Clinical Observation of Gluteal Fold Elevation with Unilateral Gluteal Maximus Myocutaneous Flap Transplanting Across Midline in Treatment of Sacrococcygeal Pilonidal Sinus
Objective To investigate the feasibility of gluteal fold elevation with unilateral gluteal maxi-mus myocutaneous flap(GMMF)transplanting across midline after removing nodules of sacrococcygeal pi-lonidal sinus(SPS)in lateral side of midline in the treatment of SPS.Methods Physical examination,color ultrasound,CT or MR were performed before operation to determine the scope of the nodules of SPS.During the operation,the nodules of SPS were completely removed in the lateral side of midline.GMMF was formed along the full length of the incision on the side with less incision,and the gluteal fold was elevated by advancing the transplantation across the back midline to the side with more incision.After operation,a comprehensive measure based on"external pressure and internal suction"was taken to make the flap close to the base and surrounding edge of the recipient area,so as to prevent poor wound healing.Results From June 2015 to June 2023,a total of 14 SPS patients were treated according to the above method,and 2 cases had a small range of mild bruising at the middle edge of the flap.The tension was re-duced by relaxing the skin suture for 3d,and then tightened after improvement.The others healed well.Observation after suture removal showed that 14 cases had different degrees of elevation of the gluteal fold,especially in the middle of the incision.In 3 cases,the elevation of the distal gluteal fold was not ob-vious,and the height difference between the two became larger,making the latter appear more depressed.However,after 2 months,the elevated gluteal fold gradually decreased,especially in the middle of the in-cision,and the gluteal fold depression at the distal end of the incision was relatively reduced.The median follow-up time was 27 months(6 to 72 months),and there was no recurrence and no scar outside the glu-teal fold.Conclusion The gluteal fold elevation with unilateral GMMF transplanting across midline in the treatment of SPS does not increase the difficulty of operation,and has a good and stable effect on SPS,significantly reducing the incidence of poor incision healing,without scar outside the gluteal fold,with good appearance,and has good reference significance,although the elevation of the distal gluteal fold was not obvious in a small number of cases.
Pilonidal sinusSacrococcygealGluteal maximus myocutaneous flapVacuum sealing drainageElastic bandaging
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