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Pediatric Surgery International Oct 2023Patients with mild pilonidal disease often experience symptom resolution without excision. We hypothesized that treating symptom-free/asymptomatic pilonidal patients...
INTRODUCTION
Patients with mild pilonidal disease often experience symptom resolution without excision. We hypothesized that treating symptom-free/asymptomatic pilonidal patients with regular epilation alone had similar recurrence rate as patients who were also treated surgically.
METHOD
Patient data were prospectively collected 2/2019-11/2022 at our Pilonidal Clinic. All patients received regular epilation; all patients presented before 12/2020 also underwent pit excision using trephines. Starting 1/2021, only symptomatic patients underwent pit excision; symptom-free patients at presentation received only regular epilation. Recurrence rates were statistically analyzed.
RESULTS
255 patients (male:54.4%, female:45.6%), median age 17.3years (IQR:15.8-19.1) were followed for median 612.5days (IQR:367.5-847). 44.1% identified as Hispanic, 36.5% Caucasian, 17.1% Asian, 2.4% Black. Median symptom duration at presentation was 180.5days (IQR:44.5-542.5). 160 patients were initially treated with surgical excision and regular epilation, while 95 patients with regular epilation only. The failure rate between patients who received surgical excision initially and recurred (9.4%) and patients who received epilation only and recurred (12.6%) was similar, after controlling for sex, race, age, comorbidities, skin type, hair color, hair thickness (p > 0.05). Patients who recurred after only undergoing regular epilation all underwent surgical excision, median 100days (IQR:59.5-123.5) after initial presentation.
CONCLUSION
Regular epilation alone is an acceptable treatment for symptom-free pilonidal patients.
Topics: Humans; Male; Female; Adolescent; Hair Removal; Pilonidal Sinus; Ambulatory Care Facilities; Recurrence; Treatment Outcome
PubMed: 37906293
DOI: 10.1007/s00383-023-05577-w -
Colorectal Disease : the Official... Oct 2023
Topics: Humans; Pilonidal Sinus; Wound Healing; Surgeons; Skin Diseases; United Kingdom; Treatment Outcome; Recurrence
PubMed: 37905742
DOI: 10.1111/codi.16796 -
Journal of Oral and Maxillofacial... Jan 2024Pilonidal sinus is an acquired chronic inflammatory condition associated with the penetration of hair fragments into the skin. In the pathogenesis of most of these...
Pilonidal sinus is an acquired chronic inflammatory condition associated with the penetration of hair fragments into the skin. In the pathogenesis of most of these cases, a traumatic event initiates the process allowing the introduction of the hairs into the skin. We report an unusual case of acquired pilonidal sinus as a consequence of the unconscious habit of chewing on the hairs in a 12-year-old girl. Although most commonly located in the gluteal cleft, it has been reported in several areas of the body (including face), but to the best of our knowledge, this is the first report in the oral cavity. Our case presented as a palatal and vestibular fistula in a patient who suffered from an undiagnosed peculiar form of hair pulling disorder that involved hair chewing but not trichophagia.
Topics: Female; Humans; Child; Trichotillomania; Pilonidal Sinus; Hair; Habits; Mouth
PubMed: 37898155
DOI: 10.1016/j.joms.2023.09.023 -
The American Surgeon Apr 2024Deep and tunneling wounds are a challenge to apply and maintain most advanced wound dressings to promote effective healing. An autologous whole blood clot is a topical...
BACKGROUND
Deep and tunneling wounds are a challenge to apply and maintain most advanced wound dressings to promote effective healing. An autologous whole blood clot is a topical treatment and has been found to be safe and effective in healing cutaneous wounds. The active coagulation whole blood (ACWB) clot treatment, using the patient's own blood, is used to treat deep and tunneling wounds, by mixing the blood with coagulation components and applying it into the wound cavity allowing the clot to re-form inside the wound. We aimed to explore ACWB treatment in hard-to-heal wounds.
METHODS
5 patients with multiple comorbidities, exhibiting surgical abdominal wound, chronic pilonidal sinus, stage 4 sacral pressure ulcer with exposed bone, post-amputation surgical site wound, and non-healing wound dehiscence at the site of a prior hip replacement, were all treated with the ACWB clot treatment.
RESULTS
Complete wound healing was observed in 4/5 cases. In the fifth case, there was a 70% reduction in the depth and surface area of the abdominal surgical wound.
DISCUSSION
The ACWB treatment was found to be effective in deep wounds with cavities and exposed structures. ACWB, in its flowable form, can effectively provide coverage of the deepest interstices of the wound's cavities by virtue of its liquid properties, forming a fibrin matrix, mimicking the role of the extracellular matrix. The flowable formulation of ACWB treatment safely and efficiently provides coverage of the entirety of the wound surface to improve the time and process of complex wound surface healing.
Topics: Humans; Blood Coagulation; Wound Healing; Abdominal Injuries; Surgical Wound; Arthroplasty, Replacement, Hip
PubMed: 37878333
DOI: 10.1177/00031348231207293 -
Journal of Clinical Immunology Nov 2023GATA2 deficiency is a rare disorder encompassing a broadly variable phenotype and its clinical picture is continuously evolving. Since it was first described in 2011, up...
GATA2 deficiency is a rare disorder encompassing a broadly variable phenotype and its clinical picture is continuously evolving. Since it was first described in 2011, up to 500 patients have been reported. Here, we describe a cohort of 31 Italian patients (26 families) with molecular diagnosis of GATA2 deficiency. Patients were recruited contacting all the Italian Association of Pediatric Hematology and Oncology (AIEOP) centers, the Hematology Department in their institution and Italian societies involved in the field of vascular anomalies, otorhinolaryngology, dermatology, infectious and respiratory diseases. Median age at the time of first manifestation, molecular diagnosis and last follow-up visit was 12.5 (age-range, 2-52 years), 18 (age-range, 7-64 years) and 22 years (age-range, 3-64), respectively. Infections (39%), hematological malignancies (23%) and undefined cytopenia (16%) were the most frequent symptoms at the onset of the disease. The majority of patients (55%) underwent hematopoietic stem cell transplantation. During the follow-up rarer manifestations emerged. The clinical penetrance was highly variable, with the coexistence of severely affected pediatric patients and asymptomatic adults in the same pedigree. Two individuals remained asymptomatic at the last follow-up visit. Our study highlights new (pilonidal cyst/sacrococcygeal fistula, cholangiocarcinoma and gastric adenocarcinoma) phenotypes and show that lymphedema may be associated with null/regulatory mutations. Countrywide studies providing long prospective follow-up are essential to unveil the exact burden of rarer manifestations and the natural history in GATA2 deficiency.
Topics: Adolescent; Adult; Child; Child, Preschool; Humans; Middle Aged; Young Adult; GATA2 Deficiency; Genetic Association Studies; Hematopoietic Stem Cell Transplantation; Italy; Prospective Studies
PubMed: 37837580
DOI: 10.1007/s10875-023-01583-8 -
ANZ Journal of Surgery Feb 2024Sacrococcygeal pilonidal sinus is a common surgical condition that requires various treatment options. This study aims to investigate the short and long-term outcomes of...
BACKGROUND
Sacrococcygeal pilonidal sinus is a common surgical condition that requires various treatment options. This study aims to investigate the short and long-term outcomes of the modified Karydakis flap method in patients with sacrococcygeal pilonidal sinus.
METHODS
A retrospective analysis was conducted on 175 patients who underwent the modified Karydakis flap method for sacrococcygeal pilonidal sinus by a single surgeon between September 2015 and February 2021. The patients' demographics, operative time, hospitalization time and complications were recorded.
RESULTS
Of the 175 patients, 125 (71.43%) were male and 50 (28.57%) were female, with a mean age of 24.93 ± 10.27 years. The mean operative time was 55.05 ± 12.33 min, the follow-up time was 39.21 ± 17.58 months, and the mean hospitalization time was 3.4 ± 1.65 days. Complications were observed in 12 (6.85%) patients, including seroma (5.14%) and wound infection (1.71%), with no observed cases of flap necrosis or recurrence.
CONCLUSION
The modified Karydakis flap method appears to be a safe and effective treatment option for sacrococcygeal pilonidal sinus, with an acceptable complication rate and no observed cases of recurrence.
Topics: Humans; Male; Female; Adolescent; Young Adult; Adult; Pilonidal Sinus; Retrospective Studies; Surgical Flaps; Postoperative Complications; Treatment Outcome; Recurrence; Sacrococcygeal Region
PubMed: 37837259
DOI: 10.1111/ans.18738 -
Lakartidningen Oct 2023Umbilical pilonidal sinus is a rare diagnosis which is characterized by an inflammatory granulomatous reaction to hair shafts penetrating the epidermis. It is most often...
Umbilical pilonidal sinus is a rare diagnosis which is characterized by an inflammatory granulomatous reaction to hair shafts penetrating the epidermis. It is most often seen in adolescent male with a hairy abdomen. The patients often present with a history of pain and umbilical discharge. Conservative treatment with hair extraction and personal hygiene is prioritized and surgery is only recommended in recurrent cases. Here one such case is presented, which was resistant to conservative treatment and where surgical excision and primary repair was indicated. No recurrence was observed 6 months postoperatively.
Topics: Adolescent; Humans; Male; Pilonidal Sinus; Rare Diseases; Umbilicus; Treatment Outcome
PubMed: 37818822
DOI: No ID Found -
Journal of Pediatric Surgery Feb 2024
Topics: Humans; Neoplasm Recurrence, Local; Laser Therapy; Hair; Lasers; Pilonidal Sinus; Treatment Outcome; Recurrence
PubMed: 37813716
DOI: 10.1016/j.jpedsurg.2023.09.005 -
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: 37797882
DOI: 10.1016/j.ad.2023.09.021 -
Colorectal Disease : the Official... Nov 2023Pilonidal disease (PD) is a common debilitating condition frequently seen in surgical practice. Several available treatments carry different benefit/risk balances. The...
AIM
Pilonidal disease (PD) is a common debilitating condition frequently seen in surgical practice. Several available treatments carry different benefit/risk balances. The aim of this study was to snapshot the current management of PD across European countries.
METHOD
Members affiliated to the European Society of Coloproctology were invited to join the survey. An invitation was extended to others via social media. The predictive power of respondents' and hospitals' demographics on the change of therapeutic approach was explored.
RESULTS
Respondents (n = 452) were mostly men (77%), aged 26-60 years, practising in both academic and public hospitals and with fair distribution between colorectal (51%) and general (48%) surgeons. A total of 331 (73%) respondents recommended surgery at first presentation of the disease. Up to 80% of them recommended antibiotic therapy and 95% did not use any classification of PD. A primary closure technique was the preferred procedure (29%), followed by open technique (22%), flap creation (7%), sinusectomy (7%) and marsupialization (7%). Approximately 27% of subjects would choose the same surgical technique even after a failure. Almost half (46%) perform surgery as office based. A conservative approach was negatively associated with acutely presenting PD (p < 0.001). Respondents who were not considering tailored surgery based on patient presentation tended to change their approach in the case of a failed procedure.
CONCLUSION
With the caveat of a heterogeneous number of respondents across countries, the results of our snapshot survey may inform the development of future guidelines.
Topics: Male; Humans; Female; Surveys and Questionnaires; Surgical Flaps; Wound Closure Techniques; Europe; Skin Diseases; Pilonidal Sinus; Recurrence
PubMed: 37794562
DOI: 10.1111/codi.16760