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Medical Abstracts
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Definite surgical
treatment of complicated recurrent pilonidal disease
witha modified fasciocutaneous V-Y advancement flap
Surgery, March 1997
Schoeller T, Wechselberger G, Otto A, Papp C.
Clinic of Plastic and Reconstructive Surgery, University
of Innsbruck, Austria.
BACKGROUND: Different methods for managing pilonidal
disease have been described in the literature.
Recurrence impairs the success of all forms of therapy,
but the lowest rates have been reported for
reconstructions involving local flaps. Nevertheless,
treatment of pilonidal disease with a fasciocutaneous
V-Y flap is not a well-established procedure. We have
modified the surgical technique and used it selectively
for complicated recurrent cases. Our experience with
this method is analyzed, and its validity is evaluated.
METHODS: Twenty-four patients with recurrent pilonidal
sinus undergoing radical excision and reconstruction
with our modified fasciocutaneous V-Y advancement flap
between 1986 and 1993 were studied retrospectively.
RESULTS: Except for two minor transient wound
dehiscences, in all cases primary healing was achieved.
Furthermore, an excellent functional result and
acceptable scar pattern were obtained in all twenty-four
patients, with a mean follow-up of 4.5 years. Neither
evidence of recurrence nor impairment of daily life
activity was noted. CONCLUSIONS: Treatment of
complicated recurrent pilonidal sinus with the described
technique offers a safe but demanding method for
definite reconstruction, and we support a more common
application.
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Bascom's operation in
the day-surgical management of symptomatic pilonidal
sinus
British Journal of Surgery, August 2000
Senapati A, Cripps NP, Thompson MR.
Department of Coloproctology, Queen Alexandra Hospital,
Portsmouth, UK.
BACKGROUND: Many treatments for symptomatic pilonidal
sinus disease have been described. Ambulatory treatment
with minimal morbidity and a rapid return to normal
activity is desirable. Bascom's operation fulfils these
requirements. This paper describes the operative
technique and results of treatment. METHODS: Some 218
patients of mean age 27 years were treated as day cases.
The mean duration of symptoms was 2.4 years. Sixty-eight
per cent of patients had complex disease with more than
two midline pits and/or a lateral discharging sinus. One
hundred and eighty-three patients (84 per cent) were
operated on under local anaesthesia. RESULTS:
Ninety-five per cent of patients have been followed up
for a mean of 12.1 (range 1-60) months. All except one
midline wound healed. Lateral wounds healed after a mean
of 4.0 (range 1-15) weeks. Postoperative complications
were few, including bleeding in 4 per cent and abscess
formation treated by reopening the lateral incision in 6
per cent. Twenty-one patients (10 per cent) have had
recurrence and have needed reoperation. CONCLUSION:
Bascom's operation is simple and results in considerable
financial savings with minimal social disruption and an
early return to work. Recurrent disease is no more
frequent than after other treatments.
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Pilonidal sinus:
experience with the Karydakis flap
British Journal of Surgery, October 1996
Kitchen PR.
Department of Surgery, St Vincent's Hospital, Melbourne,
Victoria, Australia.
A personal series of 141 patients with postanal
pilonidal sinus was treated by the Karydakis operation.
Each sinus was totally excised with a vertical eccentric
elliptical excision. A thick flap was created by
undercutting the medial edge and advancing it across the
midline so that the whole suture line was lateralized to
reduce the risk of recurrence. Follow-up was achieved in
114 patients for 1-108 months; 79 (69 per cent) were
followed for more than 18 months. Overall there were
five recurrences (4 per cent) which required further
surgery. Thirty-three patients (23 per cent) were
referred following recurrence or failure of healing
after previous surgery elsewhere; all were cured by this
method. The Karydakis operation has a low recurrence
rate because it produces a shallow midline furrow free
from scar or suture holes which is less vulnerable to
hair penetration than a midline wound.
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The
use of a laser in the
surgical treatment of an epithelial coccygeal cyst
Klinicheskaia Khirurgiia, 1993
Grubnik VV, Bakhar GA. (Article in Russian)
In acute inflammation of pilonidal sinus (PS), use of a
laser scalpel permitted to reduce considerably the
incidence of postoperative suppuration. Pain syndrome
became less pronounced, or was absent, wound swelling
disappeared at the early period. No differences in
results of surgical treatment of uncomplicated PS at the
stage of chronic inflammation in use of CO2-laser and
conventional methods of treatment were noted. An
original technique of operation for PS complicated by
multiple fistulas, purulent leaks, pyodermia has been
suggested. For plastic closure of a wound, the effect of
laser photohydraulic preparation was used. Operated on
was 31 patient, no disease recurrence was noted. Rough
cicatricial deformity of the sacro-coccygeal region was
absent.
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YAG laser
surgery for the excision of pilonidal cysts: a
comparison with traditional techniques
Lasers in Surgery and Medicine, 2000
Palesty JA, Zahir KS, Dudrick SJ, Ferri S, Tripodi G.
St. Mary's Hospital Department of Surgery, Waterbury,
Connecticut
BACKGROUND AND OBJECTIVE: Nd:YAG laser photothermal
ablation has been accepted as a treatment modality for
hemorrhoidal disease. There is little reported on its
use in treating pilonidal disease. We hypothesized that
laser would be an excellent tool for pilonidal
cystectomy, facilitating improved outcome and patient
satisfaction. STUDY DESIGN/MATERIALS AND METHODS: A
5-year retrospective study was performed comparing
Nd:YAG laser to the standard surgical technique. A
telephone questionnaire addressing the length of time
the cyst was debilitating both preoperatively and
postoperatively as well as length of convalescent time
before return to work was administered. Pain was
assessed by using an analog pain scale. RESULTS:
Operative time for the traditional pilonidal cystectomy
was 20 minutes longer than Nd:YAG laser cystectomy.
Postoperative hospital stay was similar. Laser patients
returned to work an average of 2.4 days earlier, and
their postoperative pain was less than those treated
traditionally. CONCLUSION: In an era when the medical
consumer makes decisions based on the efficacy of
treatment by using criteria such as pain, length of
hospitalization, and speed of return to work, Nd:YAG
lasers have emerged as a surgical tool that can fulfill
these criteria for certain procedures. Patient
postoperative satisfaction after laser excision was
greater when compared with those who had traditional
excisions. Postoperative pain was less, as was the pain
experienced during the first week of recovery. Cost for
both was comparable. Copyright 2000 Wiley-Liss, Inc.
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Rhomboid flap
procedure for pilonidal sinus: results from 67 cases
International Journal of Colorectal Disease, 1998
Milito G, Cortese F, Casciani CU.
Cattedra di Clinica Chirurgica, Universita di Roma Tor
Vergata, Ospedale Sant'Eugenio, Italy.
Sixty-seven patients with chronic pilonidal sinuses were
treated by excision and rhomboid flap transposition (RFT).
Primary healing was obtained in all patients except two
who developed a seroma and one who had a partial
dehiscence of the surgical wound due to a hematoma,
which necessitated drainage through the margin of the
flap. The average stay was 5.3 days (range 1-16). All
patients returned to normal activities within 2 weeks of
surgery. No late recurrence occurred after a mean
follow-up of 74.4 months (range 8-137).
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The rhomboid flap for
pilonidal disease
Colorectal Disease. 2003 May
Arumugam PJ, Chandrasekaran TV, Morgan AR, Beynon J,
Carr ND.
Colorectal Unit, Singleton Hospital, Sketty, Swansea SE2
8QA, UK.
INTRODUCTION: There have been many surgical techniques
described for the treatment of pilonidal sinuses.
Recurrent disease causes significant morbidity
particularly with time from work. AIM: To assess the
rhomboid flap's role in promoting one-stage primary
healing in pilonidal disease and to evaluate the
morbidity and recurrence. METHODS: Fifty-three patients
were prospectively recruited of which 27 had previous
multiple abscess formation requiring surgical drainage
from their pilonidal disease, although none had acute
disease at the time of surgery. By using the
transposition flap, we were able to obliterate the natal
cleft and therefore the rolling action of the buttocks
between the cleft in these patients and thereby remove
one of the factors involved in pilonidal disease.
Hospital stay, healing time, wound infection, wound
breakdown and recurrence were noted. RESULTS: There were
47 males and 6 females with a median age of 28 years
(range 16-64 years). Median follow-up was 24 months
(range 3-36 months). Post-operative morbidity involved
superficial wound infection in 7 (13%) which settled
with out-patient dressings. There were four recurrences
(7%), two occurred between the flap and the anal canal,
and the other two in the flap margin needing
intervention. All the patients healed their wounds and
the median healing time was 14 days. CONCLUSION: As this
condition affects a predominantly young population
causing significant time off from work, we feel that the
Rhomboid Flap is useful for difficult cases in that it
allows early return to full activity and does not
necessitate prolonged postoperative care.
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Interdigitating
fasciocutaneous gluteal V-Y advancement flaps for
reconstruction of sacral defects
Annals of Plastic Surgery. June 2003
Ay A, Aytekin
O, Aytekin A. Bursa State Hospital, Turkey.
The authors
describe a modification of the classic gluteal bilateral
V-Y advancement flap for sacral defect closure. After
initial debridement, the V-Y design is marked on both
sides of the defect. The incision is carried down to the
fascia of the underlying gluteus maximus muscle. The
upper and lower arms of the flaps are elevated and
advanced on the gluteal muscle toward the midline,
interdigitating each opposing arm. The overall result is
a zigzag, broken midline suture. This procedure was
carried out in 14 patients with sacral pressure sores
and in 1 patient with a chronic pilonidal sinus. All
flaps survived without major problems. There were no
recurrences during the 6 to 16 months of follow-up. The
interdigitating fasciocutaneous V-Y gluteal flap design
is effective in breaking the midline vertical scar and
preserving the gluteus maximus muscle.
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Treatment of
pilonidal sinuses by phenol injections
International Journal of Colorectal Disease 1994
Schneider IH, Thaler K, Kockerling F.
Surgical Clinic, University of Erlangen-Nurnberg,
Germany.
Six female and 39 male outpatients, who suffered from
acutely inflamed pilonidal sinus were treated by
sclerotherapy between January 1985 and December 1988.
Under local anaesthesia, 1-2 ml 80% phenol was injected
into the sinus. The phenol, which was allowed to act for
a minute, was washed out by irrigating the sinus with
physiological common-salt solution. Of the questionnaire
sent to all 45 patients, 37 proved suitable for
evaluation. Complete healing occurred in 22 cases
(59.8%). The healing time was 6.2 weeks on average.
Besides a rather frequently observed transient reddening
as a result of the local inflammation caused by the
phenol, 5 patients developed an abscess which needed
operative treatment. This study does not support the
encouraging results of previous series.
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Simple
and effective surgical treatment of pilonidal sinus:
asymmetric excision
Diseases of the Colon & Rectum, May 2000
Akinci OF, Coskun A, Uzunkoy A.
Department of General Surgery, Research and Educational
Hospital, Harran University, Sanliurfa, Turkey.
PURPOSE: This study was planned to evaluate
prospectively the results of 112 pilonidal sinus cases
treated surgically by using asymmetric excision and
primary closure with suction drain and subcuticular skin
closure. It is aimed at elimination of the causative
factors of pilonidal sinus. METHOD: The patient's age,
profession, weight and height, symptoms and signs,
duration of symptoms, previous treatments, operation
time and cost, hospital stay, return to normal activity,
complications, pathologic and microbiologic
examinations, and recurrences were noted. All pilonidal
sinus cases except pilonidal abscess and extensive
gluteal involvement were treated surgically. The
procedure consists of an eccentric, elliptical excision
of the affected tissue, mobilization of the flap to the
sacrococcygeal fascia and the suturing of its edge to
the lateral one. Penrose drains were placed in the first
eight (7.14 percent) cases, but suction drains were
placed in others. The cases were followed up for a mean
of 2.4 years. RESULTS: Twenty-eight (25 percent) cases
had undergone previous operative procedures. Of 112
patients 106 (94.6 percent) were male. Mean age was 22.1
years. Mean history of disease was 4.2 years. The
overall complication rate was 7.14 percent. Two (1.8
percent) wound infections, two wound breakdowns, three
(2.7 percent) collections, and one (0.9 percent)
recurrence were recorded. The collections were reduced
to zero after first eight cases by using a suction
drain. Sixty-eight of the patients (60.7 percent) had
body weight over 90 kg, and the mean body mass index was
24.8. The mean hospital stay was 2.6 days, and the mean
time off work was 12.4 days. The average healing time
was 13.2 days. There were no anesthetic or surgical
deaths. CONCLUSION: The natal cleft is flattened and the
incision scar and the incision line is transferred from
the midline to the lateral side by performing the
asymmetric excision and primary closure, and thus the
essential cause of pilonidal sinus is eliminated. The
procedure is simple, the complications and recurrences
are very low, and it is seen to be an excellent
procedure in the surgical treatment of uncomplicated
pilonidal sinus disease.
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Cytokeratin expression
in pilonidal sinus
British Journal of Dermatology 2002 March
Kurokawa I, Nishijima S, Suzuki K, Kusumoto K,
Sensaki H, Shikata N, Tsubura A.
Department of Dermatology, Hyogo Prefectural Tsukaguchi
Hospital, Japan.
BACKGROUND: Pilonidal sinus (PS) is considered to belong
in the category of follicular occlusion diseases (acne
triad). OBJECTIVES: The aim of our study was to
elucidate the pathogenesis of PS by evaluating its
cytokeratin (CK) expression. METHODS: CK expression in
nine cases of PS was studied immunohistochemically using
six antikeratin antibodies. RESULTS: Infundibular-like
epithelium contained CK1, 10 and 14 similar to normal
infundibulum, but it did not contain CK17. In non-infundibular-like
epithelium, CK14, 16 and 17 were detected similar to
that in normal outer root sheath. CK expression in PS
was similar to that in hidradenitis suppurativa,
suggesting that sinus epithelium may be fragile,
hyperproliferative and undifferentiated. CONCLUSIONS: PS
can be classified in the same entity as follicular
occlusion diseases based on CK expression.
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Laser depilation of the
natal cleft--an aid to healing the pilonidal sinus
Annals of the Royal College of Surgeons of England
January 2002
Odili J, Gault D.
RAFT Institute of Plastic Surgery, Mount Vernon
Hospital, Northwood, UK. odilij@raft.ac.uk
BACKGROUND: Pilonidal disease is common. Excessive hair
growth in the natal cleft is thought to be a factor in
initiating these sinuses. It is chronic and intermittent
in nature and treatment can be difficult. Hair removal
by shaving or use of creams is often advised as a
compliment to surgical treatments. However, access to
the natal cleft can be difficult. Laser removal of hair
in the natal cleft is considered as an aid to healing
the pilonidal sinus. PATIENTS AND METHODS: Over a 5-year
period, 14 patients with recurrent pilonidal disease
were treated in our unit with laser depilation. They
were all contacted by postal questionnaire, and those
with ongoing disease were asked to return to the clinic
for evaluation and possible further treatment. RESULTS:
All patients returned the postal questionnaire. Of the
14 patients, 4 had on-going disease and received further
depilation with the Alexandrite laser. All are now
healed with no reported complications. All patients
found the procedure painful and received local
anaesthetic. CONCLUSIONS: Laser depilation in the natal
cleft is by no means a cure for pilonidal disease.
Removal of hair by this method represents an alternative
and effective method of hair removal and, although long
lasting, is only temporary. However, it allows the
sinuses to heal rapidly. It is relatively safe, and
simple
to teach, with few complications. It should thus be
considered as an aid to healing the problem pilonidal
sinus.
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