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Background: Excision of the pit of the sinus with phenolisation of the sinus tract and surgical excision are two treatment modalities for patients with sacrococcygeal pilonidal sinus disease. Phenolisation seems to have advantages over local sinus excision as it is performed under local anaesthesia with a relatively small surgical procedure, less postoperative pain, minor risk of surgical site infection (8.7%), and only a few days being unable to perform normal activity (mean of 2.3 days). The disadvantage may be the higher risk of recurrence (13%) and the necessity to perform a second phenolisation in a subgroup of patients. Wide surgical excision of sacrococcygeal pilonidal sinus disease has a recurrence rate of 4 to 11%. The disadvantages, however, are postoperative pain, high risk of surgical site infection, and a longer period being unable to perform normal activity (mean of 10 days). The objective of this study is to show that excision of the pit of the sinus of sacrococcygeal pilonidal sinus disease with phenolisation of the sinus tract is a successful first-time treatment modality for sacrococcygeal pilonidal sinus disease accompanied by a quicker return to normal daily activity compared to local excision of the sinus. Methods/design: Patients with sacrococcygeal pilonidal sinus disease will be randomly allocated to excision of the pit of the sinus followed by phenol applications of the sinus tract or radical surgical excision of the sinus. Patients are recruited from a single Dutch teaching, non-university hospital. The primary endpoint is loss of days of normal activity/working days. Secondary endpoints are anatomic recurrence rate, symptomatic recurrence rate, quality of life, surgical site infection, time to wound closure, symptoms related to treatment, pain, usage of pain medication and total treatment time. To demonstrate a reduction of return to normal activity from 7.5 days in the excision group to 4 days in the phenolisation group, with 80% power at 5% alpha, a total sample size of 100 is required. Discussion: This study is a randomised controlled trial to provide evidence that phenolisation of the sinus tract compared to radical excision reduces the total number of days unable to perform normal activity. [ABSTRACT FROM AUTHOR]

Abstract: Twenty-eight subjects complaining of nail disorders were randomly selected over a period of three months. Each subject underwent either partial or a total nail avulsion with phenolisation under local anaesthesia. Subjects underwent weekly follow-up appointments to debride any eschar or callosity from the wound site. Following debridement post-operative healing was assessed. Post-operative healing was recorded as the period when there was no further discharge evident and there was normal healthy epidermis at the site of the wound. Saliva samples were collected from each subject. Salivary cortisol concentration was determined by radioimmunoassay of the samples. Three samples were collected for each subject, the first at the initial assessment, the second immediately prior to the administration of the local anaesthesia and the third 20min after the second sample. Salivary cortisol concentration was compared with post-operative healing times. It was found that as the mean salivary cortisol concentration increased, there was an associated increase in the post-operative healing times following the nail surgery, r =0.84. Cortisol in excess has been found to suppress immunological and anti-inflammatory responses. Increases in salivary cortisol concentrations may indicate a greater inflammatory response. It is likely that this response suppresses the post-operative healing times following nail surgery. [Copyright &y& Elsevier]

An ingrown toenail is an inflammatory process occurring as a result of ingrowing medial or lateral edge of the nail into the nail bed. There are various causes of this ailment. The most common are: wearing poorly fit footwear causing pressure on the nail bed from the outside, improper trimming of toenails, hereditary susceptibility, trauma, hidrosis, presence of a background systemic disease (e.g. obesity, diabetes), onychomycosis and some medicines (applied in psoriasis and protease inhibitors).The treatment depends on the progression of the ailment (preservative or surgical methods).The clinical analysis involved 156 patients suffering from an ingrown toenail and treated from the year 2000 until September 2005 in The Clinic of Thoracic Surgery, General Surgery and Oncology of Clinical University Hospital No. 2.The group included 115 males (74% of patients) and 41 females (26% of patients). The age of patients differed from 25 to 68 years (on average 43 years). We performed 174 operations of marginal resection of the nail and phenolisation of the matrix among 156 patients. 7 patients underwent the procedure on both sides and 4 patients in two toenails.The healing time of the postoperative wounds was 14-18 days. The recurrence of the ailment was found in 4 patients (2.5% of patients). There were no complications such as excessive bleeding or postoperative infection in the study group. The marginal resection of the nail connected with phenolisation of the matrix is a good method of treatment of an ingrown toenail as it causes few recurrences and complications.

Purpose Phenolisation is a minimally invasive treatment option in patients with primary pilonidal disease. However, most studies focus on patients with primary pilonidal sinus disease, while data of patients with recurrent pilonidal disease are very scarce. The purpose of this study was to evaluate phenolisation of the sinus tract in patients with recurrent pilonidal sinus disease after previous surgery for SPSD. Methods This single-center prospective cohort study included 60 patients with recurrent pilonidal disease. Loss of days of normal daily activities, surgical site infection, wound epithelization, quality of life, and complaints related to pilonidal disease were postoperatively assessed. Results A total of 57 patients (95%) were treated with phenolisation and the median loss of days of normal daily activities was 5.0 (1.0 - 12.0) days. Fifty-one patients (89.5%) resumed normal daily activities after two weeks. Surgical site infection occurred in five patients (8.8%). Compared to preoperative scores, quality of life was significantly higher 12 weeks postoperatively (p=0.014) and pain and itch scores were lower after six and 12 weeks (p ≤ 0.005). Wounds were completely healed in 45 of 51 patients (89.8%) who were available after 12 weeks of follow-up. Conclusion Phenolisation for recurrent pilonidal disease is safe with a median complete return to daily activities within five days and complete wound healing after three months in 90%. Therefore, phenolisation should be considered as a treatment option in patients with recurrent pilonidal sinus disease., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Pronk et al.)