In situ shaped skin grafting following marsupialization for sacrococcygeal pilonidal disease: a retrospective case series.

Abstract

Background: Optimal surgical management of pilonidal disease remains controversial, with existing techniques requiring trade-offs between recurrence risk and recovery time. We report our experience with unroofing and marsupialization combined with in situ-shaped skin grafting (SSG), focusing on perioperative outcomes, recovery, and recurrence.

Methods: This case series included 53 consecutive patients who underwent SSG. Outcomes analyzed included operative parameters, recovery, recurrence, complications, and patient satisfaction.

Results: The median operative time was 61 minutes (IQR, 45-70). The median hospital stay was 4 days (IQR, 3-6), with a median cost of 11 037.9 CNY (IQR, 10 519.0-11 944.0). Patients resumed pain-free activities after a median of 2 days (IQR, 2-4) and returned to work or school after 14 days (IQR, 10-15). Wound healing time was 22 days (IQR, 20-25). At the final follow-up, recurrence occurred in two patients (3.8%). No postoperative complications were observed. Sensory disturbance was reported in four patients (7.5%), none of whom reported interference with daily activities. Overall patient satisfaction was high, with a median score of 5 (IQR, 4-5).

Conclusions: This single-center series demonstrates that unroofing and marsupialization, combined with in situ SSG, is a feasible surgical approach, offering rapid functional recovery and low recurrence rates without major complications. SSG may represent an intermediate option between prolonged healing by secondary intention and extensive flap reconstruction. Prospective multicenter comparative studies are warranted to establish optimal patient selection criteria and define the long-term role of this technique.