cefoxitin and Pilonidal-Sinus

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.

Topics: Adult; Antibiotic Prophylaxis; Cefoxitin; Cloxacillin; Female; Follow-Up Studies; Humans; Male; Pilonidal Sinus; Prospective Studies; Recurrence; Surgical Wound Infection; Time Factors; Wound Healing

Two prospective studies were undertaken to examine the role of bacteria in the outcome after excision and primary suture for chronic pilonidal sinus disease. In the first study 52 consecutive patients were given cloxacillin as prophylaxis. In a second randomised study 51 patients were given 2 g cefoxitin intravenously (n = 25) or no prophylaxis (n = 26). From 49 out of 98 patients (50%) no microorganisms were isolated from sinuses preoperatively. Wound complications were observed postoperatively in 61% of the patients (63/103). A postoperative bacteriology sample was positive in 47 of 49 samples (96%). Preoperative presence of bacteria was not significantly associated with wound complications. Anaerobe isolates were present in 40% of patients preoperatively whereas aerobes were cultured in 43% postoperatively. After an observation period of 30-42 months, recurrences were 13% among the patients (7/52) who had been given cloxacillin. No recurrences were seen in the last study after an observation period of 18-30 months, for an overall 7% in both studies. We conclude that preoperative bacterial isolates, usually anaerobes, in chronic pilonidal sinuses do not influence the complication rate since bacterial isolates from infected wounds are mostly aerobes.

Topics: Adolescent; Adult; Antibiotic Prophylaxis; Bacteria; Cefoxitin; Child; Chronic Disease; Cloxacillin; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Pilonidal Sinus; Postoperative Complications; Prospective Studies; Recurrence; Surgical Wound Infection

Treatment of chronic pilonidal sinus with excision and primary suture is followed by a relatively high proportion of wound infections. The role of preoperative antibiotic prophylaxis in improving results is not clear.. One hundred fifty-three patients with chronic pilonidal sinus were operated on with radical excision and primary suture and randomized to receive a single dose antibiotic prophylaxis of 2 g cefoxitin intravenously (n = 78) or no prophylaxis (n = 75).. The most common complications consisted of partial, slight separation of wound edges with slight discharge. In the group with cefoxitin, 34 patients (44 percent) had complications compared with 32 patients (43 percent) in the group without prophylaxis. Fifty-four patients (69 percent) healed within four weeks in the group with cefoxitin, whereas 48 (64 percent) healed within four weeks in the group without prophylaxis. After a follow-up period of six to 30 months, two patients in each group had not healed. Including these, two patients (3 percent) had recurrences in the group with cefoxitin and five patients (7 percent) in the group without prophylaxis (p = 0.41).. The immediate and short-term results after excision and primary suture for chronic pilonidal sinus are not influenced significantly by a single dose prophylaxis of 2 g cefoxitin.

Topics: Adolescent; Adult; Aged; Cefoxitin; Chronic Disease; Combined Modality Therapy; Female; Humans; Male; Middle Aged; Pilonidal Sinus; Premedication; Surgical Wound Infection; Suture Techniques; Treatment Outcome

The possibility of reducing the incidence of postoperative recurrences of pilonidal fistulas by using preoperative doses of Cephoxitine and primary surgical closure is described.

Topics: Cefoxitin; Escherichia coli Infections; Humans; Pilonidal Sinus; Preoperative Care; Staphylococcal Infections; Streptococcal Infections