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Towfighi P, Huffman SS, Sayyed AA, Suvarnakar AM, Abdou S, Fitzgibbons SC, Drew EL, Youn RC, Kleiber GM. Propeller Flap Reconstruction Following Pilonidal Cyst Excision: A Single-Center Experience With Same-Day Discharge. Ann Plast Surg 2024; 93:89-93. [PMID: 38885167 DOI: 10.1097/sap.0000000000003973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
INTRODUCTION Reconstruction following pilonidal cyst resection must balance risk of recurrence, healing time, and resumption of functional routine. Propeller flaps provide a reliable and effective reconstructive option. This study highlights our experience with propeller flap reconstruction following pilonidal cyst resection and demonstrates the efficacy of same-day discharge. METHODS A single-institution retrospective chart review was performed for propeller flap reconstructions completed from March 2018 to July 2022. Patient demographics, pilonidal cyst details, operative details, and postoperative outcomes were collected. Primary outcomes included flap survival, flap complications, and pilonidal disease recurrence. RESULTS Twenty-eight outpatient propeller flap reconstructions following pilonidal cyst resections were identified in 26 patients, with two patients receiving a second propeller flap due to recurrence. Most patients were male (n = 15, 57.7%) with a mean age at time of index operation of 25.5 ± 5.8 years and mean body mass index of 26.5 ± 4.1 kg/m2. Mean symptom duration prior to index surgery was 39.3 months. Mean skin defect size following resection was 28.3 ± 15.3 cm2, with a mean flap size of 44.7 ± 35.5 cm2. Flap survival was 100% (n = 28), with five flaps (17.9%) experiencing minor wound complications and one patient (3.8%) requiring return to the operating room. Mean time to functional improvement was 24.0 ± 22.8 days. Pilonidal disease recurrence occurred in three patients (11.5%). Mean follow-up was 4.1 ± 5.4 months. CONCLUSIONS Propeller flaps provide a successful and reliable reconstructive option for pilonidal disease defects. Because patients in our cohort experienced favorable outcomes and functional improvement, we advocate for same-day discharge in order to reduce hospital and patient burden.
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Affiliation(s)
- Parhom Towfighi
- From the Georeorgetown University School of Medicine; and MedStar Georgetown University Hospital
| | | | | | - Aashka M Suvarnakar
- From the Georeorgetown University School of Medicine; and MedStar Georgetown University Hospital
| | - Salma Abdou
- Departments of Plastic Reconstructive Surgery
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Badr S. Closure of excisional defects of pilonidal sinus surgery using a perforator-based island flap. SAUDI JOURNAL FOR HEALTH SCIENCES 2020. [DOI: 10.4103/sjhs.sjhs_143_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Impact of geography and surgical approach on recurrence in global pilonidal sinus disease. Sci Rep 2019; 9:15111. [PMID: 31641150 PMCID: PMC6805955 DOI: 10.1038/s41598-019-51159-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 09/20/2019] [Indexed: 12/18/2022] Open
Abstract
Pilonidal sinus disease (PSD) is increasing globally. A recent meta-analysis and merged-data analysis showed that recurrence rates in PSD depend essentially on follow-up time and specific surgical procedures. However, the global distribution of surgical approaches and respective recurrence rates have never been studied in PSD. We aimed at studying the impact of geographic distribution of surgical approaches to treat PSD and subsequent geography-specific recurrence rates. We searched relevant databases as described previously. Recurrence rates were then associated with reported follow-up times and geographic origin. We simulated individual patients to enable analogy across data. Globally, recurrence rates range from 0.3% for Limberg/Dufourmentel approaches (95% CI 0.2–0.4) and flaps (95% CI 0.1–0.5) and up to 6.3% for incision (95% CI 3.2–9.3) at 12 months. Recurrence rates range from 0.3% for Karydakis/Bascom approaches (95% CI 0.0–0.8) up to 67.2% for incision (95% CI 7.5–100) in the USA, and 0.0% for primary asymmetric closure in Germany (95% CI 0.0–0.0). Our analysis shows that recurrence rates in PSD not only depend on therapeutic approaches and follow-up time but also on geography. Primary asymmetric closure and various flap techniques remain superior regardless of the geographical region. Some approaches have extraordinarily good outcomes in specific countries.
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Arpaci E, Altun S, Orhan E, Eyuboglu A, Ertas NM. A New Oval Advancement Flap Design for Reconstruction of Pilonidal Sinus Defect. World J Surg 2018; 42:3568-3574. [PMID: 29713735 DOI: 10.1007/s00268-018-4648-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUNDS Pilonidal sinus is a common chronic disease of the sacrococcygeal region. Although many surgical methods have been described for treating pilonidal sinus disease, controversy still exists as to the best surgical technique. The aim of this study is to present a new modified advancement flap technique named "omega flap" for the treatment of pilonidal sinus disease. MATERIALS AND METHODS This study included 18 patients with pilonidal sinus who were treated between March 2012 and August 2014. All cases underwent oval excision and omega advancement flap reconstruction. Defect size, postoperative complications, postoperative pain, painless sitting time, patient satisfaction and recurrence were evaluated retrospectively. RESULTS All patients were discharged on the first postoperative day. There was no flap necrosis. No recurrence and no major complication were observed during follow-up period. The outcomes were also satisfactory regarding functionally and aesthetically, and the patients were satisfied with the results. CONCLUSIONS Presented method has a different geometry than classical advancement flap methods. Our technique provides two-layered repair with minimal tension and off-midline closure for the reconstruction of pilonidal sinus defect. It is easily performed, reliable, associated with no recurrens and good aesthetic results.
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Affiliation(s)
- Enver Arpaci
- Department of Plastic and Reconstructive Surgery, School of Medicine, Baskent University, Hocacihan Mah. Sofa Sk. 50/18, Selçuklu-Konya, Turkey.
| | - Serdar Altun
- Department of Plastic and Reconstructive Surgery, School of Medicine, Firat University, Elazig, Turkey
| | - Erkan Orhan
- Department of Plastic and Reconstructive Surgery, Namık Kemal School of Medicine, Tekirdag, Turkey
| | - Atilla Eyuboglu
- Department of Plastic and Reconstructive Surgery, School of Medicine, Baskent University, Ankara, Turkey
| | - Nilgun Markal Ertas
- Department of Plastic and Reconstructive Surgery, School of Medicine, Baskent University, Ankara, Turkey
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Kokosis G, Barbas A, Ong C, Levinson H, Erdmann D, Mantyh CR. Flap repair of complex pilonidal sinus: a single institution experience. EUROPEAN JOURNAL OF PLASTIC SURGERY 2018. [DOI: 10.1007/s00238-017-1361-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Stauffer VK, Luedi MM, Kauf P, Schmid M, Diekmann M, Wieferich K, Schnüriger B, Doll D. Common surgical procedures in pilonidal sinus disease: A meta-analysis, merged data analysis, and comprehensive study on recurrence. Sci Rep 2018; 8:3058. [PMID: 29449548 PMCID: PMC5814421 DOI: 10.1038/s41598-018-20143-4] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 01/15/2018] [Indexed: 12/24/2022] Open
Abstract
We systematically searched available databases. We reviewed 6,143 studies published from 1833 to 2017. Reports in English, French, German, Italian, and Spanish were considered, as were publications in other languages if definitive treatment and recurrence at specific follow-up times were described in an English abstract. We assessed data in the manner of a meta-analysis of RCTs; further we assessed non-RCTs in the manner of a merged data analysis. In the RCT analysis including 11,730 patients, Limberg & Dufourmentel operations were associated with low recurrence of 0.6% (95%CI 0.3-0.9%) 12 months and 1.8% (95%CI 1.1-2.4%) respectively 24 months postoperatively. Analysing 89,583 patients from RCTs and non-RCTs, the Karydakis & Bascom approaches were associated with recurrence of only 0.2% (95%CI 0.1-0.3%) 12 months and 0.6% (95%CI 0.5-0.8%) 24 months postoperatively. Primary midline closure exhibited long-term recurrence up to 67.9% (95%CI 53.3-82.4%) 240 months post-surgery. For most procedures, only a few RCTs without long term follow up data exist, but substitute data from numerous non-RCTs are available. Recurrence in PSD is highly dependent on surgical procedure and by follow-up time; both must be considered when drawing conclusions regarding the efficacy of a procedure.
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Affiliation(s)
- V K Stauffer
- Lindenhofspital, Lindenhofgruppe, 3010, Bern, (VS), Switzerland
| | - M M Luedi
- Department of Anaesthesiology, Bern University Hospital Inselspital, University of Bern, 3010, Bern, (MML), Switzerland
| | - P Kauf
- Biomedical Statistics PROGNOSIX AG, 8001, Zurich, (PK, MS), Switzerland
| | - M Schmid
- Biomedical Statistics PROGNOSIX AG, 8001, Zurich, (PK, MS), Switzerland
| | - M Diekmann
- Department of Procto-Surgery, St. Marien-Krankenhaus Vechta, Teaching Hospital of the Hannover University, 49377, Vechta, (KW, DD), Germany
| | - K Wieferich
- Department of Procto-Surgery, St. Marien-Krankenhaus Vechta, Teaching Hospital of the Hannover University, 49377, Vechta, (KW, DD), Germany
| | - B Schnüriger
- Department of Visceral Surgery and Medicine, Bern University Hospital Inselspital, University of Bern, 3010, Bern, (BS), Switzerland
| | - D Doll
- Department of Procto-Surgery, St. Marien-Krankenhaus Vechta, Teaching Hospital of the Hannover University, 49377, Vechta, (KW, DD), Germany.
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Chen YC, Scaglioni MF, Kuo YR. Profunda artery perforator based V-Y rotation advancement flap for total vulvectomy defect reconstruction-A case report and literature review. Microsurgery 2015; 35:668-71. [DOI: 10.1002/micr.22498] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 08/02/2015] [Accepted: 08/28/2015] [Indexed: 11/07/2022]
Affiliation(s)
| | - Mario F. Scaglioni
- Department of Plastic and Reconstructive Surgery; Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine; Kaohsiung Taiwan
| | - Yur-Ren Kuo
- Department of Plastic and Reconstructive Surgery; Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine; Kaohsiung Taiwan
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Kankaya Y, Sungur N, Aslan ÖÇ, Ozer K, Ulusoy MG, Karatay M, Oruç M, Gürsoy K, Karaaslan Ö, Koçer U. Alternative method for the reconstruction of meningomyelocele defects: V-Y rotation and advancement flap. J Neurosurg Pediatr 2015; 15:467-74. [PMID: 25679381 DOI: 10.3171/2014.12.peds14133] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Skin grafts, skin flaps, fasciocutaneous flaps, muscle flaps, and musculocutaneous flaps have been used for closure of large meningomyelocele (MMC) defects that cannot be closed primarily. The V-Y rotation advancement flap technique has been used successfully for the reconstruction of defects in different areas of the body. In the present study, the authors report on their novel use of this technique in both a binary and a quadruple (butterfly) flap manner for closure of large MMC defects. They also present an algorithm that they developed for the evaluation of MMC defects. METHODS Between January 2011 and November 2013, 17 patients (13 girls and 4 boys) with extremely large MMC defects that could not be repaired by direct primary closure underwent reconstruction of the defects with binary and quadruple V-Y rotation and advancement flaps. With the patient prone, the axillary apices, the most craniad point of the intergluteal sulcus, and the posterior axillary lines were marked, and a rectangular area on the back was designed. Edges of the rectangular area and the transverse and longitudinal diameters of the defect were measured and the presence of kyphosis was noted. These measurements and their proportions were used to develop an algorithm for patient assessment. While binary flaps were planned over the transverse diameter of the defects, quadruple flaps were planned over the bisectors of the defects, which were closed by elevating fasciocutaneous flaps. RESULTS For patients whose defect diameter to back width ratio was between 0.30 and 0.50 and whose mean ratio of defect area to donor area was between 0.09 and 0.15, binary V-Y rotation and advancement flaps were used. When these values were in the range of 0.50-0.66 and 0.16-0.35, respectively, quadruple V-Y rotation and advancement flaps were preferred. The mean duration of postoperative follow-up was 10.4 months. With the exception of minor complications, such as partial necrosis of 0.5 × 0.5 cm in a quadruple flap, all the flaps healed uneventfully. CONCLUSIONS With this study, closure of MMC defects with V-Y rotation and advancement flaps has been defined for the first time in the literature. The use of this technique with multiple flaps is an effective alternative to other flap options for the closure of large MMC defects. The algorithm developed in the course of this study should facilitate evaluation and reconstruction planning for patients with MMC defects.
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Affiliation(s)
- Yüksel Kankaya
- Plastic, Reconstructive, and Aesthetic Surgery Clinic and
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Dölen UC, Sungur N, Koçer U. V-Y rotation advancement flap: A metanalysis and systematic review. EUROPEAN JOURNAL OF PLASTIC SURGERY 2014. [DOI: 10.1007/s00238-014-1021-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Perforator flaps after excision of large epidermal cysts in the buttocks. Arch Plast Surg 2014; 41:140-7. [PMID: 24665422 PMCID: PMC3961611 DOI: 10.5999/aps.2014.41.2.140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 07/22/2013] [Accepted: 08/05/2013] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Epidermal cysts are commonly occurring masses usually less than 5 cm in diameter, but in predisposed patients, epidermal cysts can grow relatively large due to chronic infection. METHODS From June 2002 to July 2010, 17 patients received 19 regional perforator-based island flaps to cover defects due to the excision of large epidermal cysts (diameter >5 cm) in the buttocks. Eight patients had diabetes, and seven had rheumatoid arthritis. The pedicles were not fully isolated to prevent spasms or twisting. RESULTS All the flaps survived completely, except for one case with partial necrosis of the flap, which necessitated another perforator-based island flap for coverage. There were two cases of wound dehiscence, which were re-closed after meticulous debridement. There were no recurrences of the masses during follow-up periods of 8.1 months (range, 6-12 months). CONCLUSIONS In patients with large epidermal cysts and underlying medical disorders, regional perforator-based island flaps can be the solution to coverage of the defects after excision.
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Yazar M, Kurt Yazar S, Celet Ozden B, Guven E, Basaran K, Alyanak A, Aydin A. Cosmetic closure of pilonidal sinus defects with bilateral transpositional adipofascial flaps. J Plast Surg Hand Surg 2013; 47:292-6. [DOI: 10.3109/2000656x.2013.765884] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Prospective Evaluation of a Single-sided Innervated Gluteal Artery Perforator Flap for Reconstruction for Extensive and Recurrent Pilonidal Sinus Disease: Functional, Aesthetic, and Patient-reported Long-term Outcomes. World J Surg 2012; 36:2230-6. [DOI: 10.1007/s00268-012-1639-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
BACKGROUND Fingertip amputation is the most common type of injury in the upper limb. Goals in fingertip amputation reconstruction are covering the defect, establishing maximum tactile gnosis, keeping the length of the finger, protecting the joint function, acquiring a well-padded pulp tissue, providing a bed for growing nail, obtaining a satisfactory cosmetic appearance and allowing the patient to return to work as soon as possible. Adjacent skin and soft tissue are the best covers for fingertip injuries. However, local homodigital flaps lack enough tissue to cover the defect. To solve this problem, we used V-Y rotation advancement flap bilaterally in fingertip amputations which meets all the reconstruction goals. Rotation besides advancement makes this flap more mobile and easier to cover larger defects in all amputation planes. METHODS Between 2007 and 2009, we performed bilateral V-Y rotation advancement flap on seven male patients' pulpa (average age, 37.6 years) whose fingertips were not replantable. RESULTS Fourteen flaps were made on 7 fingers. There was neither total nor partial flap loss. Patients had neither cold intolerance nor scar hypersensitivity. Stiffness of the PIP joint did not occur. No obvious hooked nail occurred in patients who have remaining nail matrix. Because flaps contain neurovascular bundle, there was no difference in sensation and perfusion between the finger's pre-operative and post-operative status. The result was satisfactory with painless pinching. CONCLUSION In addition to the various and versatile fingertip reconstruction methods, we want to present V-Y rotation advancement flap as a quick, reliable and aesthetic method.
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Horwood J, Hanratty D, Chandran P, Billings P. Primary closure or rhomboid excision and Limberg flap for the management of primary sacrococcygeal pilonidal disease? A meta-analysis of randomized controlled trials. Colorectal Dis 2012; 14:143-51. [PMID: 20969718 DOI: 10.1111/j.1463-1318.2010.02473.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM Sacrococcygeal pilonidal disease is a common condition afflicting the young male working and student population, resulting in considerable pain, embarrassment and loss of work days. Controversy surrounds the most appropriate surgical approach to achieve low recurrence rates whilst minimizing morbidity and permitting an early return to work. This study aims to review the published literature comparing excision followed by either primary suture or rhomboid flap repair. METHODS PubMed, EMBASE, MEDLINE and The Cochrane Library were systematically reviewed, by two independent investigators, for relevant randomized controlled trials. Keywords and MeSH terms included 'pilonidal disease', 'primary suture/repair', 'rhomboid flap' and 'limberg/modified Limberg flap'. 'Related study' function and manuscript bibliographies were searched for further relevant studies. Study quality was assessed using the Jadad score. Meta-analysis was performed on pooled data, utilizing a random effects model when heterogeneity was high and a fixed effects model when heterogeneity was low. The primary end-point assessed was disease recurrence. Secondary end-points included wound dehiscence, pain scores, hospital stay and return to work. RESULTS Six studies were eventually included for pooled analysis following exclusion of randomized controlled trials with poor methodology. Two studies compared 'off-midline' (Karydakis) primary suture with the Limberg flap repair. Six hundred and forty-one patients were included (331 flap repairs). Rhomboid flap excision demonstrated a trend towards less disease recurrence (P = 0.07), lower wound infection (P = 0.001) and dehiscence (P = 0.01). However, no significant difference was found for pain scores, hospital stay or return to work. CONCLUSION The current published literature supports the use of the rhomboid flap excision and the Limberg flap-repair procedures over primary midline suture techniques for the elective management of primary pilonidal disease. Further high-quality studies are necessary to compare flap with off-midline repairs.
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Affiliation(s)
- J Horwood
- Department of General Surgery, Wrexham Maelor Hospital, Wrexham, UK.
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Kim YH, Naidu S, Kim CY, Lee KH, Kim JT. A perforator solution for excisional defects of pilonidal sinus. J Plast Reconstr Aesthet Surg 2010; 64:138-40. [PMID: 20634161 DOI: 10.1016/j.bjps.2010.05.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Revised: 04/16/2010] [Accepted: 05/25/2010] [Indexed: 10/19/2022]
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Rao MM, Zawislak W, Kennedy R, Gilliland R. A prospective randomised study comparing two treatment modalities for chronic pilonidal sinus with a 5-year follow-up. Int J Colorectal Dis 2010; 25:395-400. [PMID: 19823853 DOI: 10.1007/s00384-009-0804-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2009] [Indexed: 02/04/2023]
Abstract
BACKGROUND The optimal treatment of chronic pilonidal sinus is a matter of debate. Although excision and suture offers faster healing, it is associated with an increased incidence of wound infection. This study compared excision and primary closure of pilonidal sinus using incorporated gentamicin impregnated collagen with conventional laying open. METHODS Consecutive patients with pilonidal sinus were randomly assigned to one of two treatment groups: (1) open method-wound left open post-excision and (2) closed method-wound closed in two layers over gentamicin impregnated collagen. The main outcome measures were operating time, hospital stay, linear analogue pain scores (days 1, 2, 4, 7 and 14), healing rates, analgesic use and cost. Rate of recurrence at 5 years was further assessed by means of a telephone survey. RESULTS Sixty patients were recruited from June 1999 to December 2000. Operating time was significantly longer in the closed method. Pain scores were significantly lower for the closed group. A significantly higher proportion of closed wounds healed at 4 weeks. The overall cost per patient was significantly lower for the closed group. Recurrence rate was similar at 5 years. CONCLUSION Excision and primary closure over a gentamicin impregnated collagen is a cost-effective method of treating pilonidal sinuses, as it ensures faster healing, causes less pain and its long-term recurrence rates are similar to other techniques.
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Affiliation(s)
- Milind M Rao
- John Goligher Colorectal Unit, Leeds General Infirmary, Leeds, UK
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Acartürk TO, Parsak CK, Sakman G, Demircan O. Superior gluteal artery perforator flap in the reconstruction of pilonidal sinus. J Plast Reconstr Aesthet Surg 2010; 63:133-9. [DOI: 10.1016/j.bjps.2008.07.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2008] [Revised: 06/22/2008] [Accepted: 07/29/2008] [Indexed: 11/28/2022]
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Abstract
PURPOSE In this study, we investigated the value of fasciocutaneous V-Y advancement flap reconstruction in the treatment of complicated or recurrent sacrococcygeal pilonidal sinus. METHODS Patients with complicated pilonidal sinus treated with a V-Y advancement flap from July 2002 through December 2005 were studied. The duration of inpatient stay, early wound complications, time of return to active work, recurrence, and patient satisfaction with the operation were recorded. RESULTS Forty-three patients were treated for recurrent or complicated sacrococcygeal pilonidal disease. All flaps remained viable without necrosis. However, 4 patients (9.3%) had wound infections, and 3 patients (7%) had hematoma. The mean hospital stay was 3 (range, 2-5) days, and time to return to active life was 17 (range, 13-25) days. The mean duration of follow-up was 48 (range, 27 to 69) months. Recurrence was detected in only one patient in the early period. Seven patients (16.3%), including 4 bilateral repairs, had numbness over the operative site. Thirty-nine patients (90.7%) were not satisfied with scars; 4 reported that the scar was not important. CONCLUSIONS In selected patients, V-Y advancement flaps provide tension-free repair with minimal recurrence rates and reliable skin coverage while flattening the natal cleft that predisposes to recurrence. Because patient dissatisfaction with cosmetic results is high, potential treatment outcomes should be discussed with patients in detail before the operation.
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Ersoy E, Devay AO, Aktimur R, Doganay B, Ozdoğan M, Gündoğdu RH. Comparison of the short-term results after Limberg and Karydakis procedures for pilonidal disease: randomized prospective analysis of 100 patients. Colorectal Dis 2009; 11:705-10. [PMID: 18637924 DOI: 10.1111/j.1463-1318.2008.01646.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The study was designed to compare the early postoperative results of the commonly used two surgical flap procedures in pilonidal disease: Karydakis and Limberg. METHOD One hundred patients were randomized into two groups and standard Limberg or Karydakis procedures were performed. All had primary sinus orifices. Infected cases and the ones with secondary orifices over 2 cm distant from primary were excluded. Data were recorded concerning complications, need for analgesia and wound dressing, periods of time off work and off driving. Patients were asked to classify their first defecation manner after the operation and also pain according to a Visual Analogue Scale with range of 1-10. RESULTS There was a significantly higher wound infection rate in the Karydakis group than in the Limberg group (13/50 and 4/50 respectively). This also resulted in significantly higher values for wound dressings and need for analgesia. The time off work and off driving and also the Visual Analogue Scale scores were not significantly different between the two groups. CONCLUSION Both procedures can be safely performed in pilonidal disease with a standard length of stay in hospital and a similar loss of productive power. However, the Karydakis flap seems to have a significant higher infection rate and this probably increases the cost.
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Affiliation(s)
- E Ersoy
- Department of General Surgery, Ataturk Research and Training Hospital, Ankara, Turkey.
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El-Khatib HA, Al-Basti HB. A perforator-based bilobed fasciocutaneous flap: an additional tool for primary reconstruction following wide excision of sacrococcygeal pilonidal disease. J Plast Reconstr Aesthet Surg 2009; 62:494-8. [DOI: 10.1016/j.bjps.2007.11.043] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2006] [Revised: 06/24/2007] [Accepted: 11/26/2007] [Indexed: 11/16/2022]
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Uygur F, Sever C, Ulkur E, Celıkoz B. Reconstruction of Large Post-Sternotomy Wound With Bilateral “V-Y Fasciocutaneous Advancement Flaps”. Ann Thorac Surg 2008; 86:1012-5. [DOI: 10.1016/j.athoracsur.2008.02.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2007] [Revised: 02/06/2008] [Accepted: 02/18/2008] [Indexed: 11/28/2022]
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