PHYSIOPATHOLOGY AND BIOMECHANISM OF WOUND HEALING AFFECTING PILONIDAL SINUS TREATMENT, PART ONE – FRISCH GEWAGT IST HALB GEWONNEN (WELL BEGUN IS HALF DONE)
*Om P. Sudrania, MBBS, MS, FRCS, FICS
ABSTRACT
Background: Study of pathophysiological biomechanisms and biomechanics relating to sacral pilonidal sinus disease (SPSD) to improve its healing. Online search for research papers regarding SPSD, surgical anatomy, etiophysiopathology, wound healing (WH) and articles retrieved from reference lists and studied under these subheads – (a) Importance of physiopathology of WH mechanism in SPSD therapy. (b) Clinical relevance of WH mechanism by scar vis-à-vis regeneration. (c) Role of skin microbiota determining WH and infection (d) Applied surgical anatomy and layered concept of histopathology of SPSD. Chronic SPSD is two layered structure formed by deeper connective tissue layer paved superficially with endo/epithelial or granulation tissue besides detritus in lumen. Deeper connective tissue forms bedrock of final healing needing preservation. Acute SPSD has detritus with inflamed hyperemic wall of cavity. (e) Applied microstructure of fibrous connective tissue and scar. Discussion and Conclusion: SPSD is empirically treated variously, yet complications or recurrences are persisting, needing to address WH pathophysiological biomechanisms and biomechanics so that an optimum treatment can be formalised.
Keywords: Sacral pilonidal sinus, wound healing mechanism, pathophysiology, surgical anatomy, histology.
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