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Archives of Surgery (Chicago, Ill. :... Apr 1947
Topics: Abnormalities, Multiple; Humans; Meningocele; Pelvis; Sacrococcygeal Region; Sacrum; Spinal Diseases; Syndrome
PubMed: 20240169
DOI: 10.1001/archsurg.1947.01230070438006 -
Annals of Plastic Surgery Mar 2016Most cases of sacral osteomyelitis arising in the setting of sacral pressure ulcers require minimal cortical debridement. When faced with advanced bony involvement, the...
INTRODUCTION
Most cases of sacral osteomyelitis arising in the setting of sacral pressure ulcers require minimal cortical debridement. When faced with advanced bony involvement, the surgeon is often unclear about how much can safely be resected. Unfamiliarity with sacral anatomy can lead to concerns of inadvertent entry into the dural space and compromise of future flap options.
MATERIALS AND METHODS
A cadaveric study (n = 6), in which a wide posterior dissection of the sacrum, was performed. Relationships of the dural sac to bony landmarks of the posterior pelvis were noted.
RESULTS
The termination of the dural sac was found in our study to occur at the junction of S2/S3 vertebral bodies, which was located at a mean distance of 0.38 ± 0.16 cm distal to the inferior-most extent of the posterior superior iliac spine (PSIS). The mean thickness of the posterior table of sacrum at this level was 1.7 cm at the midline and 0.5 cm at the sacral foramina.
CONCLUSIONS
The PSIS is a reliable landmark for localizing the S2/S3 junction and the termination of the dural sac. Sacral debridement medial to the sacral foramina above the level of PSIS must be conservative whenever possible. If aggressive debridement is necessary above this level, the surgeon must be alert to the possibility of dural involvement.
Topics: Anatomic Landmarks; Debridement; Female; Humans; Male; Middle Aged; Osteomyelitis; Pressure Ulcer; Sacrococcygeal Region; Sacrum
PubMed: 26207558
DOI: 10.1097/SAP.0000000000000503 -
Techniques in Coloproctology Dec 2016Sacral nerve stimulation is a common treatment for various pelvic floor disorders. It consists of the percutaneous introduction of electrodes through the posterior...
BACKGROUND
Sacral nerve stimulation is a common treatment for various pelvic floor disorders. It consists of the percutaneous introduction of electrodes through the posterior sacral foramina for therapeutic stimulation of the target sacral spinal nerve. The aim of our study was to determine the surface anatomical landmarks of the sacrum to facilitate identification of the posterior sacral foramina.
METHODS
This study was conducted on 20 human cadavers. The cadavers were placed in a prone position, and all the soft tissues of the sacral region were removed to allow exposure of the osseous structures. Different measurements were taken in relation to the posterior sacral foramina, the posterior superior iliac spine (PSIS) and the median sacral crest (MSC). A median coefficient of variation (CV) was determined.
RESULTS
The diameter of the second sacral foramen showed the greatest variability. The distances between each individual foramen and the MSC had an acceptable variability (CV < 20%). In contrast, the distance between foramina had a high variability. The distance between PSIS and the second posterior sacral foramen was also found to have an acceptable variability (CV < 20%). However, the angle formed by an horizontal line between PSIS and a line between PSIS and S2 foramina had high variability.
CONCLUSIONS
We found that the distance between sacral foramina and MSC is relatively constant while the distance between foramina and the relations between foramina and PSIS is highly variable. Detailed knowledge of the anatomy may facilitate electrode placement and is complementary to the regular use of fluoroscopy.
Topics: Anatomic Landmarks; Cadaver; Electric Stimulation Therapy; Female; Humans; Ilium; Male; Prone Position; Sacrococcygeal Region
PubMed: 27844258
DOI: 10.1007/s10151-016-1543-2 -
Virchows Archiv. A, Pathological... 1983We believe this to be the third reported case of an unusual congenital sacral tumor-like lesion characterized histologically by the presence of dysplastic and immature...
We believe this to be the third reported case of an unusual congenital sacral tumor-like lesion characterized histologically by the presence of dysplastic and immature renal-like tissue with a predominant glomerular and tubular structure. This lesion appears important in the differential diagnosis of extrarenal nephroblastoma, and should be regarded as a dysplastic overgrowth. An origin from mesonephric or metanephric remnants is suggested.
Topics: Child, Preschool; Diagnosis, Differential; Female; Hamartoma; Humans; Kidney; Kidney Neoplasms; Sacrococcygeal Region
PubMed: 6419458
DOI: 10.1007/BF00695053 -
The Surgical Clinics of North America Dec 2002Pilonidal disease is a disease of young people, usually men, which can result in an abscess, draining sinus tracts, and moderate debility for some. It probably results... (Review)
Review
Pilonidal disease is a disease of young people, usually men, which can result in an abscess, draining sinus tracts, and moderate debility for some. It probably results from hair penetration beneath the skin, for reasons that are not totally clear. Therapy should be simple, inflict minimal pain, have a short hospitalization, have a low recurrence rate, require minimal wound care, and allow rapid return to normal activity. No treatment meets all these ideal goals. Therefore, starting with a simple treatment and progressing to other treatments if failure occurs despite meticulous wound care and hair shaving is the logical approach. Table 1 depicts treatments from simple to more complex.
Topics: Female; Humans; Male; Pilonidal Sinus; Sacrococcygeal Region; Surgical Procedures, Operative
PubMed: 12516846
DOI: 10.1016/s0039-6109(02)00062-2 -
The Journal of Pain Jun 2003Coccygodynia (coccydynia, coccygalgia) or coccygeal pain is a well-known but rarely studied painful syndrome affecting the coccyx region. Its etiology is not well... (Review)
Review
Coccygodynia (coccydynia, coccygalgia) or coccygeal pain is a well-known but rarely studied painful syndrome affecting the coccyx region. Its etiology is not well understood. Symptoms include development of pericoccygeal soft tissues, pelvic floor muscle spasms, referred pain from lumbar pathology, arachnoiditis of the lower sacral nerve roots, local post-traumatic lesions, and somatization. In spite of advances in the treatment of other pain conditions, coccygodynia remains in a position for which therapeutic options are not clearly designed. On the basis of an anatomic review, proposed pathogenesis of coccygodynia, and the number of treatment approaches that have been proposed, we propose an algorithm for therapeutic decision making in the treatment of this syndrome.
Topics: Algorithms; Back Pain; Humans; Peripheral Nervous System Diseases; Sacrococcygeal Region
PubMed: 14622695
DOI: 10.1016/s1526-5900(03)00620-5 -
Journal of Plastic Surgery and Hand... Feb 2015The sacral region is one of the most vulnerable sites for the development of pressure sores. Even when surgical reconstruction is performed, there is a high chance of...
The sacral region is one of the most vulnerable sites for the development of pressure sores. Even when surgical reconstruction is performed, there is a high chance of recurrence. Therefore, the concept of dual-dermal-barrier fashion flaps for sacral pressure sore reconstruction was proposed. From September 2007 to June 2010, nine patients with grade IV sacral pressures were enrolled. Four patients received bilateral myocutaneous V-Y flaps, four patients received bilateral fasciocutaneous V-Y flaps, and one patient received bilateral rotation-advanced flaps for sacral pressure reconstruction. The flaps were designed based on the perforators of the superior gluteal artery in one patient's reconstructive procedure. All flaps' designs were based on dual-dermal-barrier fashion. The mean follow-up time was 16 months (range = 12-25). No recurrence was noted. Only one patient had a complication of mild dehiscence at the middle suture line, occurring 2 weeks after the reconstructive surgery. The dual-dermal fashion flaps are easily duplicated and versatile. The study has shown minimal morbidity and a reasonable outcome.
Topics: Adult; Aged; Debridement; Female; Humans; Male; Middle Aged; Pressure Ulcer; Sacrococcygeal Region; Surgical Flaps
PubMed: 25420912
DOI: 10.3109/2000656X.2013.792269 -
Microcirculation (New York, N.Y. : 1994) May 2010The aim was to investigate the existence of sacral tissue blood flow at different depths in response to external pressure and compression in elderly individuals using a...
OBJECTIVE
The aim was to investigate the existence of sacral tissue blood flow at different depths in response to external pressure and compression in elderly individuals using a newly developed optical probe prototype.
METHODS
The tissue blood flow and tissue thickness in the sacral area were measured during load in 17 individuals using laser Doppler flowmetry and photoplethysmography in a combined probe, and digital ultrasound.
RESULTS
The mean age was 68.6 +/- 7.0 years. While loading, the mean compression was 60.3 +/- 11.9%. The number of participants with existing blood flow while loading increased with increased measurement depth. None had enclosed blood flow deep in the tissue and at the same time an existing more superficial blood flow. Correlation between tissue thickness and BMI in unloaded and loaded sacral tissue was shown: r = 0.68 (P = 0.003) and r = 0.68 (P = 0.003).
CONCLUSIONS
Sacral tissue is highly compressed by external load. There seems to be a difference in responses to load in the different tissue layers, as occluded blood flow in deeper tissue layers do not occur unless the blood flow in the superficial tissue layers is occluded.
Topics: Aged; Blood Flow Velocity; Female; Humans; Laser-Doppler Flowmetry; Male; Microcirculation; Middle Aged; Optical Devices; Photoplethysmography; Pressure; Pressure Ulcer; Sacrococcygeal Region; Skin; Subcutaneous Tissue
PubMed: 20536744
DOI: 10.1111/j.1549-8719.2010.00027.x -
Clinical Pediatrics Oct 2016Sacral dimples are common physical examination findings among newborns and are rarely associated with spinal dysraphism. Screening ultrasonography for simple sacral...
Sacral dimples are common physical examination findings among newborns and are rarely associated with spinal dysraphism. Screening ultrasonography for simple sacral dimples in the absence of other physical findings leads to unnecessary health care costs and undue stress on families. This study was a retrospective chart review of infants with a sacral dimple on examination who underwent spinal ultrasonography in the first week of life. The documented indication for ultrasonography was compared to standard guidelines. Among 151 infants in the study, 80% had a normal spinal ultrasound. Of infants with abnormal ultrasonography, 7 (5%) had abnormal spinal magnetic resonance imaging and 2 infants (1%) required neurosurgical intervention. Our study revealed that nearly one-third of infants who underwent spinal ultrasonography had a simple sacral dimple and low likelihood of spinal dysraphism according to existing guidelines. Among patients who underwent spinal ultrasonography in accordance with guidelines, only a small percentage required neurosurgical intervention indicating that guidelines may need to be revised. Larger studies involving multiple centers are necessary to assess this need.
Topics: Female; Humans; Infant, Newborn; Magnetic Resonance Imaging; Male; Physical Examination; Retrospective Studies; Sacrococcygeal Region; Spinal Dysraphism; Spine; Ultrasonography
PubMed: 27554766
DOI: 10.1177/0009922816664061 -
Medicina 2020
Topics: Humans; Immunoglobulin lambda-Chains; Magnetic Resonance Spectroscopy; Male; Middle Aged; Multiple Myeloma; Sacrococcygeal Region
PubMed: 32044748
DOI: No ID Found