodology/filters.html#random. 82 men, 18 women. Despite the potential economical impact of pilonidal sinus disease, there were no fully costed economic evaluation studies investigating either direct or indirect financial consequences. 140 participants. Data are presented in Table 7. Remember: You want to clean and nourish the damaged skin, not irritate it. A secondary closure appears to minimize the postoperative edema, pain and trismus and thus contributes to enhanced patient comfort. No information on exclusion, attrition or missing data. Ten studies (1231 participants) reported rate of SSI after open compared with closed (all) treatments (AlSalamah 2007; Fazeli 2006; 68 men, 15 women. Healing time, recurrence at 6 and 12 months, RTW, other complications, LOS outpatient visits. The superiority of the offmidline technique was supported in a review by Petersen 2002. healing time, SSI, RTW, other complications, QOL, pain, operative time, time to sitting without pain, time to return to daily activities without pain, time to walk with out pain. If you found this evidence helpful, please consider donating to Cochrane. Wound healing is a complex and dynamic process and a thorough knowledge of the basics of physiology of wound healing is a must to implement principles of chronic wound care. The rest were from United Arab Emirates (UAE), Kingdom of Saudi Arabia (KSA), Kuwait, Iraq, Iran, Italy, Croatia, Denmark, and Norway. 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. Quasi RCT with 3 comparisons. Secondary intention occurs when the edges of a wound cannot be approximated (brought together), so the wound heals by filling in from the bottom up with the production of granulation tissue. Wound care is one of the most common concerns faced by nurses and care givers today. . Entwicklungen") fr noch zufriedenstellend. University of Aberdeen, c/o Section of Population Health, Polwarth Building, Foresterhill, AberdeenUK, AB25 2ZD, Queen Elizabeth Hospital, General Surgery, Sheriff Hill, GatesheadUK, NE9 6SX, Aberdeen Royal Infirmary, Ward 31, AberdeenUK, AB25 2ZN, University of Warwick, Warwick Clinical Trials Unit, Gibbet Hill Rd, CoventryUK, CV4 7AL, Rate of surgical site infection (SSI)/proportion of infected wounds, Rate of recurrence or rate of reoperation (there may be differences between how these are reported), Cochrane Wounds Group Specialised Register (Searched 24/9/09), The Cochrane Central Register of Controlled Trials (CENTRAL) The Cochrane Library 2009 Issue 3, Ovid MEDLINE 1950 to September Week 3 2009, Ovid MEDLINE(R) InProcess & Other NonIndexed Citations (September 24, 2009), EBSCO CINAHL 1982 to September Week 3 2009, Open healing compared with closed wound (all), Open healing compared with closed wound (midline), Open healing compared with closed wound (other), Closed wound (midline) compared with closed wound (other), Closed wound (other) compared with closed wound (other) (added postprotocol), Incomplete outcome data adequately addressed.
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