Plastische Rekonstruktionsmöglichkeiten beim chronischen Sinus pilonidalis

 

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Zusammenfassung

Einleitung: Der chronische Sinus pilonidalis ist eine entzündliche Erkrankung der Gesäßfalte, welche bei chronischen Verlaufsformen i. d. R. chirurgisch therapiert werden muss. Zielstellung: In dem vorliegenden Artikel werden verschiedene plastisch-chirurgische Verfahren vorgestellt. Methoden und Ergebnisse: Plastisch-chirurgische Verfahren werden anhand eigener Erfahrungswerte und unter Berücksichtigung ausgewählter Referenzen vorgestellt und diskutiert. Das radikale Débridement unter Entfernung sämtlicher Sinus und Haarnester stellt einen entscheidenden Schritt dar. Im Anschluss bestehen häufig Weichteildefekte, welche mit lokalen Lappenplastiken rekonstruiert werden müssen. Hierbei können verschiedene Lappenplastiken wie Karydakis-, Limberg-, V–Y- oder Rotationslappenplastiken zum Einsatz kommen. Schlussfolgerung: Bei Beachtung eines adäquaten Débridements und plastisch-chirurgischer Grundprinzipien kann mit den dargestellten Methoden ein suffizienter Weichteilverschluss erreicht werden.

Abstract

Introduction: Chronic pilonidal disease represents an infectious disease of the gluteal cleft that often requires surgical resection. Aim: In this article, several plastic-surgical reconstructions are presented. Methods and Results: Based on our experience and the current literature, different plastic surgical reconstructive methods are presented and discussed. Thorough debridement including sinus tracts and follicles represents an important step in the treatment algorithm. Subsequently, wide defects may remain that can require reconstructive surgery with local flaps. These may include a Karydakis procedure, Limberg transposition flap, V–Y advancement or rotation flap. Conclusion: After thorough debridement and adherence to plastic surgical principles, sufficient reconstructions can be obtained with the presented methods.

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