Intact Fragmented Fish Skin Graft as Novel Approach to Filling Sinus Pilonidal Wounds: A Case Series

Introduction: To assess the feasibility of using intact fish skin graft (FSG) to heal chronic post-surgical sinus pilonidal wounds. Pilonidal disease is a common condition of the skin and subcutaneous tissue near the upper part of the natal cleft of the buttocks. Cysts or abscesses can form due to ingrowth hairs, debris, or pressure. If infected results in severe pain, requiring surgical excision, leaving a sinus tract.

Method: Two female patients present with a history of chronic pilonidal sinus. HDM is a 21-year-old with a history of non-healing pilonidal sinus wound post-operation four years ago. LRJ is an 18-year-old patient with a pilonidal sinus for the last two years without previous surgical intervention.

Results: Due to the chronic nature of the pilonidal sinus in these patients, the application of intact fish skin graft was considered to promote healing. HDM underwent further surgery to allow for complete sinus removal. FSG was initially applied two days post-operatively, followed by application 2x weekly. The wound is closed in 48 days post-op. LRJ has sinus removal surgery, where FSG was applied during the procedure and then x2 weekly. The patient completely healed in 29 days.

Discussion: Both cases showed rapid granulation with minimal contracture allowing for earlier definite wound closure. The use of FSG is a novel and viable management option for earlier closure of post-excisional pilonidal sinus wounds.