Dufourmentel rhomboid flap for sacrococcygeal pilonidal sinus: technical details / Técnica quirúrgica del colgajo de Dufourmentel para el tratamiento de la enfermedad pilonidal sacro-coccígea

Sacrococcygeal pilonidal disease (SPD) is a chronic an uncommon entity with a variety of alternatives for treatment. One of those is the excision of the sinus tract followed by a reconstruction with the rhomboid flap described by Dufourmentel. The aim of this paper is to describe the main phases of the technique. A detailed explanation of the key steps for the implementation of Dufourmentel flap for the treatment of SPD is exposed. Excision of sacrococcygeal pilonidal sinus followed by Dufourmentel rhomboid flap is an alternative to consider in the treatment of pilonidal disease.

La enfermedad pilonidal sacrococcígea (EPS) es una entidad clínica crónica e infrecuente. Para su tratamiento se han descrito numerosas alternativas. Una de ellas es la exéresis de la zona afectada seguida de un cierre primario sin tensión, por medio de un colgajo romboidal descrito por Dufourmentel. El objetivo de este artículo es describir las fases más relevantes de la técnica. Se realiza una detallada explicación de los pasos clave para ejecutar la exéresis romboidal de la zona afectada, con la ulterior rotación de un colgajo de Dufourmentel para el tratamiento de la EPS. La exéresis romboidal de EPS seguida de la rotación de un colgajo de Dufourmentel constituye una alternativa a considerar en el tratamiento de la EPS.

Epidural anesthesia for pilonidal sinus surgery: ropivacaine versus levobupivacaine / 대한마취과학회지

BACKGROUND: Epidural anesthesia is one of the best options for lower abdominal and lower limb surgery. However, there have been insufficient reports regarding the use of epidural anesthesia for pilonidal sinus surgery. The present study was performed to compare the clinical profiles of epidural block performed with 0.75% levobupivacaine and 0.75% ropivacaine in this procedure. METHODS: Thirty patients undergoing pilonidal sinus surgery were randomly allocated into two groups: one group received levobupivacaine and the other received ropivacaine at 0.75% in a volume of 10 ml. Arterial blood pressure, heart rate, oxygen saturation, the onset time of analgesia and duration of block, highest sensory block level, perioperative and postoperative side effects, and patients' and surgeons' satisfaction were recorded. RESULTS: Hemodynamic stability was maintained in both groups throughout surgery. The onset time of analgesia (the time from epidural injection of local anesthetic to reach L2 sensorial block) was 6.26 +/- 3.49 min in the levobupivacaine group and 4.06 +/- 1.75 min in the ropivacaine group (P = 0.116). The duration of sensorial block (time for regression of sensory block to L2) was 297.73 +/- 70.94 min in group L and 332.40 +/- 102.22 min in group R (P = 0.110). Motor block was not seen in any of the patients in the study groups. Patients' and surgeons' satisfaction with the anesthetic technique were mostly excellent in both groups. CONCLUSIONS: In patients undergoing pilonidal sinus surgery, both levobupivacaine and ropivacaine produce rapid and excellent epidural block without leading to motor block or significant side effects. Although not statistically significant, the onset time of anesthesia was shorter and the duration of effect was longer with ropivacaine than with levobupivacaine in this study.

Pilonidal Sinus: Why Does it Recur

Introduction: A pilonidal sinus(PNS) is an infected tract at the natal cleft under the skin between the buttocks. It is a common problem in primary care due to the high recurrence followingsurgery. The patient treated here had a recurrent pilonidal sinus after three previous surgeries. Methods: The patient was operated by excision of the tract and closure of the wound. Results: The wound healed in two stages as explained in the study. Conclusion: The possible reason for reccurrence was detected and it was managed. Healing was complete and follow up after one year revealed no recurrence.