Flap Reconstruction of Pilonidal Sinus Using Extracellular Matrix Graft: A pilot Case Series

Pilonidal sinus disease (PS) presents as a cyst of the upper gluteal cleft causing pain, swelling and tenderness that typically affects otherwise healthy young adults. Recurrent PS leads to extended inflammation and scarring causing a chronic non-healing wound with sinus cavities under the skin. Severe or recurrent PS requires surgical intervention involving the removal of diseased tissue via wide excision and closure, though complication rates (e.g. infection, dehiscence, recurrence) are often high [1].  

Ovine forestomach matrix (OFM) decellularized extracellular matrix graft has been widely used in wound management and implant applications [2-5]. OFM is a biomimetic of tissue ECM and is anti-inflammatory [6, 7], stimulates angiogenesis [8], promotes scaffold infill and undergoes complete remodelling [8]. We have previously reported the successful use of OFM graft as an implant in the reconstruction of hidradenitis suppurativa (HS) patients, following wide excision of the axilla and fasciocutaneous flap closure [9]. In these instances, the aim of the OFM graft is to reduce surgical complications by quenching tissue inflammation, filling surgical dead space and rapidly forming well vascularized new tissue within the defect. Like HS, the tissues involved in PS are highly inflamed and contaminated, so more recently we have sought to evaluate this technique in the surgical reconstruction of PS following cystectomy via wide excision.     

Five patients underwent wide excision of diseased tissue, placement of the OFM graft in the base of the defect, fasciocutaneous flap advancement and off-midline closure. All patients healed well, with no significant wound dehiscence nor recurrence. These promising results provide preliminary insights into the successful management of PS which can otherwise lead to lengthy hospital stays, long recovery times and significant cost in otherwise healthy individuals.