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Cureus Apr 2024Pilonidal sinus (PNS) is a common occurrence in young men. It is often caused by blockage of the sebaceous glands in the hair follicles in the sacrococcygeal area....
Pilonidal sinus (PNS) is a common occurrence in young men. It is often caused by blockage of the sebaceous glands in the hair follicles in the sacrococcygeal area. Hemophilia type A is a hemorrhagic disorder caused by a deficiency of factor VIII. It presents with excessive bleeding, either spontaneously or secondary to trauma. The mainstay of treatment for PNS is often excision of the sinus; however, recently, laser ablation has started to be commonly used. In this article, we present a case of a young man with hemophilia A presenting with recurrent PNS successfully managed with laser ablation with no complications.
PubMed: 38800275
DOI: 10.7759/cureus.59092 -
Diagnostics (Basel, Switzerland) May 2024Caudal regression syndrome (CRS) is a rare congenital malformation characterized by incomplete development of the lower spine and spinal cord. Its estimated incidence...
Caudal regression syndrome (CRS) is a rare congenital malformation characterized by incomplete development of the lower spine and spinal cord. Its estimated incidence ranges from 1 to 2 per 100,000 live births, leading to a spectrum of clinical presentations. Although most cases are diagnosed during childhood, only a small number of cases have been documented in adults in the medical literature. A 27-year-old woman underwent an outpatient magnetic resonance imaging (MRI) of the thoracolumbar spine due to severe lower back pain experienced for the first time. Despite congenital leg abnormalities and multiple childhood surgeries, no further investigations were conducted at that time. MRI revealed congenital anomalies consistent with CRS, including coccygeal agenesis, L5 sacralization, and spinal cord defects. The patient also had a long-standing pilonidal cyst treated conservatively, now requiring operative treatment due to an abscess. This report underscores a rare case of CRS initially misdiagnosed and mistreated over many years. It emphasizes the importance of considering less common diagnoses, especially when initial investigations yield inconclusive results. This clinical case demonstrates a highly valuable and educative radiological finding. In the literature, such cases with radiological findings in adults are still lacking.
PubMed: 38786298
DOI: 10.3390/diagnostics14101000 -
Anales Del Sistema Sanitario de Navarra Apr 2024Currently, the focus regarding pilonidal sinus disease is put on the treatment techniques. The aim of the study is to compare postoperative long-term complications and... (Randomized Controlled Trial)
Randomized Controlled Trial Comparative Study
BACKGROUND
Currently, the focus regarding pilonidal sinus disease is put on the treatment techniques. The aim of the study is to compare postoperative long-term complications and recurrence of two surgical techniques.
MATERIAL AND METHODS
From February 2015 to December 2020, male patients with pilonidal sinus disease attended at two general surgery outpatient centers were randomly assigned to either Group 1 (n=80; excision and primary closure) or Group 2 (n=80; excision and midline closure without skin sutures). Patients with recurrent or complicated pilonidal sinus or with prior surgical procedures were excluded from the study. Intergroup postoperative results and recurrence throughout the follow-up period were analyzed.
RESULTS
Significant decrease (p<0.001) in the duration of the surgical procedure (35 to 25 minutes), length of hospital stay (one day to the day of the surgery), and of the time required to return to work (15 to 12 days) was seen for Group 2 patients. The complication rate (wound infection and seroma) was lower in Group 2 compared to Group 1 (n = 3; 3.7% vs n = 10; 12.5%; p = 0.014). During the five-year mean follow-up, five patients (6.2%) in Group 1 had recurrence compared to none in Group 2 (p = 0.023).
CONCLUSIONS
Midline primary closure method without skin sutures - easy to learn and implement and has no complication or recurrence in the long-term follow-up - may be an ideal method in cases where excision and primary repair is planned, especially in patients with sinus orifices located in the midline.
Topics: Humans; Pilonidal Sinus; Male; Adult; Recurrence; Young Adult; Treatment Outcome; Postoperative Complications; Wound Closure Techniques; Follow-Up Studies; Time Factors; Length of Stay; Suture Techniques; Operative Time
PubMed: 38725367
DOI: 10.23938/ASSN.1073 -
Annals of Medicine and Surgery (2012) May 2024The most important step in treating a pilonidal sinus is eradication by surgical excision. Over the years, various surgical techniques have been reported for wound...
BACKGROUND
The most important step in treating a pilonidal sinus is eradication by surgical excision. Over the years, various surgical techniques have been reported for wound closure, yet their management still poses a challenge. The current study compares the results of two different methods of wound management: secondary wound healing versus the Z-plasty surgical technique.
MATERIAL AND METHOD
The current clinical trial recruited 84 uncomplicated pilonidal sinus patients who were to undergo complete surgical excision of the pilonidal sinus. For wound healing, the 84 subjects were equally divided into two groups of 42 patients each. One group was selected for Z-plasty surgical wound closure and the other for the secondary healing mechanism. Outcomes measured consisted of demographic data, length of operation, complications, severity of pain, number of dressings, recurrence, and complete healing time.
RESULT
Age or sex distribution and the median BMI (kg/m²) did not significantly differ between the two groups. The length of the operation for Z-plasty subjects was significantly longer ( <0.0001). The median number of dressing changes for secondary wound healing patients was 38.69, which was significantly higher than the 4.95 dressing changes for the Z-plasty group. The total time recorded for complete wound healing was 21.61±4.27 days in the Z-plasty group and 41.23±24.28 days for secondary wound healing subjects, which was statistically significant. Twenty-four hours postoperation, patients in the secondary wound healing group had significantly more pain, and the Visual Analogue Scale scores of the Z-plasty and secondary wound healing groups were 3.42±0.76 and 6.09±1.2, respectively. Concerning the recurrence rate, there were no significant differences between the two groups. SPSS version 22 performed the analyses, and the independent -test compared the continuous variables. A value less than 0.05 was considered statistically significant.
CONCLUSION
Z-plasty is a safe and effective procedure in terms of wound complications and recurrence rate. This method is also cost-effective and better received by patients.
PubMed: 38694311
DOI: 10.1097/MS9.0000000000001866 -
The Journal of International Medical... Mar 2024This study was performed to compare the effectiveness of laser obliteration with limited excision (LOLE) versus wide excision (WE) of the pilonidal sinus. (Observational Study)
Observational Study
OBJECTIVE
This study was performed to compare the effectiveness of laser obliteration with limited excision (LOLE) versus wide excision (WE) of the pilonidal sinus.
METHODS
A prospective, cross-sectional observational study of 152 patients with chronic pilonidal sinus disease was performed from September 2019 to September 2022. Of the 152 patients, 76 underwent LOLE and 76 underwent WE. The main evaluation criteria were complete wound healing, recurrence, and the complication rate.
RESULTS
Complete healing was achieved in 74 (97.4%) patients in the LOLE group and 76 (100%) patients in the WE group. The duration of wound healing was significantly shorter in the LOLE group than in the WE group (6.5 ± 2.4 vs. 14.5 ± 2.6 weeks, respectively). Recurrence developed in six (7.9%) patients in the LOLE group and one (1.3%) patient in the WE group, with no significant difference.
CONCLUSION
According to our study and the data available in the literature, laser surgery should be included in the guidelines for the treatment and management of pilonidal disease.
Topics: Humans; Pilonidal Sinus; Prospective Studies; Cross-Sectional Studies; Neoplasm Recurrence, Local; Lasers; Recurrence; Treatment Outcome
PubMed: 38530042
DOI: 10.1177/03000605241236057 -
Updates in Surgery Jun 2024Pilonidal disease is a common condition that commonly affects the younger adult population and is often seen in both the general practice and the hospital setting.... (Review)
Review
Pilonidal disease is a common condition that commonly affects the younger adult population and is often seen in both the general practice and the hospital setting. Multiple treatment methods have gained and lost popularity over the last several decades, but more recent intervention principles show promising results. This article details the different methods of managing acute and chronic pilonidal disease ranging from treatments in the primary care setting to those in hospital theatres, with special attention to newer modalities of minimally invasive interventions. As a chronic illness that often affects those of working age, pilonidal disease can confer significant morbidity especially, but not limited to, a substantial amount of time off work. Treatment of chronic disease in particular, has evolved from midline techniques to off-midline techniques, with more recent developments offering promising solutions to reduce acute flare ups and hasten recovery time.
Topics: Pilonidal Sinus; Humans; Chronic Disease; Minimally Invasive Surgical Procedures; Acute Disease
PubMed: 38526695
DOI: 10.1007/s13304-024-01799-2 -
The British Journal of Surgery Mar 2024
Topics: Humans; Wound Healing; Pilonidal Sinus; Recurrence
PubMed: 38518113
DOI: 10.1093/bjs/znae054 -
The British Journal of Surgery Mar 2024Numerous surgical approaches exist for the treatment of pilonidal disease. Current literature on treatment is of poor quality, limiting the ability to define optimal...
BACKGROUND
Numerous surgical approaches exist for the treatment of pilonidal disease. Current literature on treatment is of poor quality, limiting the ability to define optimal intervention. The aim of this study was to provide real-world data on current surgical practice and report patient and risk-adjusted outcomes, informing future trial design.
METHODS
This UK-wide multicentre prospective cohort study, including patients (aged over 16 years) who had definitive treatment for symptomatic pilonidal disease, was conducted between May 2019 and March 2022. Patient and disease characteristics, and intervention details were analysed. Data on patient-reported outcomes, including pain, complications, treatment failure, wound issues, and quality of life, were gathered at various time points up to 6 months after surgery. Strategies were implemented to adjust for risk influencing different treatment choices and outcomes.
RESULTS
Of the 667 participants consenting, 574 (86.1%) were followed up to the study end. Twelve interventions were observed. Broadly, 59.5% underwent major excisional surgery and 40.5% minimally invasive surgery. Complications occurred in 45.1% of the cohort. Those who had minimally invasive procedures had better quality of life and, after risk adjustment, less pain (score on day 1: mean difference 1.58, 95% c.i. 1.14 to 2.01), fewer complications (difference 17.5 (95% c.i. 9.1 to 25.9)%), more rapid return to normal activities (mean difference 25.9 (18.4 to 33.4) days) but a rate of higher treatment failure (difference 9.6 (95% c.i. 17.3 to 1.9)%). At study end, 25% reported an unhealed wound and 10% had not returned to normal activities.
CONCLUSION
The burden after surgery for pilonidal disease is high and treatment failure is common. Minimally invasive techniques may improve outcomes at the expense of a 10% higher risk of treatment failure.
Topics: Humans; Aged; Treatment Outcome; Prospective Studies; Pilonidal Sinus; Quality of Life; Neoplasm Recurrence, Local; Pain; Recurrence
PubMed: 38488204
DOI: 10.1093/bjs/znae009 -
International Journal of Surgery Case... Mar 2024Pilonidal sinus is a condition that causes inflammation and abscesses in the sacral region and affects adolescents and young adults. The etiology of this condition...
INTRODUCTION
Pilonidal sinus is a condition that causes inflammation and abscesses in the sacral region and affects adolescents and young adults. The etiology of this condition remains controversial.
CASE PRESENTATION
A six year old boy was observed to have an orifice in the frontonasal region which contained hair. He had two previous infections which were treated with antibiotics. Magnetic Resonance Imaging showed no cranial malformations. Surgery was performed under general anesthesia and the pilonidal sinus was completely excised. At follow-up the child was in good health.
CLINICAL DISCUSSION
This case in a child with a frontonasal skin anomaly highlights that skin anomalies may be a cause of pilonidal sinus.
CONCLUSION
Skin malformations can be the underlying cause of pilonidal sinus in some cases.
PubMed: 38430899
DOI: 10.1016/j.ijscr.2024.109444