Pilonidal Cystectomy Using Extracellular Matrix Graft

Pilonidal sinus disease (PS) presents as a cyst of the upper gluteal cleft causing pain, swelling and tenderness that typically affects otherwise healthy young men. Recurrent PS leads to extended inflammation and scarring causing a chronic non-healing wound with sinus cavities under the skin. Untreated, PS can result in infection and an increased risk of squamous cell carcinoma [1]. Severe or recurrent PS requires surgical intervention involving the removal of diseased tissue. Complex cases, involving a large excisional area can lead to wound dehiscence, recurrence of PS, or infection of the surgical site.  Different surgical methods have been described and there is a consensus that off-midline closure lead to fewer recurrences than midline closures [1].
Xenogeneic decellularized extracellular matrix (ECM) grafts have been used for the surgical reconstructive procedures to serve as an absorbable scaffold for cellular infiltration, capillary formation, and remodeling of underlying soft tissue. Ovine forestomach matrix (OFM) ECM 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 remodeling [8]. The use of an ECM graft to support recovery after surgery where a large tissue deficit is created has the potential to improve the recovery time and cosmetic outcomes for patients with PS   
This case series evaluated the performance of a layered OFM graft† as an implant during flap reconstruction of PS. No significant wound dehiscence nor recurrence was observed across the clinical cases studied. These promising results provide preliminary insights into the successful management of PS which can cause otherwise lead to lengthy hospital stays, long recovery times and significant cost in otherwise healthy individuals.
 
 
 
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References (if applicable): 1. Kober, M.M., U. Alapati, and A. Khachemoune, Treatment options for pilonidal sinus. Cutis, 2018. 102(4): p. E23-E29.
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