Connie Harris1, R Gary Sibbald, Asfandyar Mufti, Ranjani Somayaji. 1. Connie Harris, MSc, RN, ET, IIWCC • Consultant • Perfuse Medtec Inc • London, Ontario, Canada • Wound and Ostomy Expert Consultant • Hamilton Niagara Haldimand Brant Community Care Access Centre • Hamilton, Ontario, Canada R. Gary Sibbald, BSc, MD, DSc (Hons), MEd, FRCPC (Med, Derm), FAAD, MAPWCA • Professor • Medicine and Public Health • Director • International Interprofessional Wound Care Course and Masters of Science in Community Health • Dalla Lana School of Public Health • University of Toronto • Toronto, Ontario, Canada • Past President • World Union of Wound Healing Societies • Clinical Editor • Advances in Skin & Wound Care • Philadelphia, Pennsylvania Asfandyar Mufti, BSc • Medical Student • University of Ottawa • Ottawa, Ontario, Canada Ranjani Somayaji, BScPT, MD, MPH, FRCPC • Clinical Lecturer • Division of Infectious Disease, Department of Medicine • University of Calgary • Calgary, Alberta, Canada.
Abstract
PURPOSE: To present a 10-step approach to the assessment and treatment of pilonidal sinus disease (PSD) and related wounds based on the Harris protocol, expert opinion, and a current literature review. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES: After participating in this educational activity, the participant should be better able to: ABSTRACT: Pilonidal sinus disease (PSD) is a common problem in young adults and particularly in males with a deep natal or intergluteal cleft and coarse body hair. An approach to an individual with PSD includes the assessment of pain, activities of daily living, the pilonidal sinus, and natal cleft. Local wound care includes the management of infection (if present), along with appropriate debridement and moisture management. Treatment is optimized with patient empowerment to manage the wound and periwound environment (cleansing, dressing changes, decontamination, hair removal, minimizing friction). Self-care education includes the recognition of recurrences or infection. Early surgical intervention of these wounds is often necessary for successful outcomes. Pilonidal sinus healing by secondary intention often takes weeks to months; however, the use of the Harris protocol may decrease healing times. A number of new surgical approaches may accelerate healing. Surgical closure by primary intention is often associated with higher recurrence rates. Expert opinion in this article is combined with an evidence-based literature review. The authors have tabulated 10 key steps from the Harris protocol, including a review of the surgical techniques to improve PSD patient outcomes.
PURPOSE: To present a 10-step approach to the assessment and treatment of pilonidal sinus disease (PSD) and related wounds based on the Harris protocol, expert opinion, and a current literature review. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES: After participating in this educational activity, the participant should be better able to: ABSTRACT: Pilonidal sinus disease (PSD) is a common problem in young adults and particularly in males with a deep natal or intergluteal cleft and coarse body hair. An approach to an individual with PSD includes the assessment of pain, activities of daily living, the pilonidal sinus, and natal cleft. Local wound care includes the management of infection (if present), along with appropriate debridement and moisture management. Treatment is optimized with patient empowerment to manage the wound and periwound environment (cleansing, dressing changes, decontamination, hair removal, minimizing friction). Self-care education includes the recognition of recurrences or infection. Early surgical intervention of these wounds is often necessary for successful outcomes. Pilonidal sinus healing by secondary intention often takes weeks to months; however, the use of the Harris protocol may decrease healing times. A number of new surgical approaches may accelerate healing. Surgical closure by primary intention is often associated with higher recurrence rates. Expert opinion in this article is combined with an evidence-based literature review. The authors have tabulated 10 key steps from the Harris protocol, including a review of the surgical techniques to improve PSDpatient outcomes.