Pilonidal surgery is even yet in disserviceable confusion. The approach of choice would seem to be that which first establishes fundamental principles based on an understanding of the unique characteristics and singular behavior of the pilonidal wound and proceeds from there. Instead there has been a trend toward the more devious methods of trial and error with emphasis on schemes of primary closure and largely with the tacit predication that the open method has long since reached a dead end. Furthermore, these efforts have not always respected affective variables or controls necessary to unimpeachable interpretation. Success has been individually attributed to various exclusive elements of meticulousness presumed to have been neglected by others. These include the use of special suture material or pattern of suture, different ways of obliterating dead space and of eliminating infection, preoperative preparation at times more prodigious than the surgical procedure itself and new "plans" of
BLAISDELL PC. THE HEALING OPEN PILONIDAL WOUND: Unique Characteristics and Clinical Implications. JAMA. 1947;133(13):916–922. doi:10.1001/jama.1947.02880130016004
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