eP469 - Comparative Efficacy of Pilonidal Sinus Reconstruction Incorporating an Extracellular Matrix Graft

Purpose/Background: Pilonidal sinus disease (PSD) remains a persistent challenge for clinicians, characterized by chronic inflammation in the sacrococcygeal region. When standard wound care fails and the disease progresses, surgical intervention may be required to achieve definitive closure. Reconstructive approaches vary, with several flap-based procedures having been described in the literature [1]. However, due to the quality of the tissue (i.e. local tissue inflammation and contamination), flap based approaches have relatively high reported postoperative complication rates, including seroma/hematoma and dehiscence [2]. A prior retrospective case series reported the use of an extracellular matrix (ECM) graft, termed ‘ovine forestomach matrix’ (OFM), placed under a gluteal fasciocutaneous advancement flap, with mid-line closure [3]. The intent of graft placement was to fill surgical dead space under the flap and modulate any tissue chronicity in order to reduce the risk of post-operative complications. In the authors practice we have traditionally used a mid-line closure with tie-over bolster dressing for PSD closure and have reported a dehiscence rate of 31.4% (n=11/35) [4]. In this current study, we have incorporated the use of a OFM graft into our established surgical approach, with an aim to reduce post-operative complications.Methods/Interventions: Patients were prospectively enrolled to participate in the ethics approved study (NCT05243966). Participants underwent elliptical excision and mid-line closure of a gluteal fasciocutaneous advancement flap as previously described [4]; however, prior to closure, an OFM graft was placed at the base of the defect and secured. The patients then had two full-thickness sutures tied over rolled up gauze. Patients were monitored for up to 12 months and assessed for post-operative complications, recurrence and scar satisfaction. The results of the prospective cohort were compared with a retrospective cohort previously published [4] who did not receive placement of an OFM graft.Results/Outcomes: The prospective cohort included 34 patients that received OFM graft as part of their PSD reconstruction. The prospective cohort included 5 females and 29 males, with a median age of 28.2±1.3 years, mean BMI was 27.3±0.8, with n=9/34 patients being obese. No patients had diabetes and n=3/34 reported smoking. The dehiscence rate was 14.7% (n=5/34), representing a reduced surgical dehiscence rate relative to the retrospective cohort (31.4%, n=11/35).Conclusion/

Discussion: The current comparative study has demonstrated that integration of an OFM graft as part of flap-based closure of PSD significantly reduces post-operative complication rates.1. Bi, S., et al., Surgical procedures in the pilonidal sinus disease: a systematic review and network meta-analysis. Sci Rep, 2020. 10(1): p. 13720.2. Kaser, S.A., et al., Primary wound closure with a Limberg flap vs. secondary wound healing after excision of a pilonidal sinus: a multicentre randomised controlled study. Int J Colorectal Dis, 2015. 30(1): p. 97-103.3. Chaffin, A.E., et al., Surgical reconstruction of pilonidal sinus disease with concomitant extracellular matrix graft placement: a case series. J Wound Care, 2021. 30(Sup7): p. S28-S34.4. Nasseri, Y., et al., Bilateral Gluteal Fasciocutaneous Advancement Flaps With and Without Tie-Over Sutures in Treatment of Chronic Pilonidal Disease: A Prospective Case Series. Am Surg, 2023. 89(6): p. 2499-2504.