Therapievergleich bei infiziertem Sinus pilonidalis – Unterschiede von Narbenqualität und Outcome nach Sekundärheilung oder Limberglappenplastik im Rahmen einer prospektiven Studie

 

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Zusammenfassung

Hintergrund: Nach der Exzision eines infizierten Sinus pilonidalis gibt es verschiedene Therapieoptionen des Defekts. Wir verglichen Sekundarheilung und Limberglappenplastik hinsichtlich Narbenqualität und Beschwerden, Rezidivhäufigkeit, Arbeitsunfähigkeit und Patientenzufriedenheit 1 Jahr postoperativ.

Methodik: Von 55 Patienten, welche 2011–2012 im KlinikumStadtSoest an einem Sinus pilonidalis operiert wurden, konnten 16 Patienten mit sekundärer Wundheilung und 17 Patienten mit Limberglappenplastik eingeschlossen werden. Insbesondere interessierten uns die Objektivierbarkeit der Narbenqualität und -elastizität durch die Parameter der Hautdehnbarkeit und -verschieblichkeit. Hierzu kam eine von uns entwickelte Messmethode zur Ermittlung des Sakral-Lumbalen Hautdehnungsquotienten (SL-Quotient) und der Sakralen Hautverschieblichkeit zum Einsatz. 100 gesunde Probanden dienten als Kontrollgruppe. Die Schmerzskalen, Rezidivhäufigkeit, Zufriedenheit der Patienten mit Verlauf und kosmetischem Ergebnis sowie die Dauer der Arbeitsunfähigkeit wurden ebenfalls ermittelt.

Ergebnisse: Der Sakral-Lumbale Hautdehnungsquotient fiel in der Limberggruppe signifikant besser aus, als in der Sekundärheilungsgruppe. Bezüglich der Verschieblichkeit gab es eine deutliche Tendenz zu günstigeren Werten in der Limberggruppe. Die Dehnbarkeit und Verschieblichkeit in der Limberggruppe entsprach den Referenzwerten aus der gesunden Probandengruppe. Die Dehnbarkeit nach sekundärer Wundheilung war hingegen signifikant (p=0,001) schlechter als in der gesunden Referenzgruppe. Die Dauer der Arbeitsunfähigkeit nach der Lappenplastik war in der Limberggruppe (MW 29 Tage) signifikant (p=0,02) geringer als die Dauer nach der Sinusexzision in der Gruppe mit sekundärer Wundheilung (MW 63 Tage). Bezüglich der Schmerzen, Zufriedenheit mit Verlauf und kosmetischem Ergebnis sowie Anzahl der Rezidive zeigten sich keine Unterschiede zwischen den Patientengruppen.

Schlussfolgerung: Durch den Wundverschluss mittels Limberglappenplastik nach Exzision eines infizierten Sinus pilonidalis kann nicht nur die Dauer der Arbeitsunfähigkeit reduziert werden, sondern auch eine Narbe entstehen, die besser verschieblich und dehnbar ist, im Vergleich zur Sekundärheilung. Schmerzen und Zufriedenheit waren in beiden Gruppen sehr günstig, ohne Gruppenunterschiede. Folgestudien an einem größeren Patientenkollektiv und mit längerem Follow-up sind geplant. Wir stellen unseren Patienten zunächst weiterhin beide Therapieoptionen als mögliche Alternativen dar.

Abstract

Objective: There are various options for wound treatment after the excision of a pilonidal sinus. The aim of our study was to compare secondary healing to Limberg flap wound closure, with a focus on scar quality and patient complaints, rate of recurrence, period of absence from work as well as functional and aesthetic results one year after surgery.

Method: 33 out of 55 patients who underwent pilonidal sinus excision in our department (KlinikumStadtSoest, Soest, Germany) between 2011 and 2012 were enrolled in the study. 16 of these 33 patients had chosen secondary wound healing and 17 were treated with a Limberg flap for defect coverage. First and foremost, we aimed to objectify scar quality and elasticity by measuring the parameters of skin distensibility and mobility. To this end, we used a self-developed method to ascertain the sacral lumbar skin distension quotient (SL quotient) as well as sacral skin mobility. 100 healthy volunteers served as a control group. Also we collected information about pain, time of absence from work and frequency of recurrence and asked patients about their satisfaction with the functional and aesthetic results.

Results: The results for the sacral lumbar skin distension quotient were significantly better after Limberg flap wound closure compared with secondary wound healing. As regards distensibility, there was a marked trend to more favourable values in the Limberg group. No differences in distensibility and mobility were observed between the Limberg group and the control group, whereas skin distensibility was significantly reduced (p=0.001) in secondary healing compared with the control group. Time off work was significantly longer in secondary healing (mean 63 days) than after Limberg flap (mean 29 days). No differences were identified regarding patient satisfaction, pain scores and frequency of recurrence.

Conclusion: Wound closure via Limberg flap after the excision of an infected pilonidal sinus not only helps to reduce absence from work, but also produces a scar which is more distensible and movable compared with secondary healing. Patient satisfaction and pain scores were very good in both groups, with no differences observed by us. We are planning to collect more data with a bigger sample of patients and a longer follow-up period in future studies. For the time being, we will continue to provide both treatment methods to our patients.

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