2011, 35 (6): 877-81.
Doursounian L, Maigne JY, Cherrier B, Pacanowski J.
Department of Orthopaedic Surgery and Traumatology, Saint-Antoine University Hospital, APHP, 184 rue du Faubourg-Saint-Antoine, 75012, Paris, France.
Postoperative infection is a regular complication in coccygectomy. The authors propose the use of a topical skin adhesive on the postoperative wound as a contribution to the prevention of this complication. It was used on the first 56 patients in this study. The rate of infection was 3.6% compared with the 14% rate of infection in a previous study.
The 80 following patients had, in addition to the skin adhesive, two prophylactic antibiotics for 48 hours (cefamandole and ornidazole), a preoperative rectal enema, and closure of the incision in two layers. The rate of infection dropped to 0.0%.
Topical skin adhesive constitutes a significant contribution in the prevention of infection after coccygectomy.
The surgical technique is described as follows:
The posterior aspect of the coccyx was directly approached through a small longitudinal incision (about 5 cm) in the gluteal cleft. The coccyx was exposed by subperiostal dissection. In case of instability, the dissection progressed through the disc between the sound and the mobile segment and anterior release of the coccyx performed as described by Key , i.e. working from the proximal to the distal part. In the case of instability, the coccyx segment(s) furthest from the abnormal disc was removed. In the case of spicule, only the coccyx segment with the spur was removed and in the other cases, the dysplasic segment was removed. The wound was closed over a suction drain.
In the first 56 cases, only the skin was closed. In the subsequent 80 cases, the wound was closed in two layers- one deep layer, for which absorbable sutures were used, and a skin layer closed with nylon sutures. Topical skin adhesive was applied on the wound in all cases (see details below).