Técnica de Karydakis modificada para el tratamiento del sinus pilonidal gigante / Modified Karydakis procedure for giant pilonidal sinus

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Delayed wound healing in sacrococcygeal pilonidal sinus coincides with an altered collagen composition.

BACKGROUND: Although patients with pilonidal sinus are young and, thus, are expected to heal well, a delayed healing with high risk of recurrence frequently is observed. This study was initiated to test whether disorders in the extracellular matrix (ECM) may be detected in patients with pilonidal sinus and delayed wound healing or recurrent disease, respectively. METHODS: In 48 patients, tissue specimens were obtained at the index operation. All patients were treated by local excision and primary wound closure. The collagen type I/III ratio, the expression of matrix metalloproteinase (MMP)-1, -9, and -13, as well as the proliferation index (Ki67) and the macrophage infiltrate (CD68) were measured. Patients with an uneventful wound healing by primary intention were compared with those in which the healing by primary intention fails (secondary healing), and patients suffering first onset of pilonidal sinus or to those patients who had undergone previous surgery for pilonidal sinus. Clinical parameters and comorbidity were evaluated. RESULTS: Patients with secondary healing, exhibited at the index operation a significantly lower collagen type I/III ratio (2.34+/-0.4) compared with patients with problem-free wound healing (3.04+/-0.7). Furthermore, significantly higher expression of MMP-1, -9, and 13, and a significantly higher proliferation index (Ki67) were found in the specimens of the patients with secondary healing. In patients in whom the operation was performed because of a recurrence expression of both Ki67 and CD68 were significantly higher. Smokers had an increased risk for suffering recurrent disease, but did not show differences in the collagen ratio. CONCLUSIONS: As a novel finding, this study indicates that disturbances of the ECM may predict a delayed wound healing after pilonidal sinus surgery.

Pilonidal sinus associated with cellular blue nevus. A previously unrecognized association.

A neoplasm associated with a pilonidal sinus (PS) is a rare occurrence in the course of a common disease. Early detection is imperative. To our knowledge, pilonidal disease associated with a cellular blue nevus (CBN) has not been reported. There is a 10% diagnostic error rate with this last lesion. Here we report the case of a 19-year-old man with recurrent sacrococcygeal PS infection associated with an indurated dome-shaped blue-black nodule 1.7 cm in diameter. Clinical diagnosis of the nodule was uncertain suggesting a pigmentary or a vascular tumor. A complete resection of the two lesions was achieved. Pathological study showed a CBN showing a predominantly alveolar pattern associated with a chronic pilonidal disease. The tumor cells showed diffuse strong reactivity for melan-A and HMB-45, and focal reactivity for S-100 protein. Staining for Ki-67 (MIB1) was virtually negative. Differential diagnoses included atypical CBN, borderline melanocytic tumor and malignant melanoma. Radical excision provides a good prognosis for the rare association consisting of a common disease such as PS with the uncommon CBN.

Infrared and Raman microspectroscopy of foreign materials in tissue specimens.

Infrared and Raman spectra of materials found in tissue specimens submitted for histopathologic diagnosis have been recorded. These foreign materials range in size from approximately 5 to 50 microm, and the vibrational spectra have been used to identify them. Examples include cholesterol and polytetrafluoroethylene (PTFE) in an implant case, polyethylene terephthalate (PET) and polyacrylonitrile (PAN) in a pilonidal cyst, and carbenicillin in a skin biopsy. In some instances, either the infrared or Raman spectra were sufficient to make a definitive identification, while in other cases both were necessary. Because some of the samples fluoresced with visible excitation at 532 nm, FT-Raman spectra with 1064-nm excitation were also recorded. The flexibility of sampling for vibrational microspectroscopy and the value of the recorded data in assisting pathologists render medical diagnoses in the examples cited and other cases are discussed.

Cytokeratin expression in pilonidal sinus.

BACKGROUND: Pilonidal sinus (PS) is considered to belong in the category of follicular occlusion diseases (acne triad). OBJECTIVES: The aim of our study was to elucidate the pathogenesis of PS by evaluating its cytokeratin (CK) expression. METHODS: CK expression in nine cases of PS was studied immunohistochemically using six antikeratin antibodies. RESULTS: Infundibular-like epithelium contained CK1, 10 and 14 similar to normal infundibulum, but it did not contain CK17. In non-infundibular-like epithelium, CK14, 16 and 17 were detected similar to that in normal outer root sheath. CK expression in PS was similar to that in hidradenitis suppurativa, suggesting that sinus epithelium may be fragile, hyperproliferative and undifferentiated. CONCLUSIONS: PS can be classified in the same entity as follicular occlusion diseases based on CK expression.