背景:鼻窦疾病是一种常见且使人衰弱的疾病。手术治疗仍然是控制慢性病的主要手段,选项包括中线和非中线伤口闭合方法。然而,最优方法仍然不确定。无张力中线技术的最新发展需要进一步探索。
目的:为了评估中线和非中线伤口闭合方法对藏毛窦的影响,并确定最佳的中线襟翼程序。
方法:2022年6月,我们搜索了Cochrane伤口专业注册,中部,MEDLINE,Embase,CINAHL加EBSCO,和临床试验登记处。我们还扫描了纳入研究的参考清单,以及评论,荟萃分析,和健康技术报告。我们没有使用任何语言,出版日期,或学习设置限制。
方法:我们纳入了平行的RCT,参与者在没有皮瓣技术的情况下进行中线闭合,以及在毛发窦治疗中进行中线闭合。我们排除了准实验研究和对出现脓肿的参与者进行研究。
方法:我们遵循标准Cochrane方法。关键结果包括伤口愈合(伤口愈合时间,伤口愈合的比例),复发率,伤口感染,伤口裂开,回到工作的时间,和生活质量。我们使用Cochrane偏差风险2工具评估了这些结果中的偏差,并通过GRADE方法评估了证据的确定性。
结果:我们纳入了33项研究,其中3667名参与者被分析。纳入研究的参与者的中位年龄或平均年龄为21.0至34.2岁,以男性代表为主。地理上,试验主要在中东进行.我们确定了9个干预比较。在这个抽象中,我们关注并介绍了三个主要比较的总结结果。非中线闭合与常规中线闭合相比,非中线闭合可能会缩短伤口愈合时间(平均差异(MD)-5.23天,95%置信区间(CI)-7.55至-2.92天;3项研究,300名参与者;中等确定性证据)。然而,两种方法在伤口愈合的比例上可能几乎没有差异(100%对88.5%,风险比(RR)1.13,95%CI0.92至1.39;2项研究,207名参与者;非常低的确定性证据)。离线中线闭合可能导致较低的复发率(1.5%对6.8%,RR0.22,95%CI0.11至0.45;13项研究,1492名参与者;中度确定性证据)和伤口感染(3.8%对11.7%,RR0.32,95%CI0.22至0.49;13项研究,1568名参与者;中等确定性证据),并可能降低伤口裂开率(3.9%对8.9%,RR0.44,95%CI0.27至0.71;11项研究,1389名参与者;低确定性证据)。此外,离线中线关闭可能会导致恢复工作的时间减少(MD-3.72天,95%CI-6.11至-1.33天;6项研究,参与者820;低确定性证据)。没有关于生活质量的数据。非中线闭合与无张力中线闭合非中线闭合可缩短伤口愈合时间(非中线闭合的中位数为14天,无张力中线闭合的中位数为51天;1项研究,116名参与者;低确定性证据),并在三个月时增加伤口愈合率(94.7%对76.4%,RR1.24,95%CI1.06至1.46;1项研究,115名参与者;低确定性证据),但可能导致复发率几乎没有差异(5.4%对7.8%,RR0.69,95%CI0.30至1.61;6项研究,551名参与者;非常低的确定性证据),伤口感染(2.8%对6.4%,RR0.44,95%CI0.16至1.17;6项研究,559名参与者;非常低的确定性证据),和伤口裂开(2.5%对3.0%,RR0.82,95%CI0.17至3.84;3项研究,250名参与者;非常低的确定性证据)与无张力中线闭合相比。此外,与无张力中线关闭相比,中线关闭可能会导致更长的恢复工作时间(MD3.00天,95%CI1.52至4.48天;1项研究,60名参与者;低确定性证据)。没有关于生活质量的数据。与Limberg皮瓣相比,Karydakis皮瓣与Limberg皮瓣可能在伤口愈合时间上几乎没有差异(MD0.36天,95%CI-1.49至2.22;6项研究,526名参与者;中度确定性证据)。与Limberg皮瓣相比,Karydakis皮瓣可能导致伤口愈合的比例几乎没有差异(80.0%对66.7%,RR1.20,95%CI0.77至1.86;1项研究,30名参与者;低确定性证据),复发率(5.1%对4.5%,RR1.14,95%CI0.61至2.14;9项研究,890名参与者;低确定性证据),伤口感染(7.9%对5.1%,RR1.55,95%CI0.90至2.68;8项研究,869名参与者;低确定性证据),伤口裂开(7.4%对6.2%,RR1.20,95%CI0.41至3.50;7项研究,776名参与者;低确定性证据),和重返工作岗位的时间(MD-0.23天,95%CI-5.53至5.08天;6项研究,541名参与者;低确定性证据)。没有关于生活质量的数据。
结论:本Cochrane综述检查了藏毛窦的中线和非中线伤口闭合选择,主要基于年轻成人的研究。非中线皮瓣手术表明,与传统的中线闭合术相比,藏毛窦可能有好处。与各种离线中线皮瓣技术。当将非中线翻盖闭合与无张力中线闭合进行比较时,低确定性的证据表明,伤口愈合可能会改善,恢复工作的时间可能会增加,而非常低的确定性证据表明,可能没有证据表明其他结局存在差异.在评估的非中线技术中可能没有发现优势的证据。两种手术的选择都可能基于临床医生的偏好,经验,患者特征,和病人的喜好。为了更准确地确定这些封闭技术的好处和潜在危害,进一步的大规模和精心设计的试验是必不可少的。具体来说,迫切需要更多针对儿科人群的研究,除了成人研究。
Pilonidal sinus disease is a common and debilitating condition. Surgical treatment remains the mainstay for managing chronic disease, with options including midline and off-midline wound closure methods. However, the optimal approach remains uncertain. Recent developments in tension-free midline techniques require further exploration.
To assess the effects of midline and off-midline wound closure methods for pilonidal sinus, and to determine the optimal off-midline flap procedures.
In June 2022, we searched the Cochrane Wounds Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL Plus EBSCO, and clinical trials registries. We also scanned the reference lists of included studies, as well as reviews, meta-analyses, and health technology reports. We applied no language, publication date, or study setting restrictions.
We included parallel RCTs involving participants undergoing midline closure without flap techniques and off-midline closure for pilonidal sinus treatment. We excluded quasi-experimental studies and studies that enroled participants presenting with an abscess.
We followed standard Cochrane methodology. The critical outcomes included wound healing (time to wound healing, proportion of wounds healed), recurrence rate, wound infection, wound dehiscence, time to return to work, and quality of life. We assessed biases in these outcomes utilising the Cochrane risk of bias 2 tool and appraised evidence certainty via the GRADE approach.
We included 33 studies with 3667 analysed participants. The median or average age of the participants across the included studies ranged from 21.0 to 34.2 years, with a predominant male representation. Geographically, the trials were primarily conducted in the Middle East. We identified nine intervention comparisons. In this abstract, we focus on and present the summarised findings for the three primary comparisons. Off-midline closure versus conventional midline closure Off-midline closure probably reduces the time to wound healing (mean difference (MD) -5.23 days, 95% confidence interval (CI) -7.55 to -2.92 days; 3 studies, 300 participants; moderate-certainty evidence). However, there may be little to no difference between the two methods in the proportion of wounds healed (100% versus 88.5%, risk ratio (RR) 1.13, 95% CI 0.92 to 1.39; 2 studies, 207 participants; very low-certainty evidence). Off-midline closure probably results in lower rates of recurrence (1.5% versus 6.8%, RR 0.22, 95% CI 0.11 to 0.45; 13 studies, 1492 participants; moderate-certainty evidence) and wound infection (3.8% versus 11.7%, RR 0.32, 95% CI 0.22 to 0.49; 13 studies, 1568 participants; moderate-certainty evidence), and may lower rates of wound dehiscence (3.9% versus 8.9%, RR 0.44, 95% CI 0.27 to 0.71; 11 studies, 1389 participants; low-certainty evidence). Furthermore, off-midline closure may result in a reduced time to return to work (MD -3.72 days, 95% CI -6.11 to -1.33 days; 6 studies, 820 participants; low-certainty evidence). There were no data available for quality of life. Off-midline closure versus tension-free midline closure Off-midline closure may reduce the time to wound healing (median 14 days in off-midline closure versus 51 days in tension-free midline closure; 1 study, 116 participants; low-certainty evidence) and increase wound healing rates at three months (94.7% versus 76.4%, RR 1.24, 95% CI 1.06 to 1.46; 1 study, 115 participants; low-certainty evidence), but may result in little to no difference in rates of recurrence (5.4% versus 7.8%, RR 0.69, 95% CI 0.30 to 1.61; 6 studies, 551 participants; very low-certainty evidence), wound infection (2.8% versus 6.4%, RR 0.44, 95% CI 0.16 to 1.17; 6 studies, 559 participants; very low-certainty evidence), and wound dehiscence (2.5% versus 3.0%, RR 0.82, 95% CI 0.17 to 3.84; 3 studies, 250 participants; very low-certainty evidence) compared to tension-free midline closure. Furthermore, off-midline closure may result in longer time to return to work compared to tension-free midline closure (MD 3.00 days, 95% CI 1.52 to 4.48 days; 1 study, 60 participants; low-certainty evidence). There were no data available for quality of life. Karydakis flap versus Limberg flap Karydakis flap probably results in little to no difference in time to wound healing compared to Limberg flap (MD 0.36 days, 95% CI -1.49 to 2.22; 6 studies, 526 participants; moderate-certainty evidence). Compared to Limberg flap, Karydakis flap may result in little to no difference in the proportion of wounds healed (80.0% versus 66.7%, RR 1.20, 95% CI 0.77 to 1.86; 1 study, 30 participants; low-certainty evidence), recurrence rate (5.1% versus 4.5%, RR 1.14, 95% CI 0.61 to 2.14; 9 studies, 890 participants; low-certainty evidence), wound infection (7.9% versus 5.1%, RR 1.55, 95% CI 0.90 to 2.68; 8 studies, 869 participants; low-certainty evidence), wound dehiscence (7.4% versus 6.2%, RR 1.20, 95% CI 0.41 to 3.50; 7 studies, 776 participants; low-certainty evidence), and time to return to work (MD -0.23 days, 95% CI -5.53 to 5.08 days; 6 studies, 541 participants; low-certainty evidence). There were no data available for quality of life.
This Cochrane review examines the midline and off-midline wound closure options for pilonidal sinus, predominantly based on young adult studies. Off-midline flap procedures demonstrate there may be benefits over conventional midline closure for pilonidal sinus, with various off-midline flap techniques. When off-midline flap closures were compared to tension-free midline closure, low-certainty evidence indicated there may be improved wound healing and increased time to return to work for off-midline closure, whilst very low-certainty evidence indicated there may be no evidence of a difference in other outcomes. There may be no evidence of an advantage found amongst the off-midline techniques evaluated. The choice of either procedure is likely to be based on a clinician\'s preference, experience, patient characteristics, and the patients\' preferences. To more accurately determine the benefits and potential harms of these closure techniques, further large-scale and meticulously-designed trials are essential. Specifically, there is a pressing need for more studies addressing the paediatric population, in addition to adult studies.