traditional technique
The most feared but most effective technique for treating pilonidal cysts is en bloc resection of the disease with natural healing (without stitches).
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Benefit:
- Lower relapse rate 3-5%
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Why not?
- Worse aesthetic result
- Longer return time to daily activities, which may varybetween 3 months and 1 year.
- Greater postoperative pain
- Scar illness (the scar may become fragile and wounds may appear on it)
- Need for long-term assistance in changing dressings
Why can't you close the traditional technique with stitches?
In the traditional technique, the closure of the points in the midline (middle of the body) is associated with a drastic increase in the number of recurrences (cyst return), about 30% more than in the open technique. Probably due to hair loss in the central region.
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In addition, these stitches have to be given with a lot of tension, which can cause the stitches to open very easily.
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Another negative point of wound closure is the increased incidence of infections in the surgical wound, which can cause an even greater delay in returning to usual activities.
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The Patchwork - An alternative
A great alternative for those who have complex, recurrent cysts or want to try a faster recovery is the use of flaps (rotating a piece of adjacent, disease-free tissue to cover the wound).
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Benefits:
- Faster return to activities (average 1-2 months)
- Good aesthetic results when well executed.
- Low relapse rate (3-10%)
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Disadvantages:
- Improperly executed flaps, or in patients with associated diseases, can result in necrosis, which can be a serious problem, further increasing the open area of surgery._cc781905-5cde-3194-bb3b- 136bad5cf58d_
- The flaps generate a cavity in the covered area, which dramatically increases the chance of postoperative infection when compared to the traditional technique
- Great increase in postoperative pain when compared to minimally invasive techniques.
Should I operate by these techniques?
There is currently a trend in the medical literature to perform minimally invasive treatments for the treatment of pilonidal cyst in the first instance, due to faster recovery.
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However, there are still benefits in performing traditional techniques, especially when it comes to recurrence, there is greater evidence that the traditional technique has a higher long-term cure rate of the disease, although the technological revolution has brought excellent results.
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When choosing the technique with your surgeon, we will suggest some points to consider:
- How long can you take time off from your activities?
- Do you have someone available to change dressings?
- Can your type of disease be treated by minimally invasive techniques?