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Cureus Nov 2023We report an unusual case of the vulval sinus with persistent seroanguinous discharge in a 59-year-old postmenopausal woman. Examination revealed a 9-cm isolated sinus...
We report an unusual case of the vulval sinus with persistent seroanguinous discharge in a 59-year-old postmenopausal woman. Examination revealed a 9-cm isolated sinus tract in the right labiocrural fold. This sinus tract was excised under anesthesia. Histological analysis showed skin with a deep dermal sinus tract showing edematous and heavily inflamed granulation tissue. There was no evidence of malignancy or dysplasia. Hidradenitis was ruled out on histology. This case report summarizes the importance of early diagnosis and prompt treatment involving complete excision of the vulval sinus to reduce long-term morbidity and consequences of this rare entity.
PubMed: 38060761
DOI: 10.7759/cureus.48355 -
Actas Dermo-sifiliograficas Feb 2024In 2013, Canoui-Poitrine et al. identified three hidradenitis suppurativa (HS) phenotypes by a latent class (LC) analysis, based on anatomical sites of involvement.
BACKGROUND
In 2013, Canoui-Poitrine et al. identified three hidradenitis suppurativa (HS) phenotypes by a latent class (LC) analysis, based on anatomical sites of involvement.
OBJECTIVE
To improve the classification of the gluteal phenotype (LC3) patients given their diverse lesion types and differences in clinical profile.
MATERIAL AND METHODS
We designed a bicentric study gathering all LC3 patients (n=83) from two hospitals. We conducted a two-step cluster analysis among them and also compared their characteristics with the rest of the HS patients (n=661).
RESULTS
Compared with global HS series, LC3 patients were more frequently non-obese men, with smoking habit, an associated arthropathy, and a more frequent history of pilonidal sinus. The analysis of LC3 patients yielded two clusters: cluster 1 (38.3%) included elderly female patients, with later diagnosis of the disease and more sinus tracts; cluster 2 (61.7%) encompassed more men with earlier disease onset and more nodules and folliculitis lesions.
LIMITATIONS
The study's limitations include its retrospective nature, bicentric design, and small sample size.
CONCLUSION
The heterogeneous clinical presentation of HS makes it essential to have a good classification of the patients. Gluteal phenotype could actually be classified into two "subphenotypes" with a different clinical profiles and management.
Topics: Male; Humans; Female; Aged; Hidradenitis Suppurativa; Retrospective Studies; Hospitals; Severity of Illness Index
PubMed: 38048948
DOI: 10.1016/j.ad.2023.11.003 -
Cureus Oct 2023Background Pilonidal sinus disease (PSD) is a chronic skin condition caused by hair retention that affects the sacrococcygeal cleft. The purpose of this study is to...
Background Pilonidal sinus disease (PSD) is a chronic skin condition caused by hair retention that affects the sacrococcygeal cleft. The purpose of this study is to compare the efficacy of negative pressure wound therapy (NPWT) to routine daily dressings (DDs) in wound healing after complex or infected pilonidal sinus tract excision. Materials and methods The study included 81 individuals who had extensive local excisions for pilonidal sinuses that were complex or infected. Randomly selected participants were given either NPWT or the usual dressing. Between the two groups, the length of hospitalization, the amount of time needed to resume daily activities, and the amount of time needed for full wound closure were compared. Results Forty-two patients received NPWT, while 39 patients received DDs as usual. There was no discernible difference between the two groups in terms of operating time or hospital stay. However, patients who underwent NPWT experienced a quicker final wound closure (59.24 ± 10.21 days compared to routine DD with a mean time of 75.31 ± 14.68 days, P = 0.001) and returned to normal activities earlier (17.36 versus 21.75 days in NPWT and routine DD, respectively). Conclusion Compared to patients who received standard DDs, those who were postoperatively managed with NPWT showed faster wound healing and return to normal activities. Whenever feasible, this strategy may be employed to improve patient recovery.
PubMed: 38034161
DOI: 10.7759/cureus.48049 -
Zhonghua Wei Chang Wai Ke Za Zhi =... Nov 2023Sacrococcygeal pilonidal disease(SPD) is an acquired disease intimately related to the presence of hair in the gluteal groove. Although its pathogenesis is still...
Sacrococcygeal pilonidal disease(SPD) is an acquired disease intimately related to the presence of hair in the gluteal groove. Although its pathogenesis is still controversial, numerous treatment options are available for SPD including gluteal groove and surrounding skin hair removal, sinusectomy, open healing by secondary intention, primary closure, and local excision with flap reconstruction. Lacking of standardized diagnosis and treatment processes of SPD in China, Chinese Medical Doctor Association Anorectal Branch and its Clinical Guidelines Committee jointly organized experts in this field to form expert consensus opinion on the basis of summarizing latest research progress in China and abroad, experts' clinical experience and principles of evidence-based medicine. The expert group formed opinion in 12 terms of SPD diagnosis, risk factors, non-surgical treatment, surgical treatment, minimally invasive treatment, and wound management, and developed the "Chinese expert consensus on the diagnosis and treatment of sacrococcygeal pilonidal disease (2023 edition)" after rounds of discussion and revision, to improve the diagnosis and treatment of SPD.
Topics: Humans; Consensus; Surgical Flaps; Wound Healing; China; Pilonidal Sinus
PubMed: 37974345
DOI: 10.3760/cma.j.cn441530-20231007-00116 -
Surgical Laparoscopy, Endoscopy &... Feb 2024We aimed to compare endoscopic pilonidal sinus treatment (EPSIT) and pit/sinus punch needle excision, brushing, ablation and irrigation (PEBAI) method that was performed...
PURPOSE
We aimed to compare endoscopic pilonidal sinus treatment (EPSIT) and pit/sinus punch needle excision, brushing, ablation and irrigation (PEBAI) method that was performed with principles similar to EPSIT but without fistuloscope and vision in the treatment of pilonidal sinus disease (PSD).
METHODS
Patients who underwent EPSIT and PEBAI methods for PSD in a single center between January 2020 and October 2021 were retrospectively analyzed. The primary endpoint was healing, the secondary endpoints were operative time, pain, wound closure, quality of life, cosmetic results, and cost.
RESULTS
One hundred 4 patients who underwent EPSIT and 184 patients who underwent PEBAI were included in the study. Age ( P =0.871), sex ( P =0.669), BMI ( P =0.176), number of pits ( P =0.99) were similar in both groups. The operative time for PEBAI [20 min (18 to 32)] was shorter than EPSIT [32 min (24 to 44)] ( P <0.0000, u value=3096, z-score=-9.459). Postoperative first ( P =0.147) and 14th day( P =0.382) pain scores, postoperative analgesic requirements ( P =0.609), time to return to daily activities ( P =0.747), time to return to work ( P =0.345), and wound complications ( P =0.816) were similar, whereas the wound closure time was earlier after EPSIT [32 d (24 to 41)] than after PEBAI [37 d (26 to 58)] ( P <0.00001, u value=5344, z-score=6.22141). The median follow-up was 24 (12 to 34) months. Complete wound healing ( P =0.382), recurrence rate ( P =0.533), quality of life at first month and (Wound evaluation scale score at first year ( P =0.252) were similar in both groups. However, the cost of PEBAI [54.8 € (50.13 to 64.96)] was significantly lower than cost of EPSIT [147.36 € (132.53 to 169.60)] ( P <0.00001, u value=0, z-score=7.210).
CONCLUSIONS
PEBAI method is a cheaper alternative to EPSIT with similar surgical principles and clinical outcomes.
Topics: Humans; Pilonidal Sinus; Quality of Life; Retrospective Studies; Treatment Outcome; Pain; Recurrence
PubMed: 37971236
DOI: 10.1097/SLE.0000000000001245 -
Revista Da Associacao Medica Brasileira... 2023We investigated the effectiveness of combining laser treatment with phenol in the management of pilonidal sinus.
OBJECTIVE
We investigated the effectiveness of combining laser treatment with phenol in the management of pilonidal sinus.
METHODS
We present here a retrospective analysis of patients with pilonidal sinus disease who were treated in the general surgery clinic of the Balikesir University Hospital between October 2019 and February 2022.
RESULTS
Recurrence was observed in three patients (13.6%) in the laser treatment group and one patient (4.8%) in the laser-phenol treatment group after the fourth month. Notably, 22 (91.7%) patients in the laser treatment group and 21 (95.5%) patients in the laser-phenol treatment group had complete healing.
CONCLUSION
Although not statistically significant, the laser-phenol treatment group exhibited a lower recurrence rate and a higher complete healing rate.
Topics: Humans; Phenol; Retrospective Studies; Pilonidal Sinus; Treatment Outcome; Neoplasm Recurrence, Local; Phenols; Lasers; Skin Diseases; Recurrence
PubMed: 37971129
DOI: 10.1590/1806-9282.20230740 -
Skeletal Radiology Jul 2024Chordomas are rare, low-grade malignant tumors often found in the sacrococcygeal region and prone to local recurrence. We report an atypical presentation of a...
Chordomas are rare, low-grade malignant tumors often found in the sacrococcygeal region and prone to local recurrence. We report an atypical presentation of a 40-year-old patient with a symptomatic midline retrococcygeal lesion that was presumptively treated as a pilonidal cyst due to its clinical and imaging features. After surgical pathology rendered the diagnosis of chordoma, the patient required salvage surgery in the form of partial sacrectomy with soft tissue flap coverage. In addition to the unusually predominant retrococcygeal location, surgical pathology identified an intervertebral disc origin rather than the typical osseous origin. To our knowledge, this presentation of chordoma with coccygeal intervertebral origin and a large subcutaneous mass at imaging has rarely been reported in the literature. We describe this case to raise awareness of atypical presentations of sacrococcygeal chordoma that may lead to erroneous presumptive diagnosis and treatment.
Topics: Humans; Pilonidal Sinus; Diagnosis, Differential; Adult; Chordoma; Sacrococcygeal Region; Male; Magnetic Resonance Imaging; Spinal Neoplasms; Tomography, X-Ray Computed
PubMed: 37953332
DOI: 10.1007/s00256-023-04492-4 -
JAMA Surgery Jan 2024Recurrence continues to be a significant challenge in the treatment and management of pilonidal disease. (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Recurrence continues to be a significant challenge in the treatment and management of pilonidal disease.
OBJECTIVE
To compare the effectiveness of laser epilation (LE) as an adjunct to standard care vs standard care alone in preventing recurrence of pilonidal disease in adolescents and young adults.
DESIGN, SETTING, AND PARTICIPANTS
This was a single-institution, randomized clinical trial with 1-year follow-up conducted from September 2017 to September 2022. Patients aged 11 to 21 years with pilonidal disease were recruited from a single tertiary children's hospital.
INTERVENTION
LE and standard care (improved hygiene and mechanical or chemical depilation) or standard care alone.
MAIN OUTCOMES AND MEASURES
The primary outcome was the rate of recurrence of pilonidal disease at 1 year. Secondary outcomes assessed during the 1-year follow-up included disability days, health-related quality of life (HRQOL), health care satisfaction, disease-related attitudes and perceived stigma, and rates of procedures, surgical excisions, and postoperative complications.
RESULTS
A total of 302 participants (median [IQR] age, 17 [15-18] years; 157 male [56.1%]) with pilonidal disease were enrolled; 151 participants were randomly assigned to each intervention group. One-year follow-up was available for 96 patients (63.6%) in the LE group and 134 (88.7%) in the standard care group. The proportion of patients who experienced a recurrence within 1 year was significantly lower in the LE treatment arm than in the standard care arm (-23.2%; 95% CI, -33.2 to -13.1; P < .001). Over 1 year, there were no differences between groups in either patient or caregiver disability days, or patient- or caregiver-reported HRQOL, health care satisfaction, or perceived stigma at any time point. The LE group had significantly higher Child Attitude Toward Illness Scores (CATIS) at 6 months (median [IQR], 3.8 [3.4-4.2] vs 3.6 [3.2-4.1]; P = .01). There were no differences between groups in disease-related health care utilization, disease-related procedures, or postoperative complications.
CONCLUSIONS AND RELEVANCE
LE as an adjunct to standard care significantly reduced 1-year recurrence rates of pilonidal disease compared with standard care alone. These results provide further evidence that LE is safe and well tolerated in patients with pilonidal disease. LE should be considered a standard treatment modality for patients with pilonidal disease and should be available as an initial treatment option or adjunct treatment modality for all eligible patients.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT03276065.
Topics: Child; Humans; Male; Adolescent; Young Adult; Hair Removal; Quality of Life; Pilonidal Sinus; Neoplasm Recurrence, Local; Postoperative Complications; Lasers; Recurrence; Treatment Outcome
PubMed: 37938854
DOI: 10.1001/jamasurg.2023.5526 -
Techniques in Coloproctology Dec 2023Non-excisional techniques for pilonidal sinus disease (PSD) have gained popularity over the last years. The aim of this study was to review short and long-term outcomes... (Review)
Review
Non-excisional techniques for pilonidal sinus disease (PSD) have gained popularity over the last years. The aim of this study was to review short and long-term outcomes for non-excisional techniques with special focus on the additive effect of treatment of the inner lining of the sinus cavity and the difference between primary and recurrent PSD. A systematic search was conducted in Embase, Medline, Web of Science Core Collection, Cochrane and Google Scholar databases for studies on non-excisional techniques for PSD including pit picking techniques with or without additional laser or phenol treatment, unroofing, endoscopic techniques and thrombin gelatin matrix application. Outcomes were recurrence rates, healing rates, complication rates, wound healing times and time taken to return to daily activities. In total, 31 studies comprising 8100 patients were included. Non-excisional techniques had overall healing rates ranging from 67 to 100%. Recurrence rates for pit picking, unroofing and gelatin matrix application varied from 0 to 16% depending on the follow-up time. Recurrence rates after additional laser, phenol and endoscopic techniques varied from 0 to 29%. Complication rates ranged from 0 to 16%, and the wound healing time was between three and forty-seven days. The return to daily activities varied from one to nine days. Non-excisional techniques are associated with fast recovery and low morbidity but recurrence rates are high. Techniques that attempt to additionally treat the inner lining of the sinus have worse recurrence rates than pit picking alone. Recurrence rates do not differ between primary and recurrent disease.
Topics: Humans; Pilonidal Sinus; Gelatin; Neoplasm Recurrence, Local; Wound Healing; Phenol; Recurrence; Treatment Outcome
PubMed: 37930579
DOI: 10.1007/s10151-023-02870-7 -
The American Surgeon Apr 2024The sacrococcygeal area supports the lower body and endures mechanical forces during movement. However, current treatment methods for deep caudal sacrococcygeal defects...
The sacrococcygeal area supports the lower body and endures mechanical forces during movement. However, current treatment methods for deep caudal sacrococcygeal defects have limitations, resulting in insufficient tissue for deep pocket obliteration and considering only the two-dimensional advancement plane in a three-dimensional defect topology. Our study proposes using a rotational V-Y fasciocutaneous advancement island flap to reconstruct deep caudal sacrococcygeal defects. By considering the three-dimensional nature of the defect, we distinguish a coccygeal plane of the V-Y flap from a sacral plane and set different directions and depths of movement for each plane. From March 2016 to July 2022, 12 patients underwent successful treatment with this surgery, and no complications or recurrences were observed in the study group. Our research found that patients in our study exhibited a smaller intercoccygeal angle than the average angle of the general Korean population, as previously reported. This implies a more pronounced curvature between the sacral and coccygeal planes. Therefore, our methods, which consider the three-dimensional structures of sacrococcygeal pathology, are significant. This technique provides a mechanically robust reconstruction after resecting deep sacrococcygeal pathology, with well-padded tissue to prevent dead space and wound disruption.
Topics: Humans; Postoperative Complications; Pressure Ulcer; Sacrococcygeal Region; Surgical Flaps
PubMed: 37914195
DOI: 10.1177/00031348231211034