Effect of Platelet Rich Plasma on Healing of Operated Pilonidal Sinus by Open Method
Condition: Pilonidal Disease of Natal Cleft
MeSH terms: Pilonidal Sinus
Study type: Interventional

Summary: 
      The aim of the study is to assess the healing promotion effect of platelet rich plasma in
      patient being operated for sacrococcygeal pilonidal sinus disease by open excision
    

Detailed description: 
      Sacrococcygeal Pilonidal disease is an infection of the skin and subcutaneous tissue at or
      near the upper part of the natal cleft of the buttocks. Pilonidal cavities are not true cysts
      and lack a fully epithelialized lining; however, the sinus tracts may be epithelialized.

      Pilonidal sinus disease (PNS) has an incidence of approximately 26 per 100,000 population
      with a male predominance of 2:1 and the mean age of those affected is from 19 to 30 years of
      age. It occurs rarely after the age of 45 and children.

      Pilonidal sinus disease is characterized by natal cleft suppuration due to hair follicle
      infection. The disease results from chronic infection of hair follicles and subsequent
      formation of a subcutaneous abscess because of persistent folliculitis. Hair then enters the
      abscess cavity and provokes a foreign body tissue reaction; chronic suppuration and discharge
      through a midline sinus follow.

      Some individuals are asymptomatic with midline pits in the sacrococcygeal area, Symptomatic
      Pilonidal sinus results in chronic discharging wounds that cause pain and impact upon quality
      of life and social function. These sinuses may become infected and present as acute
      abscesses. Management of these abscesses is uncontroversial and revolves around incision and
      drainage, however, the mode of surgical management of the chronic discharging sinus is
      variable, contentious, and problematic.

      The Principles of Surgical strategies require eradication of the sinus tract, complete
      healing of the overlying skin, and prevention of recurrence. Many methods are available for
      surgical management of PNS which is treated by wide excision. After excision, the wound may
      be left open to heal with granulation tissue, or may be immediate closed with a midline
      closure or by using a flap (Z-plasty, karydakis, Bascom or Rhomboid flaps). However, there is
      not yet a consensus on the optimal treatment.

      Excision and healing by granulation is still preferred due to the low recurrence rate of
      (3.4%) compering with other methods (20.6%) for midline closure and (10.3%) for off-midline
      closure but the healing time is lengthy and requires a prolonged time of daily dressing with
      a risk of infection and delayed wound healing. Therefore, the search for a treatment with
      minimal pain, accelerated healing time and a short span of time for returning to the normal
      daily activities is vastly pursued.

      A recent method to promote the wound-healing process is the local administration of an
      autologous platelet concentrate suspended in plasma named as platelet rich plasma (PRP) which
      contains growth factors. Concentrated growth factors have been reported to accelerate wound
      healing by 30-40% giving a satisfactory outcome in the treatment of chronic skin and soft
      tissue lesions, maxillofacial and plastic surgeries by presenting these high amounts of
      growth factors and chemokines.

      When platelets become activated, Seven fundamental protein growth factors that are actively
      secreted by platelet initiate all wound healing process, including platelet derived growth
      factor (PDGF), epidermal growth factor (EGF), transforming growth factor (TGF), vascular
      endothelial growth factor (VEGF), Fibroblast growth factor (FGF), connective tissue growth
      factor (CTGF) & insulin like growth factor (ILGF 1) all participate in the acceleration of
      wound-healing process.
    

Intervention name(s): Platelet Rich Plasma
Intervention type(s): Biological
Intervention description(s): Autologous PRP obtained via double centrifugation process of the participant's blood sample. PRP was prepared by the double Spain strategy.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment