Evaluation of the efficacy of the Z-plasty surgical technique vs. secondary wound healing mechanism in the treatment of the pilonidal sinus, A clinical trial

Abstract Background The most important step in the treatment of a pilonidal sinus is eradication by surgical excision. Over the years, a wide variety of surgical techniques have been reported for wound closure, yet their management still poses a challenge. The current study compares the results of two different methods of wound management: secondary wound healing versus the Z-plasty surgical technique. Material and Method: The current clinical trial recruited 86 uncomplicated pilonidal sinus patients who were to undergo complete surgical excision of the pilonidal sinus. For wound healing, the 86 subjects were equally divided into two groups of 43 patients each. One group was selected for Z-plasty surgical wound closure and the other for the secondary healing mechanism. Outcomes measured for both groups consisted of demographic data, length of operation, complications, severity of pain, number of dressings, recurrence, and complete healing time. Result In both groups, there were no significant differences observed in demographic data (age, sex, and BMI). The number of dressings applied in the Z-plasty group was significantly fewer than that in the secondary wound healing group. The duration for complete wound healing among the Z-plasty subjects was statistically significantly shorter in comparison with the other study group. The length of operation for secondary wound healing patients was significantly shorter than that for the Z-plasty group. During the first 24 hours after surgical excision of the pilonidal sinus, the severity of pain, measured by the VAS (Visual Analogs Scale), was the same for the two groups. However, after the first 24-hour postoperative period, the severity of pain was significantly less for Z-plasty patients than for the secondary wound healing group (based on lower use of analgesics and higher satisfaction). Conclusion Z-plasty is a safe and effective procedure in terms of wound complications and recurrence rate. This method is also cost-effective and better received by patients, since its shorter healing time, easier wound care, and lower degree of pain facilitate a faster return to work. Therefore, Z-plasty can be considered an alternative to traditional treatment methods. Trial registration: The trial is registered in the Iranian Registry of Clinical Trials (IRCT id: IRCT20111211008375N16) in 01/06/2018.