Fluorescence Image Guided Use of an Antibiofilm Agent in the Treatment of Recalcitrant Pilonidal Ulcers: A Case Review

Abstract

Pilonidal sinus disease afflicts more than 70,000 Americans each year. Despite advances in surgical and nonsurgical techniques, some patients develop recalcitrant sacrococcygeal ulcers following treatment. These wounds can persist for weeks to months and interfere with the patient’s daily activities and ability to work. Nonhealing pilonidal wounds arise following attempts at primary closure, complicated by surgical site infection, and when a pilonidal left open to heal by secondary intention fails to close in a timely fashion. A recent study evaluating the effectiveness of fluorescence imaging in detecting bacteria suggests that more than 80% of surgical wounds, including nonhealing pilonidal ulcers, contain levels of bacteria that inhibit wound healing. The study concluded that fluorescence imaging improved the detection of high bacterial load 11-fold. Using fluorescence imaging to guide antiseptic treatment in nonhealing pilonidal ulcers holds promise in closing these difficult-toheal wounds. In addition, bacteria in nonhealing wounds favor a biofilm phenotype. The use of an agent designed to deconstruct the biofilm and kill bacteria may facilitate closure of nonhealing pilonidal ulcers. Two patients with nonhealing pilonidal ulcers are presented in whom fluorescence imaging guided the application of an antibiofilm agent. The nonhealing ulcers had been present for several months in all cases. The results suggest that further investigation on fluorescence guided antibiofilm therapy may be a viable option for troublesome pilonidal wounds.

Keywords

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