The association between skin-suturing technique, prolonged healing and recurrence after Bascom's Cleft lift surgery

BACKGROUND: The optimal treatment for complex Pilonidal Sinus Disease (PSD) is still debated. Despite great advances with the introduction of off-midline closure techniques, healing problems and recurrence remain challenges. We aimed to investigate whether choice of skin-suturing technique in Bascom's Cleft lift (BCL) procedure influenced risk of prolonged healing or recurrence. METHODS: We analysed the data of 540 unique patients who underwent BCL surgery at Randers Regional Hospital between 2016 and 2022. During this period, a technical revision of technique caused a shift from extracutaneous to intracutaneous closure creating two groups for comparison. Prolonged healing was defined as lack of complete epithelialization at the second post-surgical follow-up (maximum 14 weeks post-surgery). RESULTS: There was no difference in time-to-healing among the suture groups with a 76% rate of primary healing in both groups. At 5 years post-surgery, the cumulative incidence proportion (CIP) of recurrence was 9.1% in the intracutaneous group and 5.7% in the extracutaneous group (p = 0.41). At 5 years post-surgery, the CIP of recurrence was 14.0% among patients with prolonged healing and 7.0% among patients with primary healing (p < 0.05). CONCLUSIONS: In our study population, choice of skin-suturing technique did not affect risk of prolonged healing nor recurrence after BCL surgery. However, patients experiencing prolonged healing after surgery had significantly higher risk of recurrence, emphasizing the need for increased efforts to prevent post-surgical wound dehiscence.