Dear Editor,
I read with great interest the article entitled “Controversies in the Management of Pilonidal Disease: Expert Recommendations from a Modified Delphi Survey and Review of the Literature” by Arslan et al.1, which was recently published in your journal. The authors have provided valuable insights into treatment options for pilonidal sinus disease and have contributed to the ongoing discussion on optimizing management strategies for this condition.
However, one important point that I believe deserves mention is the role of platelet-rich plasma (PRP) in pilonidal sinus treatment. PRP has been increasingly studied as a minimally invasive method that promotes wound healing and reduces recurrence rates.2, 3 Several recent studies have reported encouraging outcomes with PRP plus curettage. The role of PRP in the treatment of pilonidal disease (PD) has also been described in a book chapter.4 Moreover, combining PRP with other surgical techniques has shown promising results.5 A recent systematic review concluded that PRP can be used as an adjuvant treatment in PD surgery to improve therapeutic outcomes and reduce adverse events.6 That review included nine studies using PRP as an adjunct to surgical or minimally invasive methods and demonstrated a shorter healing time with PRP use, including in open surgical approaches. Additionally, it found that minimally invasive procedures combined with multiple PRP applications achieved more positive outcomes.
Another systematic review and meta-analysis by Brewer et al.7 reported reduced healing time, postoperative pain, and time off work with PRP application. As heterogeneity in PRP preparation and application methods remains a major limitation, both reviews emphasized the need for well-designed, high-powered, randomized controlled trials.
In my opinion, the omission of PRP from the discussion leaves out a potentially useful therapeutic option that could further enrich the perspective offered by the article. Including data on PRP-based management would provide readers with a more comprehensive overview of the current treatment landscape for pilonidal sinus disease.
