Influence of failure of primary wound healing on subsequent recurrence of pilonidal sinus. Combined prospective study and randomised controlled trial

To find out whether failure of primary wound healing after excision and primary suture for chronic pilonidal sinus predicts recurrence.Follow-up of one prospective study and one subsequent randomised, multicentre study.Three teaching hospitals in WesternNorway.A total of 197 consecutive patients operated on for chronic pilonidal sinus.Fifty two patients in the prospective group were given cloxacillin perioperatively. In the randomised study, 145 patients were randomised to have either a single preoperative dose of cefoxitin 2 g intravenously (n = 73) or no prophylaxis (n = 72). Patients were followed up for a median of 7 years.Recurrence of pilonidal sinus.In the prospective group there were 10 recurrences (19%). In the randomised study 6 patients (8%) who had been given antibiotic prophylaxis had a recurrence compared with 14 patients (19%) who had not been given prophylaxis (p = 0.09). In both groups, failure of primary normal healing was significantly associated with early recurrence (p = 0.0002). Neither the use of antibiotics nor sex had any significant influence on the incidence of recurrences. Most recurrences occurred within the first year.Wound complications significantly influenced the recurrence rate whereas antibiotics did not. Most recurrences were seen early.