COMPARISON OF WOUND INFECTION AFTER PILONIDAL SINUS EXCISION WITH PRIMARY REPAIR VERSUS FLAP COVERAGE: A RANDOMIZED CONTROLLED TRIAL

Background: Pilonidal sinus disease (PSD) is a chronic inflammatory condition affecting the sacrococcygeal region, often seen in young adults. Its management poses a surgical dilemma due to varied treatment options and recurrence risks. Primary midline closure is widely practiced due to procedural simplicity, but it is frequently associated with higher complication rates. Flap techniques offer an alternative with potential benefits in wound healing and infection control. This study compares the clinical efficacy and recovery outcomes of Primary Repair and Flap Coverage techniques in PSD excision. Objective: To evaluate and compare the postoperative outcomes, wound healing patterns, and infection severity between Primary Repair and Flap Repair techniques in pilonidal sinus surgery. Methods: A randomized controlled trial was conducted involving 70 patients diagnosed with PSD, divided equally into Primary Repair (n=35) and Flap Repair (n=35) groups. Patient demographics including age, sex, BMI, smoking status, and previous abscess history were recorded. Postoperative parameters—hospital stay, wound healing duration, and wound condition—were assessed using the Surgical Wound Assessment and Analysis (SWAA) scale. Data were analyzed using SPSS version 25. Statistical significance was set at p<0.05. Results: The Primary Repair group had a shorter mean hospital stay (3.31 ± 1.06 days) compared to the Flap Repair group (3.74 ± 1.55 days). Mean wound healing duration was also faster in the Primary Repair group (23.66 ± 20.88 days) versus Flap Repair (30.26 ± 14.33 days). However, the SWAA score indicated more favorable wound outcomes in the Flap group (0.74 ± 1.25) compared to Primary Repair (1.14 ± 1.57; p = 0.03). Smoking prevalence was higher in the Primary Repair group (20.0% vs. 11.4%). Conclusion: Primary Repair provides a faster recovery with shorter hospitalization, while Flap Repair results in superior wound healing quality. Personalized surgical planning based on patient risk profiles is essential to optimize treatment outcomes for pilonidal sinus disease.