Primary pilonidal sinus repair: the outcome of 5 different techniques. can a modification be near ideal or provide a benefit?

Although various surgical treatment procedures for pilonidal sinus disease have been evaluated, no clear agreement has been reached as to which one is optimal for the lower incidence of wound infection, wound dehiscence and recurrence rate, almost certainly because there is none. This study was intended to investigate the outcome among five different selected primary closure techniques and to investigate the possibility of decreasing the operation costs by omitting the subcutaneous suture usage in some primary techniques. Prospective study considering morbidity and recurrence as the main outcome measures. This study included 94 patients: 84 male and 10 females with chronic pilonidal sinus disease who were operated on. All underwent excision and primary closure under spinal [64- 61 males, 3 females] or general anaesthesia [30 patients 23 males, 7 females] between May 2004 and February 2007. Patients were prescribed IV prophylactic antibiotic. 5 different techniques were done. They were simple closure technique in the midline, full-thickness z-plasty flap, semi-open, semi-closed closure techniques, musculofascial flap, and the modified musculofascial flap. Early wound complications with delayed wound healing had occurred in seven patients. Two patients had wound dehiscence [one due to haematoma in the modified group and the 2nd due to wound deep infection in the group of musculofascial flap]. A case of seroma occurred in the modified group. Four cases [4.25%] had minor wound breakdown due to superficial wound infections. They were one case in the simple closure method, one in the musculofascial flap, the third in the full thickness z-plasty and the fourth in the modified musculofascial flap procedure. Late postoperative complications: One patient suffered from late wound dehiscence in of the modified group due to infected haematoma. Two cases of recurrence had occurred. One of the superficial wound infections in the simple closure technique. The 2[nd] case was that of the deep wound infection in the musculofascial flap no recurrence has occurred in either the full-thickness z-plasty flap, the semi-open, semi-closed closure, or in the modified group.No significant difference in operation time, time of wound healing, time to return work, patient's or surgeon's satisfaction and cost effectiveness. Best treatment is still unclear. A perfect operation for pilonidal sinus disease should be simple with short hospital stay and low recurrence and complication rate associated with minimal pain, cost effective and have short off work time. Judging the results of the different procedures is difficult because there are no enough significant differences to prefer one to other procedures. Further investigations into the whole medical, financial and social aspects of these procedures for the treatment and management of pilonidal disease are still required

Correction of secondary deformities of the cleft lip nose

For both unilateral and bilateral cleft lip nasal deformity, the general trend has been toward operation on the cleft lip nose at the time of initial lip surgery. Secondary surgery to further modify the nasal shape is often necessary and many patients desire complete septorhinoplasty in their teen years. The purpose of the study was to evaluate the results of the methods to correct secondary cleft lip nose deformity. This study carried out on 22 patients; [five females and 17 males] with secondary cleft lip nose deformities, their ages ranged from five to 34 years with mean 17.6 years. All of them were admitted to our department at Al-Azher University Hospital, Damietta. There is nasal symmetry with improved nasolabial and nasofacial relationship, improve speech, and airway passage in 17 patients

Treatment of lateral ray polydactyly of the hand [duplicate thumb]

The prime function of the thumb to be in opposition against the other digit and the prerequisites for stable pinch especially a stable metacarpophalangeal ulnar collateral ligament. The purpose of this study was to evaluate the results of the operative treatment of lateral ray polydactyly of the hand and to consider appropriate surgical procedures. Eight patients underwent management of lateral ray polydactyly of the hand [12 individual thumbs] during the period from May 2006 to July 2007. Cases were classified morphologically into three types on the basis of Stelling's classification. In addition, these types were divided into seven types on the basis of radiographic evaluation on the basis of Wassel's classification. All patients were treated in Damietta Al-Azher University Hospital, all of them were treated surgically; three of 12 thumbs retained persistent deviation and required secondary surgery in the form of exploration and tendon repositioning to correct deviation of growth after one year. Four patients suffered from postoperative pain. The pain occurred at that protuberant point

Reconstruction of posttraumatic perineal defects

Posttraumatic perineal defects restrict abduction of the thigh, interfere with sitting, walking, performance of normal excretory and sexual functions and distort the external genitalia. This study evaluates the different methods of reconstruction of perineal defects according to the type of contracture. 24 patients suffering from perineal defect, 16 males and 8 females. Their ages ranged from 6 to 5.8 years with mean of 13.88 years. They underwent reconstruction after releasing of contracture either by skin grafts, Z-plasty or, local flaps from adjacent areas depending on the conditions of the surrounding tissues. In 14 cases release of scar by incision or excision with free skin grafts were carried out, while local flap transfers including skin elongation procedures such as Z-plasty were performed in 5 patients, V-Y plasty in 2 patients and regional flap transfers i.e. pedicled axial local flap transfers were performed in last 3 cases. In this paper, we classify perineal contractures into five types and present our conclusion depending on the criteria for selecting appropriate surgical methods according to contracture types. Our results suggest that there are four key features of surgical methods for perineal reconstruction: size; depth; location and shape

One stage repair of hypospadias

This study was done on 63 patients with various degrees of hypospadias, their ages renged from 3 months to 35 years. The location of native meatus was anterior penile in 30, middle in 25 and penoscrotal in 8. Several techniques for correction of hypospadias were used depending on the location of the abnormal meatus. Suprapublic drainage was used in proximal penile and penoscrotal varieties, while urethral drainage was 4% while in proximal shaft and penoscrotal level was 37.5%. Due to low incidence of complication of one stage repair for all types of hypospadias, this should be recommended with selection of the suitable technique for each type

Proximally based lateral forearm fasciocutaneous flap for elbow coverage of post burn defect

Twenty-two patients suffering from postburn contracted elbow, 15 females and 7 males during the period from June 2002 to July 2004. Their ages ranged from 3 to 33 years with mean 17.9 years. All patients' elbow defect after releasing of the contracture were covered by the proximally based lateral forearm fasciocutaneous flap, the split thickness skin graft is applied over the flap donor site in 4 from 22 patients and the remaining 18 patients' flap donor site is closed by suturing the edge. Flap survival was 100 per cent and graft take on the flap donor site was excellent

Fasciocutaneous flaps in resurfacing of chronic ulcers of the buttock and the lower limb

Fasciocutaneous flaps have challenged some principles such as the safe length width ratio, and the concept that flaps should be proximally based in the leg. This article aiming the effectiveness of different types of fasciocutaneous flaps in covering the chronic ulcers of the buttocks and the lower limbs. Fasciocutaneous flaps were used in the treatment of 35 patients suffering from chronic ulcers of buttock and lower limb due to different etiologies during the period from August 2000 and December 2004. 9 patients with buttock ulcer, 15 patients with ulcer of leg and 11 patients with ulcer of ankle and foot. From 35 fasciocutaneous flap performed, 3 flaps were lost due to obesity, atherosclerosis, hematoma formation under the flap and subsequent severe sepsis, in another 3 patients partial skin graft loss from the donor site were recorded

Reconstruction of anterior neck burn deformities

Correction of the anterior neck burn deformities are preventable rather than surgically correctable by splinting the burned neck in extension position during the acute stage of burn at the end of edema stage. This article aims to compare between releasing of contractures with immediate resurfacing with split thickness skin graft in 30 patients and releasing of contractures of the neck and resurfacing with skin flap in 34 patients. Points of comparison were good aesthetic results as determined by the cervicomental angle obtained, the subjective opinion of patients and good range of motion of the neck, complications of surgery as recontracture again, complementary procedure, postoperative splint and its duration. Regarding patients' satisfaction and complications rate patients of group two revealed better aesthetic results and good range of motion rather than in group one. There were four flap failure attributed to bleeding disorder and to technical errors. Anterior neck burn sequelae thus can be safely treated by enbloc resection and resurfacing with flaps rather than skin graft if possible