Abstract:

Objective To summarize the application experience of transcoccygeal transverse curved incision in debridement of sacral sinus infection after Miles.

Methods A total of 15 patients，taking the lithotomy position，refer to the preoperative sinus angiography results as needed to make a transverse arc incision the joint of the coccygeal's tip and both sides of ischial tuberosity，separating along the anterior sacral space to the sides，removing the sinus and sinus Wall scar tissue，if necessary，by the abdominal group physician through the abdominal incision along the iliac crest to the top of the sinus tract and meet with the perineal group of doctors，the deep sinus can be completely removed.According to the need，the greater omentum can be free after tamponade to the sacral anterior to promote healing.

Results All 15 patients underwent successful operation and were followed up until the incision was completely healed.All of them had an average of 109 minutes of surgery and an average of 265 ml of bleeding.The average time to heal the perineal incision was 27 days.Ten patients（66.7%）underwent debridement through the anterior transverse arc incision，and 5 patients（33.3%）were treated with transabdominal and posterior transverse arc shaped incision.Two male patients had anterior tibiofibular rupture hemorrhage during operation，and hemostasis was obtained after suture fixation and gauze padding compression and hemostasis.One male patient with sinus apex at the level of sacral sinus was treated with transperitoneal anterior transverse arc incision.The small intestine was perforated with pelvic floor peritoneal hiatus and anterior to the sinus.Excision and side to side anastomosis were performed.After the sinus was completely removed，the omentum was filled to the anterior iliac crest，and no infection occurred after the operation.Five patients with preoperative perineal bulge or appendix pain were significantly relieved or disappeared after the incision was completely healed.

Conclusion The key to the intractable infection of the perineal incision and the sinus formation after the mile is complete debridement.The debridement through the anterior cross curved incision of the tailbone is well exposed and easy to operate.

Key words: miles postoperative, sinus, transverse arc incision, debridement