Silicone foam sponge for pilonidal sinus

SIR,-I read with interest the paper by Mr R A B Wood and Professor L E Hughes on the above subject (18 October, p 131) and would like to make the following conuments. The disadvantages of permitting an excised wound to iheal by "packing and granulation" are those of prolonging healing time (inpatient and outpatient), delaying wound contractions, and promoting repair by tissue that is weaker and dissimilar to that which surrounds it. The application of such a method of treatment should thus be examined very critically before being used on wounds made in the proximity of bone in particular-namely, the sacrococcygeal region -and pressure sores. The resulting epithelisation may adhere to bone and suffer frequent breakdown. Treatment for sacrococcygeal pilonidal sinus by the Z-plasty or rotation flap repair permits complete healing within 8-14 days (normal healing for trunk wounds). Any arguments that favour the "lay open and pack" technique serve only to advance a method that requires considerable outpatient attention. The recurrence rates for all forms of treatment for this condition vary from O to 300'o, being highest for wounds repaired by simple closure and approximately zero for repair by flaps.'-4 As a new technique in packing, the apparent advantages of silicone foam elastomer are (a) pain-free removal and (b) plasticity. May I therefore suggest that its principal application is as an obturator to retain biological or other dressings in elderly patients whose general debility precludes a general anaesthetic for major flap or skin graft surgery. Even those among us who are "packing" enthusiasts will have observed that wound aftercare-change of dressings, medicated baths, and regular attendance at clinics-tends only to encourage patients to prolong their convalescence unless they are self-employed. Basic human attitudes are unlikely to alter significantly by substituting silicone foam for the conventional gauze pack. Moreover, the silicone sponge may yet prove the more expensive. S C SOOD Guy's Hospital, London SEl