-
International Journal of Surgery... Jan 2024
Topics: Humans; Pilonidal Sinus; Neoplasm Recurrence, Local; Wound Healing; Surgical Flaps; Skin Diseases
PubMed: 37738007
DOI: 10.1097/JS9.0000000000000768 -
Journal of Surgical Case Reports Sep 2023A 19-year-old male patient presented with a slow-growing mass on his scalp over a 10-year history. After resecting the mass, he was diagnosed with pilonidal cyst based...
A 19-year-old male patient presented with a slow-growing mass on his scalp over a 10-year history. After resecting the mass, he was diagnosed with pilonidal cyst based on the clinical and histological findings. An unusual pilonidal disease is observed on the scalp in this report.
PubMed: 37724067
DOI: 10.1093/jscr/rjad493 -
International Wound Journal Jan 2024Postoperative wound healing problems and recurrence remain common for pilonidal sinus disease (PSD). Our study aimed to examine the effect of comorbidities in addition...
Postoperative wound healing problems and recurrence remain common for pilonidal sinus disease (PSD). Our study aimed to examine the effect of comorbidities in addition to the classic known factors that may affect wound complications and recurrence after PSD surgery. We retrospectively analysed 282 adolescent patients operated on in our clinic between 2014 and 2021. We gathered the postoperative wound healing patterns of the patients under four groups. With a mean age of 15.49 ± 1.45, 59.9% (n = 169) were male, 40.1% (n = 113) were female and 23.8% (n = 67) had recurrence. When examined according to the wound healing groups, 53.5% (n = 151) had an uneventful wound, 22.6% (n = 64) had prolonged wound care, 17.7% (n = 50) of the postoperative wounds did not close and had a recurrence and 6% (n = 17) had recurrence after the wound was healed. The number of sinuses, abscess presentation and the incidence of comorbid disease in group 1 were found to be statistically significantly lower than all other groups. Seborrheic dermatitis, obesity and psychiatric diagnoses showed high statistical association with group 3 and acne with group 4. In patients with seborrheic dermatitis or psychiatric diagnosis, a significant correlation was found between wound healing according to the type of surgery (p < 0.05). The wound healing patterns of these patients after total excision and primary closure surgeries were included in Group 3 with a statistically significant high rate. As two new factors, the significance of the presence of seborrheic dermatitis and psychiatric comorbidities should be evaluated in these patients whose wounds remain open postoperatively and do not respond to primary wound care and eventually relapse. Further histologic and pathologic investigations are needed for seborrheic dermatitis and PSD relation. Awareness of these diseases may change the decision of the type of surgery, and their treatment within the same time may support wound healing and ultimately reduce recurrence.
Topics: Humans; Male; Female; Adolescent; Retrospective Studies; Dermatitis, Seborrheic; Pilonidal Sinus; Neoplasm Recurrence, Local; Wound Healing; Postoperative Complications; Recurrence; Treatment Outcome
PubMed: 37722760
DOI: 10.1111/iwj.14404 -
Cureus Aug 2023Background This study sought to determine the COVID-19 pandemic and vaccination's effects on the number of patients presenting with emergent surgical illnesses or...
Background This study sought to determine the COVID-19 pandemic and vaccination's effects on the number of patients presenting with emergent surgical illnesses or requiring emergency general surgical procedures. We compared the number of presenting cases and surgical emergencies before the pandemic, in 2019, and during the pandemic, before and after the COVID-19 vaccination's introduction. Method This observational retrospective chart review was conducted at a tertiary hospital in Al-Qassim, Saudi Arabia. The data were retrospectively collected for three periods (July 1 to September 30) in 2019, 2020, and 2021 using a data collection sheet for demographic data, visit date, comorbidities, emergency procedure type, COVID-19 test result, length of hospitalization, ICU admission status, and surgical case mortality. Results The study included 152 participants with a mean age of 36.1 (SD: 16) years, and 69.7% of them were male. Common surgical conditions were identified as acute appendicitis (49.3%), skin abscesses and pilonidal sinus (21.7%), and diabetic foot (9.2%) across all three years. The most frequent (48.7%) surgical procedure was appendectomy. A decrease in surgical emergencies rate was observed during the year 2020, as compared to 2019 and 2021. The general surgery emergency rate was highest in 2021 among patients admitted for procedures post-vaccination (38.8%). Conclusion Common surgical emergencies were most frequent in 2021, after the COVID-19 vaccine's introduction. Future research areas include the impact of the pandemic on delays or the severity and complication of surgical or medical cases.
PubMed: 37719613
DOI: 10.7759/cureus.43630 -
International Wound Journal Jan 2024Pilonidal sinus disease (PSD), a chronic inflammatory disease, affects the sacrococcygeal soft tissue, especially in young adults. The ideal treatment for PSD remains...
BACKGROUND
Pilonidal sinus disease (PSD), a chronic inflammatory disease, affects the sacrococcygeal soft tissue, especially in young adults. The ideal treatment for PSD remains divergence. This study evaluated the application of a simplified modified Limberg flap combined with vacuum-assisted closure for treating PSD.
METHODS
This prospective study was conducted from 1 June 2017 to 31 March 2022 in Changhai Hospital, Naval Military Medical University, Shanghai, China. The study included 88 male patients (91.7%) and 8 female patients (8.3%). The 96 patients ranged in age from 15 to 34 years (mean ± SD, 23 ± 4.4). Under general anaesthesia, all patients underwent simplified modified Limberg flap reconstruction with vacuum-assisted closure. The patient's weight, surgical time, extubation time, hospital stay, time to return to normal life or work, wound infection, wound dehiscence and recurrence rate were recorded. The visual analogue scale (VAS) score and the Vancouver scar score were used to score patients' pain and scars in the surgical area.
RESULTS
The volume of resected diseased tissue was 13.5-120 (mean ± SD, 34.993 ± 24.406) cm . The average surgical time during the treatment period was 97.68 ± 18.72 min, and the average extubation time was (6.36 ± 1.55) days, the mean hospital stay was 19.4 days; no patients were lost to follow-up. None of the patients experienced post-operative recurrence, wound infection, seroma or hematoma. Six patients (6.3%) experienced wound dehiscence at the flap tip around the natal cleft. The mean time to the resumption of daily activities was 26.3 days. The average VAS pain score was (6.00 ± 1.53) points, and the average Vancouver scar score was (5.96 ± 1.51) points, 12 patients (12.5%) were dissatisfied with their aesthetic results, and the average beauty satisfaction score is (6.64 ± 1.28) points.
CONCLUSIONS
Simplified modified Limberg flap reconstruction with vacuum-assisted closure surgery is an effective and innovative method for the treatment of PSD, with a low recurrence rate and rapid recovery.
Topics: Young Adult; Humans; Male; Female; Adolescent; Adult; Cicatrix; Pilonidal Sinus; Prospective Studies; Negative-Pressure Wound Therapy; China; Neoplasm Recurrence, Local; Postoperative Complications; Skin Diseases; Wound Infection; Pain; Recurrence; Treatment Outcome
PubMed: 37691134
DOI: 10.1111/iwj.14353 -
European Radiology Jan 2024To evaluate the interobserver agreement for the features of natal cleft pilonidal sinus disease (PSD) on magnetic resonance imaging (MRI) and propose a standardized...
OBJECTIVE
To evaluate the interobserver agreement for the features of natal cleft pilonidal sinus disease (PSD) on magnetic resonance imaging (MRI) and propose a standardized checklist for reporting PSD on MRI.
MATERIALS AND METHODS
Forty MRI studies of 39 discrete patients with PSD were retrospectively evaluated by five independent radiologists using a standardized checklist. Fleiss' Kappa (k) coefficients of agreement were used to test the agreement between categorical variables. The MRI features of the natal cleft sepsis associated with PSD were classified into four main categories: morphology, branching and extensions, external skin openings, and the relationship of the PSD to the coccyx. A survey was created and disseminated online among general surgeons who treat patients with PSD to assess the relevance of the MRI features proposed in the standardized checklist.
RESULTS
The overall agreement regarding the identification of morphology of the natal cleft sepsis was moderate (k = 0.59). Lateral and caudal extensions interobserver agreement was substantial (k = 0.64 and 0.71, respectively). However, the overall agreement regarding the individual parts of anal sphincter involved was moderate (k = 0.47). Substantial interobserver agreement was found in assessing the proximity of the PSD to the coccyx (k = 0.62).
CONCLUSION
Preoperative MRI can delineate the extensions and branching of PSD with substantial agreement. MRI is superior in describing the deep extensions of PSD with better reliability than assessing the number and locations of the external openings. Expert consensus agreement is needed to establish the MRI features necessary for optimal reporting of PSD.
CLINICAL RELEVANCE STATEMENT
MRI can offer valuable information about the extent of sepsis associated with pilonidal sinus disease, particularly in cases with involvement of critical anatomical structures such as the coccyx and anal triangle. MRI can potentially contribute to more accurate patient stratification and surgical planning.
KEY POINTS
• The interobserver agreement for assessing PSD's lateral and caudal extension on MRI is substantial. • MRI can describe deep extensions and branching of PSD with superior reliability than assessing the number and site of external openings. • Reporting the relationship between natal cleft sepsis in PSD and the anal region may influence the surgical approach and postoperative healing.
Topics: Humans; Retrospective Studies; Pilonidal Sinus; Observer Variation; Reproducibility of Results; Magnetic Resonance Imaging; Sepsis
PubMed: 37566273
DOI: 10.1007/s00330-023-10018-2 -
JAAD Case Reports Aug 2023
PubMed: 37555193
DOI: 10.1016/j.jdcr.2023.06.003 -
International Journal of Surgery Case... Aug 2023Fragmentation of the surgical drain is an unusual negative consequence of using a drainage system postoperatively. Even though it is rare, multiple management approaches...
BACKGROUND
Fragmentation of the surgical drain is an unusual negative consequence of using a drainage system postoperatively. Even though it is rare, multiple management approaches were documented in the literature.
CASE PRESENTATION
A 19-year-old male patient who had a history of recurrent pilonidal sinus disease that was operated on twice 4 months apart. He presented to our hospital for postoperative follow-up, during which the inserted drain was assessed. While withdrawing the drain, part of it was damaged and missed. The location of the misplaced drain was assessed by a lumbosacral region computed tomography (CT) scan. The decision was made to proceed with less invasive methods using interventional radiology techniques to avoid wide excision and incision reopening complications and prolonged healing time. A fluoroscopy procedure was performed to create three-dimensional anterolateral, frontal posterior views. Then the fragmented drain was retrieved successfully by a minimally invasive technique. The postoperative period was uneventful.
DISCUSSION
Drain fragmentation and/or dislodgement is a highly challenging event that requires highly innovative intervention. Multiple treatment options are available as open surgery techniques and endoscopic approaches.
CONCLUSION
This case highlights the potential role of fluoroscopy as an outstanding effective choice that could be carried out promptly and safely at the bedside under local anesthetic and reduce the patient's hospital stay.
PubMed: 37515851
DOI: 10.1016/j.ijscr.2023.108542 -
Cirugia Y Cirujanos 2023The aim of this study was to compare the effectiveness of crystallized phenol and laser in the treatment of sacrococcygeal pilonidal sinus (SPS) disease.
BACKGROUND
The aim of this study was to compare the effectiveness of crystallized phenol and laser in the treatment of sacrococcygeal pilonidal sinus (SPS) disease.
RESULTS
A total of 80 patients (40 crystallized phenol, 40 laser) were included in the study. The procedure time was significantly shorter in the crystallized phenol group than in the laser group (543 and 837 s, p < 0.001). While there was no significant difference in recurrence and patient satisfaction between the groups (p > 0.05), the visual pain scale pain score and post-procedural complications were significantly lower in the laser group (p < 0.05). There was no significant difference between the number of sinuses and recurrence, bleeding, pain, and patient satisfaction (p > 0.05).
CONCLUSIONS
Crystallized phenol and laser used in the treatment of SPS disease have a low recurrence and similar long-term patient satisfaction. However, laser treatment has fewer intraoperative complications and post-operative pain severity than crystallized phenol.
Topics: Humans; Phenol; Pilonidal Sinus; Treatment Outcome; Neoplasm Recurrence, Local; Phenols; Pain, Postoperative; Lasers; Recurrence; Sacrococcygeal Region
PubMed: 37440707
DOI: 10.24875/CIRU.22000461