Assessment of the effect of platelet rich plasma on the healing of operated sacrococcygeal pilonidal sinus by lay-open technique: a randomized clinical trial

Mohamed M Gohar, Reda F Ali, Khaled A Ismail, Taha A Ismail, Nahla A Nosair, Mohamed M Gohar, Reda F Ali, Khaled A Ismail, Taha A Ismail, Nahla A Nosair

Abstract

Background: Sacrococcygeal pilonidal sinus disease (PSD) is an infection of the skin and subcutaneous tissue at the upper part of the natal cleft of the buttocks. Excision and healing by granulation "lay-open" method is still more preferable than other methods of midline closure or using flaps but the healing time is lengthy. The present study was performed to assess the healing promotion effect of platelet-rich plasma (PRP) on the pilonidal sinus wounds treated by the lay-open method.

Methods: One hundred patients suffering from PSD were randomly divided into two groups, they were treated by the lay-open method, at General surgery department, Kafr El-Sheik University hospital, Egypt, during the period from December 2018 to December 2019. Group (A) was adopted the regular dressing postoperatively, while group (B) was treated with PRP injection into the wound at 4 and 12 postoperative days.

Results: Accelerated rate of wound healing was detected in group (B) in day 10, with a significant difference detected in days 15, 20, 25 and 30 postoperative, with a mean time of complete healing 45 ± 2.6 days in group B, while it was 57 ± 2.4 days in group A with a p-value of 0.001 which indicates considerable effect in the treated group.

Conclusions: PRP injection is an effective new technique in accelerating the healing of pilonidal wound after surgery, with a significant decrease in post-operative pain, complications and an early return to work.

Trial registration: retrospectively registered.

Trial registration number: 12/35/1016 issued on December 2018 from the Institution Review Board at Kafr El Sheikh University. ClinicalTrials.gov identifier: NCT04430413.

Keywords: Lay-open excision; PRP; Pilonidal sinus.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of patients
Fig. 2
Fig. 2
Postoperative outcome in both groups
Fig. 3
Fig. 3
Mean wound volume in each group for the follow-up period

References

    1. Khanna A, Rombeau J. Pilonidal disease. Clinical Colon Rectal Surgery. 2011;19(24):46. doi: 10.1055/s-0031-1272823.
    1. Notaro JR. Management of recurrent pilonidal disease. Seminars in Colon and Rectal Surgery. 2003;14(4):173–185. doi: 10.1053/j.scrs.2004.03.002.
    1. Hull TL, Wu J. Pilonidal disease. Surg Clin N Am. 2002;82(6):1169–1185. doi: 10.1016/S0039-6109(02)00062-2.
    1. Darwish A, Eskandaros M, Hegab A. Sacrococcygeal pilonidal sinus: modified sinotomy versus lay-open, limited excision, and primary closure. Egyptian J Surg. 2017;36(1):13–19. doi: 10.4103/1110-1121.199901.
    1. McCallum I, King PM, Bruce J, Al-Khamis A. Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Cochrane Database Syst Rev. 2007;4.
    1. Ferrara N, Henzel WJ. Pituitary follicular cells secrete a novel heparin-binding growth factor specific for vascular endothelial cells. Biochem Biophys Res Commun. 1989;161(2):851–858. doi: 10.1016/0006-291X(89)92678-8.
    1. Veevers-Lowe J, Ball SG, Shuttle worth A, Kielty CM. Mesenchymal stem cell migration is regulated by fibronectin through α5β1-integrin-mediated activation of PDGFR-β and potentiation of growth factor signals. J Cell Sci. 2011;124(8):1288. doi: 10.1242/jcs.076935.
    1. Corman M, Brian B. Erin M. pilonidal sinus. Colon, rectal and anus. surgery. 2005;5(19):616–625.
    1. Oncel M, Kurt N, Kement M, Colak E, Eser M, Uzun H. Excision and marsupialization versus sinus excision for the treatment of limited chronic pilonidal disease: a prospective, randomized trial. Techniques in Coloproctology. 2002;6(3):165–169. doi: 10.1007/s101510200037.
    1. Al-Jaberi TMR. Excision and simple primary closure of chronic pilonidal sinus. Eur J Surg. 2001;167(2):133–135. doi: 10.1080/110241501750070600.
    1. Elgohary H, Oraby E. Pilonidal sinus: minimal excision and primary closure under local anesthesia. The Egyptian Journal of Surgery. 2015;34(4):287–292. doi: 10.4103/1110-1121.167393.
    1. Redler LH, Thompson SA, Hsu SH, Ahmad CS, Levine WN. Platelet-rich plasma therapy: A systematic literature review and evidence for clinical use. The Physician and Sports medicine. 2011;39(1):42–51. doi: 10.3810/psm.2011.02.1861.
    1. Spyridakis M, Christodoulidis G, Chatzitheofilou C, Symeonidis D, Tepetes K. The role of the platelet-rich plasma in accelerating the wound-healing process and recovery in patients being operated for pilonidal sinus disease: preliminary results. World J Surg. 2009;33(8):1764–1769. doi: 10.1007/s00268-009-0046-y.
    1. Bahar M, A kbarian M, Azadmand A. Investigating the effect of autologous platelet-rich plasma on pain in patients with pilonidal abscess treated with surgical removal of extensive tissue. Iran Red Crescent Med J. 2013;15(11):10–13.

Source: PubMed

3
Iratkozz fel