BACKGROUND: For patients with large and deep-seated recurrent complex pilonidal sinuses, the use of traditional open excision or flap reconstruction surgery may lead to high surgical difficulty, significant local damage, numerous complications, slow healing, and a high risk of recurrence. This article reports a case of recurrent complex pilonidal sinus and discusses the advantages of Bascom II combined with VSD treatment involving the preservation of tissue bridges.
METHODS: The patient, a 31-year-old male, presented with recurrent swelling, pain, and purulent discharge from the sacrococcygeal region for over a year. Upon physical examination, extensive lumps and sinus tracts were observed in the lumbosacral tail area, with the lesion extending from L4 to the tip of the coccyx. Under general anesthesia, a segmental resection was performed, and the lumbosacral mass lesion was excised, preserving normal tissue bridges. The mature sinus tract at the upper part of the coccyx was removed, and Bascom II reconstruction surgery was performed. In the late stage at the site of lumbar sacral lesion excision, VSD was applied to promote wound healing.
CONCLUSIONS: The combination of Bascom II with lesion tunnel-like removal can reduce the damage, elevate gluteal cleft, and lower the recurrence rate. Subsequently, with the addition of VSD, it can accelerate the elimination of necrotic tissue, reduce infection risk, and expedite wound healing.
CONCLUSIONS: This case explores the advantages and characteristics of combining various techniques in the treatment of recurrent complex pilonidal sinuses, emphasizes the utility of VSD as an adjunctive therapy for large lesions.

The problem of the treatment of pilonidal disease, affecting 5% of the adult working-age population and occupying the fourth place in the structure of coloproctological diseases after hemorrhoids, paraproctitis and anal fissure, is extremely relevant today. The history of the choice of approaches to surgical treatment has almost 2 centuries. Based on different theories of etiopathogenesis, various methods of surgical treatment have been proposed. However, the results of treatment leave much to be desired. To date, there is no \'gold standard\' of surgical treatment of pilonidal disease, nor any standardization in this matter. The aim of the investigation is to compare the two, in our opinion, the most versatile methods of surgical treatment of the nosology under consideration, which allow to achieve a good cosmetic result in cases of any complexity without long-term disability - Limberg flap and Bascom II plastics. Indicators such as the duration of the intervention, the level of postoperative pain, postoperative complications, the duration of disability, patient satisfaction with the cosmetic result, relapses were evaluated. As a result, patients after performing Bascom II noted less postoperative pain and were more satisfied with the cosmetic result. A significantly lower percentage of relapses was noted in the group with Limberg flap. The percentage of complications and terms of disability was not significantly different.
Проблема лечения пилонидальной болезни, поражающей 5% взрослого трудоспособного населения и занимающей четвертое место в структуре колопроктологических заболеваний после геморроя, парапроктита и анальной трещины, чрезвычайно актуальна в наши дни. История выбора подходов к оперативному лечению насчитывает почти два века. Исходя из разных теорий этиопатогенеза были предложены различные методы хирургического лечения. Однако результаты лечения оставляют желать лучшего. В настоящее время не приходится говорить ни о \'золотом стандарте\' хирургического лечения пилонидальной болезни, ни о какой-то стандартизации в этом вопросе. Цель работы состоит в сравнении двух, на наш взгляд, наиболее универсальных методик хирургического лечения рассматриваемой нозологии, позволяющих добиться хорошего косметического результата в случае любой сложности без длительной утраты трудоспособности - это иссечение с пластикой по Limberg и Bascom II. Оценивали такие показатели, как длительность вмешательства, уровень послеоперационной боли, послеоперационные осложнения, длительность нетрудоспособности, удовлетворенность пациента косметическим результатом, рецидивы. В результате пациенты после выполнения операции Bascom II отмечали менее выраженную послеоперационную боль и были более удовлетворены косметическим результатом. Достоверно меньший процент рецидивов был отмечен в группе с пластикой по Лимбергу. Процент осложнений и сроки нетрудоспособности достоверно не различались.