108 Harley Street CPD Snippets - Pilonidal Sinus part 2

108 Harley Street CPD Snippets Pilonidal Sinus - Non-Healing sacro-coccygeal wounds - A 'colorectal headache' Presented by Colorectal surgeon Mr Emin Carapeti You can catch part one of the presentation:    • Pilonidal Sinus Part 1 | Mr Emin Cara...   Non healing wounds Aetiology: Incomplete excision of disease ? Poor technique Wound dehiscence Infection Subcutaneous walling off/cavity Median time to wound healing 40-90 days1 Socioeconomic cost Hospital stay/visits Community resources Return to work Normal daily activities Quality of life Psychological wellbeing Surgery Re-excision Flap reconstruction Tertiary referral / Plastic surgery Dressings Wound clinic / tissue viability nurse Negative pressure wound therapy Topical 10% metronidazole ointment (Ortem, SLA Pharma) Prospective study of 20 consecutive patients (17 male) with persistent wound ≥6 weeks following surgery 52 month study period Ointment applied to wound once daily Standard dressing regiment Patient demographics Follow up at 2, 4, 6, 8 and 10 weeks to assess healing* *Healed wound: complete epithelialisation Results Wounds healed in 18 patients (Healing rate: 90%) Median time to heal: 4 weeks (3–8 weeks) Median follow up period: 13 months (6-17 months) 2 patients had recurrent disease after healing – 1 surgery Baseline Indolent wound 12 months post surgery 2 weeks 50% decrease in defect Less symptoms 4 weeks Healed wound No symptoms 30 Male x4 previous operations recurrent diseaseSurgery elsewhere 8 weeks “Karydakis Flap”Day 8 wound infection and breakdown Mean time to heal 37 days (SD+/-26) Success 89.2% Recurrence 10.2% N=1 skin reaction (2%) 5 year study period 116 patients - 93 male (80%) First consultation £210 Excision £927 Flap £1076 F/U consultation £121 Median sick days 10 Cost/day to economy £770 Average cost per patient £11,439 Actual Costs: Total £1,326,943 Of which recurrent surgery costs £294,046 Predicted saving Cost for 6 weeks treatment is £120 Potential saving of £226,393 Non healing wounds Significant clinical problem Indolent, long standing, difficult to treat / heal Psychological and socioeconomic impact Patients ‘fed up’, not keen on more surgery ORTEM (10% metronidazole) should be tried as first line Rx High success low cost and safe