Wundheilungsstörungen nach Exzision und offener Behandlung eines Sinus pilonidalis

Zusammenfassung

Einleitung Der Sinus pilonidalis ist eine meist chronische punktuelle Infektion der behaarten Haut im Bereich von Hautfalten, überwiegend im Bereich der Rima ani. Die offene Wundbehandlung stellt hierbei nach wie vor die am häufigsten durchgeführte Therapiemaßnahme dar. Dennoch kann es im Rahmen der offenen Wundbehandlung zu Heilungsstörungen kommen, die den Verlauf erheblich komplizieren können.

Methoden Im Folgenden wird eine Übersicht über Wundheilungsstörungen nach Exzision eines Sinus pilonidalis gegeben. Dabei werden die Heilungsdauer und Häufigkeit anhand aktueller Daten ermittelt und die Ursachen der Heilungsstörungen evaluiert. Des Weiteren werden mögliche Behandlungsoptionen dargestellt und Behandlungsempfehlungen abgegeben.

Ergebnisse Die Auswertung publizierter Daten zur Wundheilungsdauer ergab, dass die Wunden nach durchschnittlich 2 Monaten verheilt sind. Die Ergebnisse der Bundeswehrkohortenstudie zeigen exemplarisch, dass im Zeitraum bis zu 3 Monaten nahezu alle Wunden verheilt sind. Es verbleibt jedoch ein geringer Prozentsatz an nicht verheilenden Wunden. Die Häufigkeit von erheblich verzögerter Wundheilung wird in der Literatur mit 2 – 5% angegeben. Die Einflussfaktoren auf die Wundheilung nach Sinus-pilonidalis-Exzision sind neben der Größe und Symmetrie der Exzisionswunde auch weitere Details der offenen Wundbehandlung. Als Therapieoptionen bei ausbleibender Wundheilung werden neben Intensivierung der vormaligen offenen Wundbehandlung die neuerliche Exzision und Anfrischung der Wunde genannt. Des Weiteren werden aber auch Strategiewechsel zur plastisch-rekonstruktiven Versorgung bzw. zu einer anderen Oberflächenbehandlung empfohlen.

Schlussfolgerung Die Exzisionswunde eines Sinus pilonidalis sollte spätestens nach 3 – 4 Monaten verheilt sein, danach kann die Wunde als signifikant verzögert heilende Wunde bzw. als Wundheilungsstörung angesehen werden. Etwa zu diesem Zeitpunkt sollte der Befund erneut evaluiert und ggf. ein Wechsel des Behandlungskonzeptes vorgenommen werden.

Abstract

Introduction Pilonidalis sinus disease is a mostly chronic selective infection of the hairy skin in the area of skin wrinkles, mainly in the area of the natal cleft. Open treatment is still the most common recommended therapy. Nevertheless, there may be healing disorders within the framework of open wound treatment, which can significantly complicate the course.

Methods The following is an overview of wound healing disorders after excision of pilonidalis sinus. Healing time and frequency are determined on the basis of current data and the causes of the healing disorder are evaluated. In addition, possible treatment options are presented and treatment recommendations are made.

Results The evaluation of published data on wound healing period showed that the wound usually heals after a mean of two months. The results of the German forces cohort study show by way of example that almost all wounds have healed in the period up to three months. However, a small percentage of non-healing wounds remain. The frequency of significantly delayed wound healing is given in the literature as 2 – 5%. The influencing factors for wound healing after sinus pilonidalis excision are not only the size and symmetry of the excision wound but also other details of open wound treatment. In addition to intensification of the previous open wound treatment, the new excision and refreshment of the wound are mentioned as treatment options in the event of a lack of wound healing. Furthermore, changes in strategy for plastic-reconstructive procedures or other surface treatment are also recommended.

Conclusion The excision wound of pilonidalis sinus should be healed after three to four months at the latest, after which the wound can be regarded as a wound with significantly delayed healing or as a wound healing disorder. Around this time, the findings should be re-evaluated and, if necessary, a change in the treatment concept should be made.

Schlüsselwörter

Pilonidalsinus - Exzision - primär offene Wunde - offene Wundbehandlung - Wundheilungsstörung - Wundheilung

Key words

pilonidal sinus - excision - primary open wound - wound healing - open wound care - delayed wound healing

Publication History

Article published online:
17 December 2020

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