EP303 - Evaluating The Impact Of Extracellular Matrix Products On Primary Closure Outcomes In Pilonidal Disease Excision – A Pilot Study

ePoster Presenter(s)

• 

  Joseph Sciacca, DO

  Colorectal Fellow
  University at Buffalo
  University at Buffalo
  Buffalo, NY, United States

  Disclosure information not submitted.

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Author(s)

• JH

  Justin Harvey, MD

  General Surgery Resident
  University at Buffalo
  Buffalo, New York, United States

  Disclosure information not submitted.
• JM

  Joseph D. Mills, MD

  Associate Program Director
  University at Buffalo
  West Seneca, New York, United States

  Disclosure information not submitted.

Senior Author(s)

• 

  Jessica Martinolich, MD

  Assistant Clinical Professor
  University at Buffalo
  Buffalo, New York, United States

  Disclosure information not submitted.

Author(s)

• tA

  timothy M. Adams, MD

  Colorectal surgeon
  University of Buffalo Surgery
  Buffalo, New York, United States

  Disclosure information not submitted.
• JV

  Jeffery J. Visco, n/a

  Assistant Program Director SUNY at Buffalo
  UBMD
  Clarence Center, New York, United States

  Disclosure information not submitted.
• 

  Bethany Wood Harvey, MD (she/her/hers)

  Colorectal Surgery Fellow
  Albany Medical Center
  WILLIAMSVILLE, NY, United States

  Disclosure information not submitted.
• JO

  John Ortolani, MD

  Clinical Assistant Professor
  University at Buffalo Jacobs School of Medicine
  Buffalo, New York, United States

  Disclosure information not submitted.
• MF

  Mark Falvo, MD

  Assistant Professor Department of Surgery, Jacobs School of Medicine & Biomedical Sciences
  State University of New York at Buffalo
  EAST AMHERST, New York, United States

  Disclosure information not submitted.
• SB

  Steven Barone, ASCRS Member

  Clinical Assistant Professor
  University at Buffalo
  Williamsville, New York, United States

  Disclosure information not submitted.

Purpose/Background: Pilonidal disease is a common disease that continues to present a management challenge due to its variable clinical presentation, lack of standardized treatment guidelines, and high recurrence rates. Numerous surgical strategies have been described, ranging from minimally invasive techniques to complex flap reconstructions, yet no single approach has demonstrated universal superiority. The chronicity, postoperative morbidity, and impact on quality of life further underscore the complexity of care and the need for individualized treatment strategies. Recently, the use of extracellular matrices (ECM) has emerged as an adjunct in promoting wound healing with several case series suggesting expedited wound healing in pilonidal disease. In this pilot study, we aim to determine if utilization of ECM combined with primary closure of pilonidal sinus results in decreased post-operative complications and improved healing.

Methods/Interventions: We present a single center retrospective analysis of patients undergoing elective surgery for pilonidal disease with and without addition of ECM, from 2021 until August 2025. Porcine bladder ECM was utilized based on availability and surgeon preference. Surgical technique was standardized with placement of ECM between each layer to decrease potential space with primary skin closure and closed suction device placement. Primary outcome of interest was wound dehiscence greater than 1cm. Secondary outcomes were total complications, infection, average number of post-operative visits, and wound care referrals. Statistical comparisons between groups were made using chi-square, Fisher's exact test, and Mann-Whitney U test dependent on sample size, expected frequencies, and data distribution to ensure accurate statistical comparisons.

Results/Outcomes: Of 43 patients undergoing surgical management of pilonidal disease, 14 (32.56%) had ECM incorporated into their closure. There was no statistical difference between demographic groups. 72.1% of the total cohort were male. The average age was 29.1. 44.2% of patients were obese. Comorbidities were low amongst the group. At follow up visit, wound dehiscence greater than one centimeter occurred in 39.5% of patients (n=17); 35.7% with ECM compared to 41.4% without ECM (p 0.72). (Figure 1). Overall post-operative complication rate with ECM was 57.14% vs 65.52% (p 0.59). Post-operative infection rates with ECM were 7.14% vs 6.9% without ECM (p 1.0). Wound care referral rates with ECM were 14.29% vs 20.69% (p 1.0) (Figure 2). The average number of post-operative visits was 3.21 with ECM vs 3.97 (p 0.76).

Conclusion/Discussion: Pilonidal disease management presents many challenges. This study suggests a trend toward a decrease in post-operative complication and decreased wound dehiscence with the use of layered porcine bladder ECM with primary closure. We acknowledge the limitations of our study, including the retrospective nature of review and a small study size. Future endeavors include a prospective, randomized trial involving various ECM particulates to further elucidate the impact of ECM on pilonidal disease management, as well as evaluating the financial impact.

Table 1: Demographic Characteristics and Outcomes
Figure 1 and 2: Primary and Secondary Outcomes