Pilonidal disease and the sail flap procedure: everything patients need to know
Written in association with:Pilonidal disease (PD) is a common chronic inflammatory condition that primarily affects the natal cleft region, particularly in adolescents and young adults under the age of 30. It is relatively rare in individuals over 40 and is twice as prevalent in males as in females. A wide range of treatment options exists, from conservative measures to surgical interventions, reflecting significant variations in clinical practice and the absence of a clearly superior technique. Therefore, a personalised approach to managing PD is essential to restore patients’ comfort and well-being.
Are you considering a surgical solution for pilonidal disease? One promising option is the sail flap technique. In his latest article, renowned consultant general, laparoscopic, upper GI, and bariatric surgeon, Mr Ricardo Camprodon, delves into the details of this procedure, discussing who may be suitable candidates, the recovery process, and potential risks.
What causes pilonidal disease?
Pilonidal disease is an acquired condition believed to arise from a combination of biomechanical factors, including hair thickness, skin vulnerability, and friction, which facilitate hair penetration into the skin. This penetration triggers a foreign body reaction, leading to inflammation, sinus formation, and, in some cases, infection. Additional contributing factors include a deep natal cleft, obesity, and a consistently warm, moist environment.
The condition typically presents with intermittent periods of quiescence and acute inflammatory flares, which may involve pain, swelling, and drainage from the affected area.
What is the sail flap procedure and what does it entail?
The sail flap procedure is an evolved version of the Bascom technique, developed to effectively treat pilonidal disease. Mr Camprodon advocates this method over other advancement flap techniques due to its simplicity, reproducibility, and standardisation, which often result in better outcomes with lower rates of infection and recurrence.
This procedure involves removing only the diseased tissue, thereby minimising tissue trauma and reshaping the natal cleft to flatten it. This approach promotes faster healing, an earlier return to normal activities, and greater patient satisfaction.
Surgical steps:
- Anaesthesia: The procedure is performed under general anaesthesia.
- Preparation: The area is shaved, cleaned, and the extent of the disease is assessed.
- Marking and excision: The sail flap is carefully marked on the skin, ensuring minimal excision of healthy tissue.
- Closure: The wound is closed in multiple layers using sutures, which helps distribute pressure and reduce the risk of wound breakdown.
Recovery process
The sail flap procedure is typically performed as a day-case surgery. Recovery involves:
- Drain and sutures: A small suction drain is removed three days post-surgery, and skin sutures are removed around the tenth day.
- Wound care: Patients are advised not to disturb the dressing and to avoid prolonged sitting until the sutures are removed, reducing the risk of wound infection and dehiscence.
- Return to activities: Most patients can resume normal activities within ten days. Mild discomfort and swelling are expected but can be managed with pain relief.
Risks and complications
Like any surgical procedure, the sail flap technique carries potential risks, although these are generally minimal. Complications may include:
- Wound infection
- Bruising and bleeding
- Wound breakdown
- Seroma formation
- Recurrence of pilonidal disease
Key considerations for success
Evidence suggests no single flap technique is clearly superior, making the choice of procedure highly dependent on patient characteristics and the surgeon’s training and experience. Meticulous surgical technique and attentive postoperative care are crucial in reducing complications.
One often overlooked factor is smoking, which significantly impacts postoperative infection rates and wound healing. Patients are strongly encouraged to stop smoking before surgery; even one week of smoking cessation prior to the procedure can yield significant benefits.
Why choose the sail flap technique?
With its focus on limiting tissue trauma, promoting faster recovery, and delivering consistent results, the sail flap procedure offers an excellent option for the surgical treatment of pilonidal disease. Under the expertise of Mr Ricardo Camprodon, up to 95% of pilonidal disease cases can be successfully managed with this technique.
For further information about the sail flap procedure or to discuss your suitability for surgery, don’t hesitate to reach to Dr Camprodon via his Top Doctors profile.
