Pilonidal sinus excision - Forum

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Dottore

Pilonidal sinus excision - Ärzteforum

Post#1 »

I think I should change from elliptical excision and primary closure to the Bascom technique - any comments?


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الجراح

Re: Pilonidal sinus excision - Ärzteforum

Post#2 »

What's the Bascom technique for pilonidal sinus?

Dottore

Re: Pilonidal sinus excision - Ärzteforum

Post#3 »

Heard Dr. Bascom speak and had coffee with him. Another speaker from U.K. presented her results using the technique.

The principle of the procedure is once again to avoid midline suture line, and to elevate the midline off the sacrum.

Use L.A. with adrenaline - hence Day Case (Office procedure is the U.S. equivalent!). Carefully excise each midline pit individually, and ensure the defects so formed communicate laterally with the sinus cavity. Incise vertically into the sinus cavity aprox 2-3cms away from midline. Undercut the midline fat from the sinus cavity. Suture that midline fat to the overlying skin (sorry I know that is difficult to understand!). Do NOT pack but cover with dressing. Finished!

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Lady Surgeon

Re: Pilonidal sinus excision - Ärzteforum

Post#4 »

The Bascom approach to pilonidal disease emphasizes keeping the incision away from the midline and not excising any excess tissue.

With an abscess, I and D from a vertical incision 1-2 cm lateral to the midline.

For an excision, excise just the pits with the tip of an 11 blade, excising just a tiny rim of tissue around each pit. Then, make an incision as above and clean out the hair and granulation tissue underneath the midline from this lateral incision.

Apparently, the natural forces in the pilonidal area pulled the midline apart so midline wounds take longer to heal.

Have the patient keep the area hair free forever by having it shaved or using depilatory creams.

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الجراح

Re: Pilonidal sinus excision - Ärzteforum

Post#5 »

But how well does it work?

forceps

Re: Pilonidal sinus excision - Ärzteforum

Post#6 »

Pilonidal sinus surgery is one of very few surgical procedures which I dislike,due to the high recurrence rate in any surgical technique you choose,for this reason I generally adopt a conservative,nonexcisional methods basically meticulous hair control by natal cleft shaving,improved perineal hygiene,and limited lateral incision and drainage for abscess. In persistent and recurrent sinuses I do elliptical excision and primary closure with very modest results. I have no experience with Bascom techniqe(below you will find the original article of Bascom).

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Billroth

Re: Pilonidal sinus excision - Ärzteforum

Post#7 »

I too went to this session on pilonidal disease. I am afraid I was very disappointed and none the wiser.

The key message seemed to be to 'stay out of the ditch' (seems logical but no evidence.

I enjoyed Prof Allen-Mersh's review and it seemed that there was potential uses for marsupialisation as getting reasonable results with a simple procedure. There may also be a role for the D-shaped Kariadakis operation although there was no description as to how to do it and it does seem a bit extensive and radical.

There was an interesting presentation from Ms Senatapi on Bascom's operation but I was not convinced by her results.

Finally I got the impression that Dr Bascom no longer used his own operation in everyday practice. If that is the case then i is not a great advert.

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