Fibrin glue is a quick and effective treatment for primary and recurrent pilonidal sinus disease
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By
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T. S. Sian
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P. J. J. Herrod
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J. E. M. Blackwell
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E. J. O. Hardy
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J. N. Lund
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November 9, 2018
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Clinical Scorecard: Fibrin Glue: A Rapid and Effective Solution for Managing Primary and Recurrent Pilonidal Sinus Disease
At a Glance
| Category | Detail |
|---|
| Condition | Pilonidal sinus disease (PSD), a chronic and recurring condition affecting mainly young adults |
| Key Mechanisms | Fibrin glue mimics the final coagulation cascade forming a fibrin clot that promotes tissue healing by stimulating macrophages and collagen production |
| Target Population | Patients with primary or recurrent PSD, including those with multiple natal cleft pits and secondary tracts |
| Care Setting | Same-day discharge surgical setting under general or local anesthesia without antibiotic prophylaxis |
Key Highlights
- PSD has a significant impact on social life and work, with a male predominance and mean age of 30 years
- Traditional wide excision surgeries have high tissue loss, prolonged healing, and recurrence rates up to 18%
- Fibrin glue application offers rapid return to normal activities, high patient satisfaction, minimal aftercare, and cost benefits
Guideline-Based Recommendations
Diagnosis
- Identify sinus tracts using blunt fistula probe
- Assess for multiple pits and secondary tracts
- Exclude infected sinuses prior to fibrin glue treatment
Management
- Perform meticulous curettage of sinus tracts to remove hair and granulation tissue
- Flush tracts with saline before fibrin glue injection
- Inject fibrin glue to obliterate sinus tracts, allowing glue to set before trimming excess
- Discharge patients same day with oral paracetamol and hygiene advice
Monitoring & Follow-up
- Follow patients for at least 1 year postoperatively to assess recurrence
- Advise patients to return to full normal activities within 2–3 days post-procedure
Risks
- Avoid fibrin glue in patients with excessive scarring or chronic induration due to low-grade sepsis
- Recognize that infected sinuses require incision and drainage rather than glue application
Patient & Prescribing Data
Adults and children with primary or recurrent PSD, including those with previous surgical or glue treatments
Fibrin glue treatment results in rapid recovery, minimal pain, no need for wound care, and an overall cure rate exceeding 90% with repeat applications
Clinical Best Practices
- Use fibrin glue as a minimally invasive alternative to wide excision or flap procedures in suitable PSD cases
- Ensure complete removal of hair and granulation tissue before glue application to optimize outcomes
- Perform procedures under general anesthesia with patient positioned to expose natal cleft for access
- Avoid prophylactic antibiotics as standard practice during fibrin glue treatment
- Educate patients on hygiene and early return to normal activities post-procedure
References
