A Fascio-cutaneous Z-Plasty for a Non-healing Pilonidal Wound

Christina V. Warner, MD; Jean-Sebastien Trepanier, MD; Kunal Kochar, MD; Slawomir J. Marecik, MD, FACS; Anders F. Mellgren, MD, PhD, FACS; John J. Park, MD, FACS, FASCRS

Product Details
Product ID: ACS-5544
Year Produced: 2018
Length: 4 min.


Background: Closure of large pilonidal wounds is a challenging problem for the patient and surgeon. The fascio-cutaneous Z-plasty is one of several options for primary closure of such wounds. This video demonstrates the surgical steps of a Z-plasty creation for a non-healing pilonidal excision wound. Methods: We present a 15-year-old male with a large pilonidal wound after undergoing a pilonidal cystectomy for acute abscess. Despite the application of wet-to-dry dressing changes, the wound failed to close by secondary intent. We detail the technique of creating a fascio-cutaneous Z-plasty, a modification of the adipo-cutaneous Z-plasty originally described by Monro and McDermott in 1965, and identify key points in the procedure for a successful repair. Results: The patient recovered well after Z-plasty closure of the pilonidal wound. The wound was completely healed at 3 month follow-up. Conclusion: The fascio-cutaneous Z-plasty is an excellent option for closure of complex wounds and should be a part of the colorectal surgeon's armamentarium for closure of large and/or non-healing pilonidal excision wounds.