Serum CitH3 and TSLP as predictive biomarkers for impaired wound healing after bascom cleft lift surgery in pilonidal sinus disease: a nomogram-based risk model

Objective To investigate the predictive value of serum citrullinated histone H3 (CitH3) and thymic stromal lymphopoietin (TSLP) for postoperative wound healing outcomes in patients with pilonidal sinus (PS), and to construct a nomogram-based risk prediction model. Methods This prospective observational study enrolled 181 patients with PS who underwent Bascom cleft lift between November 2022 and August 2025. According to wound-healing status at 6 weeks postoperatively, patients were classified into a good-healing group ( n = 155) and a poor-healing group ( n = 26). Serum CitH3 and TSLP levels were measured preoperatively by ELISA. Independent risk factors were identified through univariable and multivariable logistic regression analyses, and a nomogram prediction model was constructed. Model performance was evaluated using receiver operating characteristic (ROC) curve analysis, calibration plots, and decision curve analysis. Results Wound-healing impairment occurred in 26 patients (14.36%). Compared with the good-healing group, the poor-healing group exhibited significantly higher body-mass index (BMI), fasting blood glucose (FBG), C-reactive protein (CRP), CitH3 and TSLP levels, together with significantly lower albumin (ALB) levels (all P 0.05). Within the poor-healing cohort, serum CitH3 and TSLP were positively correlated (r = 0.562, P 0.05). ROC analysis yielded individual AUCs of 0.804 for CitH3 and 0.780 for TSLP; combining the two biomarkers increased the AUC to 0.922. Multivariable logistic regression identified elevated BMI, FBG, CRP, CitH3 and TSLP as independent risk factors, whereas higher ALB was protective. The nomogram achieved AUCs of 0.958 in the training set and 0.970 in the validation set, with good calibration (Hosmer–Lemeshow test, P 0.05). Conclusion Elevated serum CitH3 and TSLP levels are closely associated with impaired wound healing after Bascom cleft lift for PS and demonstrate favorable predictive performance. The nomogram developed in this study holds promise as a reference tool for individualized risk assessment and clinical decision-making; however, its clinical utility warrants validation through multicenter, large-scale investigations.