RU2849240C1 - Method for opening an abscess of a pilonidal cyst using a skin punch biopsy instrument - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: two round holes are made in the protruding areas of the abscess using a punch biopsy device. The pus is evacuated, and the cavity is cleaned using a clamp and napkins moistened with an antiseptic solution. Next, the cavity is tamponaded by passing a napkin through it. The napkin is removed the day after the operation. The cavity is washed with an antiseptic solution using a syringe through the holes, and a dry sterile bandage is applied.

EFFECT: this method improves access for curettage of the cavity and reduces the duration of the surgical operation, facilitates wound care in the postoperative period, and avoids the need for drains in the wound.

1 cl, 4 dwg, 2 ex

Description

The invention relates to medicine, namely to proctology, and can be used to treat an abscess of the epithelial coccygeal passage (hereinafter referred to as ECP).

A method for surgical treatment of a suppurating epithelial coccygeal tract at the abscess stage is known, which consists of opening the abscess with a cutting instrument, evacuating the purulent exudate, excising the tract and primary openings, treating the purulent cavity, installing a drain into the wound cavity, fixed to the skin with ligatures, treating the cavity with an antiseptic solution, daily rinsing of the wound until the exudation stops, applying an antiseptic dressing, and removing the drains (RU 2319455, published 20.03.2008).

The disadvantages of this method are insufficient drainage of the cavity, complex wound care and a high recurrence rate.

A single-stage surgical treatment method for epithelial coccygeal tract infection, with or without suppuration, is also known, as is the surgical treatment of purulent inflammation of a pilonidal cyst. This method can be open or closed (RU 2595503, published August 27, 2016). With the open method, after opening the coccygeal abscess, excision of the epithelial coccygeal tract is performed. The surgical wound is not sutured, but packed, and dressings are applied in the postoperative period.

The disadvantages of this method are difficulties in caring for the postoperative wound, secondary infection of the postoperative wound, long healing times, scar formation, and a high risk of disease recurrence.

A one-stage closed surgical treatment for epithelial pilonidal sinusitis, with or without suppuration, involves excision of the epithelial pilonidal sinus and the purulent focus, placement of a tubular drain in the cavity floor, and its externalization through the superior and inferior angles of the surgical wound. The wound is then sutured. Irrigation is performed through the drainage system during the postoperative period. (RU 259553, published August 27, 2016).

The disadvantages of this method are the need to install drains, suture failure, and suppuration of the postoperative wound after drainage removal.

For acute suppuration of the abscess, a two-stage treatment method is also used. The first stage involves incising the abscess and debridement of the cavity and surrounding tissues for 4-6 days. Then, after the acute inflammation has subsided, the second stage involves excision of the abscess and suturing the wound using various methods.

The disadvantages are long healing times and a high risk of relapse.

The closest prototype to the claimed technical solution in terms of its technical essence and achievable technical result is excision of a pilonidal cyst without an abscess using punch biopsy—a modified version of the Bascom "pit-picking" and Gips procedures. Under local anesthesia in the prone position, a punch biopsy instrument is used (possibly under the guidance of a surgical probe) to extract the cyst along the ECS. A small scalpel, small scissors, Kocher forceps, a Volkmann spoon, and a disposable dermal curette are then used to thoroughly remove all residual tissue and cyst walls. Then, copious irrigation with saline is performed, small central wounds are sutured with loosely placed sutures, and lateral wounds are left open for drainage. A compression bandage is applied, and patients are advised to lie supine in bed, applying pressure to the bandage for the first 24 hours. After its removal, a patch is applied, and patients are advised to continue changing these patches twice a day at home for the first 2 weeks, after showering with running water, rinsing the open wounds for at least 5 minutes each time. [Basso, L., Pietroletti, R., Micarelli, A., Bicaj, A., Costi, U., Crocetti, D., D'Ermo, G., & Gallo, G. The impact of experience on recurrence rates after biopsy punch excision for pilonidal disease // Colorectal disease. 2022. No. 24(8), (984-991)].

The disadvantages of the prototype are that the incision is made along the course of the coccygeal cyst, which is inappropriate when treating an abscess, since its localization and spread do not always correspond to the course of the coccygeal cyst.

The objective of the invention is to develop a method for surgical treatment of pilonidal cyst abscess, which allows for more effective drainage of wound discharge, providing convenient access for wound curettage, facilitating the process of postoperative wound care, and reducing the healing time of the postoperative wound.

This problem is solved by the fact that in the method of opening the pilonidal cyst abscess using a punch biopsy instrument for the skin, two round holes are made in the protruding areas of the abscess with a punch biopsy device, the pus is evacuated, the cavity is cleaned with a clamp and napkins soaked in an antiseptic solution, then the cavity is tamponed by passing the napkin through and through, the next day after the operation the napkin is removed, the cavity is washed with a syringe through the holes with an antiseptic solution, and a dry sterile dressing is applied.

The technical result is improved access for cavity curettage, reduced surgical duration, and easier postoperative wound care. This method also eliminates the need for wound drainage.

The invention is explained with drawings and photographs.

Fig. 1 shows a diagram of how to make holes, where 1 is skin, 2 is hole, 3 is projection of hole into abscess cavity, 4 is abscess cavity, 5 is subcutaneous fat.

Fig. 2 shows the creation of holes with a punch biopsy instrument, where 6 is the DERMO PUNCH skin punch biopsy instrument, 4 is the ECC abscess.

Fig. 3 shows the obtained holes, where 2 are holes obtained using the DERMO PUNCH skin punch biopsy instrument.

Fig. 4 shows the postoperative wound one week after the operation, where 2 are postoperative wounds at the site of the holes obtained with the DERMO PUNCH punch biopsy instrument.

Incision of the abscess at its most prominent points serves specific purposes. One of these is to ensure maximum drainage of the purulent contents. Furthermore, it minimizes the risk of infection spread by creating a direct path for drainage.

The DERMO PUNCH is a medical instrument consisting of a cylindrical knife with a sharp cutting edge at one end. It is designed to create round holes or take skin biopsies using a rotating motion. This instrument is available in several sizes, allowing for the creation of holes of the required diameter and depth. The advantage of a DERMO PUNCH incision is its precision and accuracy due to the even distribution of pressure and minimal tissue trauma. This allows for the creation of holes with smooth edges and a predictable size. Therefore, such wounds have a lower risk of uneven scarring and lacerations, faster healing, a lower risk of infection, less bleeding time and pain in the postoperative period, and a more satisfactory aesthetic outcome.

Drainage is not required, as the open round opening helps maintain adequate drainage from the wound during the postoperative period. Furthermore, these openings allow for rinsing the cavity with antiseptic solutions using a syringe starting the day after surgery.

The treatment method is carried out as follows:

1) The opening of the ECC abscess is performed with two round holes using a punch biopsy device (Fig. 1, 2).

2) Evacuate pus and other contents of the wound, clean the cavity using a clamp and napkins soaked in an antiseptic solution, and rinse with a 3% hydrogen peroxide solution (Fig. 3).

3) Next, the cavity is tamponed by passing the napkin through it.

4) The next day after the operation, the napkin is removed, the cavity is washed with a syringe through the holes with antiseptic solutions, followed by the application of a dry sterile bandage.

One week after surgery, a new epithelial layer forms at the site of the holes created by the DERMO PUNCH biopsy instrument, closing the wound (Fig. 4). A satisfactory aesthetic result is observed.

The surgery is performed with the patient lying prone under local anesthesia. The surgical site is prepared in the intergluteal fold. Circular holes are made using a punch biopsy instrument. The next step is the evacuation of pus and other contents of the cavity (usually hair). The size of the holes allows for complete curettage of the cavity. The wound cavity is cleaned with an antiseptic solution using a clamp and napkins and irrigated with a 3% hydrogen peroxide solution. The cavity is tamponaded by passing a napkin through it. The following day, the napkin is removed, and the cavities are irrigated with antiseptic solutions using a syringe through the existing holes. The wounds are gaping; the placement of rubber drains is not required. A dry sterile dressing is applied. Postoperatively, the patient is able to independently care for the wound, irrigating it with antiseptic solutions using a syringe.

Example 1. Patient U., 24 years old. Admitted to the proctology department with a diagnosis of L05.0 – pilonidal cyst with abscess.

The patient's condition is satisfactory. Respiratory rate is 18 beats per minute. Pulse is 70 beats per minute. Blood pressure is 120/80 mmHg. The tongue is moist. The abdomen is painless on palpation in all sections. Symptoms of peritoneal irritation are negative.

Local status: in the intergluteal fold of the sacrococcygeal region there is a dense infiltrate measuring 5.0 × 2.0 cm, painful on palpation, with hyperemia of the skin above it, with softening and fluctuation, with pinpoint fistula openings without pathological discharge.

The abscess was incised and drained using the proposed method. At the end of the surgery, the cavity was packed with a through-and-through drape. The following day, the drape was removed, and the cavity was irrigated freely with antiseptic solutions using a syringe through the openings. The wounds were gaping, and rubber drains were not required. The aseptic dressing was changed daily, and the cavity was irrigated through and through with antiseptic solutions using a syringe (3% hydrogen peroxide solution and 0.05% aqueous chlorhexidine solution). The patient was discharged on the fourth day for outpatient treatment with recommendations. During the follow-up interview four weeks after discharge, the patient reported no difficulty irrigating the wound at home. Local status: two rounded postoperative scars were present in the intergluteal fold at the level of the coccygeal bones at the site of previously made circular incisions. No early or late postoperative complications were observed.

Example 2. Patient M., 67 years old. Admitted to the proctology department with a diagnosis of L05.0 – pilonidal cyst with abscess.

The patient's condition is satisfactory. Respiratory rate is 17 beats per minute. Pulse is 83 beats per minute. Blood pressure is 140/90 mmHg. The tongue is moist. The abdomen is painless on palpation in all areas. Symptoms of peritoneal irritation are negative.

Local status: in the intergluteal fold of the sacrococcygeal region, an infiltrate with local hyperemia, hyperthermia, fluctuation in the center, measuring 2.0 × 2.0 cm, painful on palpation, is determined.

The abscess was incised and drained using the proposed method. At the end of the surgery, the cavity was packed with a through-and-through drape. The following day, the drape was removed, and the cavity was irrigated freely with antiseptic solutions using a syringe through the openings. The wounds were gaping, and rubber drains were not required. The aseptic dressing was changed daily, and the cavity was irrigated through and through with antiseptic solutions using a syringe (3% hydrogen peroxide solution and 0.05% aqueous chlorhexidine solution). The patient was discharged on the fourth day for outpatient treatment with recommendations. At the six-week follow-up visit, the patient reported no difficulty irrigating the wound at home. Local status: two rounded postoperative scars were present in the intergluteal fold at the level of the coccygeal bones at the site of previously made circular incisions. No early or late postoperative complications were observed.

This method allows for safe opening of the ECS abscess to a specified depth and width, shortening the duration of the surgical operation, performing curettage of the abscess cavity walls, maintaining the outflow of exudate from the wound for a longer period without the use of drains, reducing the healing time and facilitating wound care in the postoperative period, which helps to reduce the duration of inpatient treatment.

Claims (1)

A method for opening a pilonidal cyst abscess with a skin punch biopsy instrument is characterized by making two round holes in the protruding areas of the abscess with a punch biopsy device, evacuating the pus, cleaning the cavity with a clamp and napkins soaked in an antiseptic solution, then tamponing the cavity by passing the napkin through it, the day after the operation the napkin is removed, the cavity is washed with a syringe through the holes with an antiseptic solution, and a dry sterile dressing is applied.