Ovine Forestomach Matrix Graft Reduces Surgical Dehiscence in Fasciocutaneous Flap-Based Closure of Pilonidal Disease: A Comparative Study

Background Fasciocutaneous flap advancement is a newer alternative surgical approach in pilonidal sinus disease (PSD). This comparative study aimed to assess whether the use of an ovine forestomach matrix (OFM) graft implanted beneath a fasciocutaneous flap closure could minimize dehiscence complications in PSD. Methods PSD patients who received OFM and a fasciocutaneous flap were prospectively enrolled. Findings were compared to retrospective data from control patients who did not receive an OFM graft. Study outcomes were time to heal, incidence of dehiscence, and scar cosmesis. A within-study cost-utility analysis estimated costs and quality-adjusted life-years (QALYs). Results A total of 46 patients who received a flap advancement and OFM graft were compared to 48 retrospective control patients who were treated with flap advancement alone. No difference in median healing time was found in the OFM group (8.0 (IQR: 4.2, 15.8) weeks) compared to the control group (8.0 (IQR: 6.0, 15.2) weeks) (p=0.79). The incidence of dehiscence was significantly less in the OFM group (18%) versus the control group (46%) (p=0.005). The probability of dehiscence in the control group was 3.2 times greater compared to the OFM group. In a cost-utility analysis, the OFM group dominated the control group, with higher QALYs (0.24 vs. 0.23) and lower costs ($4,157 vs. $4,219). Conclusions The use of OFM graft with a fasciocutaneous flap resulted in a significantly lower incidence of dehiscence and potentially higher quality-of-life and cost savings, while maintaining a midline incision with favorable cosmesis.