Effectiveness of fascial tissue flaps and skin flaps with layered sutures for repair of wounds after excision of sacrococcygeal pilonidal sinus / 中国修复重建外科杂志

OBJECTIVE@#To investigate the feasibility and effectiveness of fascial tissue flaps and skin flaps with layered sutures for repairing wounds after excision of sacrococcygeal pilonidal sinus.@*METHODS@#Between March 2019 and August 2022, 9 patients with sacrococcygeal pilonidal sinus were admitted, including 7 males and 2 females with an average age of 29.4 years (range, 17-53 years). The disease duration ranged from 1 to 36 months, with a median of 6 months. There were 7 cases with obesity and dense hair, 3 cases with infection, and 2 cases with positive bacterial culture of sinus secretion. The wound area after excision ranged from 3 cm×3 cm to 8 cm×4 cm, with a depth of 3-5 cm, reaching the perianal or caudal bone; there were 2 cases with perianal abscess formation and 1 case with caudal bone inflammatory edema. Enlarged resection was performed during operation, and the fascial tissue flap and skin flap were designed and excised at both left and right sides of the buttock, ranging from 3.0 cm×1.5 cm to 8.0 cm×2.0 cm. A cross drainage tube was placed at the bottom of the wound, and the fascial tissue flap and skin flap were advanced and sutured in three layers, namely, 8-string sutures in the fascial layer, barbed wire reduction sutures in the dermis, and interrupted skin sutures.@*RESULTS@#All 9 patients were followed up 3-36 months, with an average of 12 months. All incisions healed by first intention, and no complication such as incisional dehiscence or infection in the operative area occurred. There was no recurrence of sinus tracts, the shape of gluteal sulcus was satisfactory, both sides of buttocks were symmetrical, local incision scar was concealed, and the shape disruption was minimal.@*CONCLUSION@#Fascial tissue flaps and skin flaps with layered sutures for repairing wounds after excision of sacrococcygeal pilonidal sinus can effectively fill the cavity and reduce the incidence of poor incision healing, with the advantages of small trauma and simple operation.

Chinese expert consensus on the diagnosis and treatment of sacrococcygeal pilonidal disease (2023 edition) / 中华胃肠外科杂志

Sacrococcygeal pilonidal disease(SPD) is an acquired disease intimately related to the presence of hair in the gluteal groove. Although its pathogenesis is still controversial, numerous treatment options are available for SPD including gluteal groove and surrounding skin hair removal, sinusectomy, open healing by secondary intention, primary closure, and local excision with flap reconstruction. Lacking of standardized diagnosis and treatment processes of SPD in China, Chinese Medical Doctor Association Anorectal Branch and its Clinical Guidelines Committee jointly organized experts in this field to form expert consensus opinion on the basis of summarizing latest research progress in China and abroad, experts' clinical experience and principles of evidence-based medicine. The expert group formed opinion in 12 terms of SPD diagnosis, risk factors, non-surgical treatment, surgical treatment, minimally invasive treatment, and wound management, and developed the "Chinese expert consensus on the diagnosis and treatment of sacrococcygeal pilonidal disease (2023 edition)" after rounds of discussion and revision, to improve the diagnosis and treatment of SPD.

Surgical outcome of modified Karydakis flap and modified Limberg flab in the management of sacroccygeal pilonidal disease: a comparative study

Introduction: Sacrococcygeal pilonidal disease (SPD) is a chronic suppurative condition of the sacrococcygeal region causing chronic sinus tract or cyst. It is an acquired complex disease more common in young adult males, causing considerable morbidity and long periods of interruption in work or education. From simple conservative techniques to complex flap reconstruction, many debatable treatment options are offered; however clear dynamics toward the widespread use of minimally invasive methods and off-midline flap reconstruction are suggested in all guidelines, which recommend the Karydakis and Limberg flap modification. The plethora of literature compares procedures for identification of a single best treatment approach, which has proven to be difficult. The surgical outcome of both techniques is compared in the present study. Objective: To compare the surgical outcomes of the modified Karydakis flap (MKF) versus the modified Limberg flap (MLF) in SPD. Materials and Methods: The present study was conducted at the general surgery department on SPD patients who were ≥18 years old. A total of 67 participants were included after obtaining the informed consent, with group A comprising 33 patients undergoing the MLF procedure and group B comprising 34 patients undergoing the MKF procedure. Results: The mean patient age was 28.85 (range, 18-44) years old. For the MKF and MLF methods, the average operating duration was 32.5 (range, 25-40) and 54.5 (range, 45-65) minutes, respectively. The MKF approach was found to significantly improve pain score, mean sitting painless time, return to normal activity, wound healing time, and patient satisfaction. Conclusion: Comparative outcomes were seen between both MKF and MLF; however, our findings show that MKF is a more favourable method than MLF with superior outcomes. (AU)

Quiste pilonidal del ombligo: presentación de dos casos / Umbilical pilonidal sinus: presentation of two cases

Resumen Introducción: El quiste pilonidal del ombligo (QPO) es una entidad muy infrecuente y por eso no es reconocida precozmente. El objetivo de este manuscrito es dar a conocer esta patología. Reporte de casos: Presentamos dos pacientes referidos por un proceso inflamatorio del ombligo, con descarga de mal olor. El primer paciente, luego de dos meses de tratamiento local sin resolución, es intervenido resecando la lesión umbilical, comprobando en ese momento la existencia de contenido piloso en el quiste. En el segundo paciente se plantea el diagnóstico durante la anamnesis y se confirma con el examen físico. En ambos casos se efectuó una resección parcial del ombligo incluyendo la lesión pilonidal. La biopsia confirmó el diagnóstico. El resultado posoperatorio ha sido satisfactorio y sin recaídas. Discusión y Conclusión: Hay escasa literatura relacionada con el QPO. Se proponen el tratamiento conservador y la opción de resección quirúrgica del quiste. En nuestra limitada experiencia se procedió a resecar la lesión y recomendar la depilación de la región periumbilical. No podemos descartar la alternativa de manejo conservador en futuros casos, antes de proponer la cirugía.

Introduction: Umbilical pilonidal sinus (UPS) is a rare condition and is therefore not detected early. The aim of this document is to discuss this pathology. Case report: We present two patients referred due to an inflammatory process of the navel, with the presence of a malodor. The first patient, after two months of unsuccessful local treatment, was intervened by a resection of the umbilical lesion, verifying hair content in the sinus. In the second patient the diagnosis was evident during anamnesis and confirmed with the physical examination. In both cases, a partial resection of the umbilicus was performed, including the pilonidal sinus. Biopsy confirmed the diagnosis. The postoperative result has been satisfactory, without relapse. Discussion and Conclusion: There are not much literature related to UPS. Conservative treatment or surgical resection of the sinus is proposed. In our limited experience we proceeded to a surgical resection of the lesion and recommend eliminating the hairs of the periumbilical region. We cannot rule out the conservative management option in future cases, before proposing surgery.

Pediatric endoscopic pilonidal sinus treatment (PEPSiT): technical description and initial experience / Tratamento endoscópico pediátrico do seio pilonidal (PePSiT, em inglês): Descrição técnica e experiência inicial

Pilonidal sinus is an acquired condition characterized by lesions at the median or paramedic intergluteal crease resulting form in grown hair at the subcutaneous, deep sacrococcygeal issue. Multiple surgicalmethods havebeen described, the optimal pilonidal sinus treatment remains controversial. The preset retrospective study reports outcome form pediatric endoscopic pilonidal sinus treatment in patient under 18 years old. (AU)

O seio pilonidal é uma condição adquirida caracterizada por lesões na prega interglútea mediana ou paramédica, resultando em cabelo crescido na área subcutânea e profunda do sacrococcígeo. Vários métodos cirúrgicos foram descritos, o tratamento ideal do seio pilonidal permanece controverso. O estudo retrospectivo predefinido relata os resultados do tratamento endoscópico do seio pilonidal pediátrico em pacientes com menos de 18 anos de idade. (AU)

Modified endoscopic pilonidal sinus treatment (EPSiT): personal experience / Tratamento endoscópico do cisto pilonidal modificado (EPSiT): experiência pessoal

Abstract Pilonidal disease is common problem in the sacrococcygeal region, especially among young adults. The optimal surgical approach is debatable. Herein, we present our experience in management of recurrent pilonidal disease using the endoscopic approach.

Resumo A doença pilonidal é um problema comum na região sacrococcígea, principalmente em adultos jovens. A literatura ainda não apresenta consenso quanto à abordagem cirúrgica ideal. Aqui, os autores apresentam sua experiência no tratamento de doença pilonidal recorrente usando a abordagem endoscópica.

Enfermedad pilonidal sacrocoxígea: análisis de 2 técnicas quirúrgicas: experiencia personal / Sacrocoxygeal pilonidal disease: analysis of 2 surgical techniques: personal experience

Resumen Introducción: La enfermedad pilonidal sacrocoxígea (EPSC) es una patología crónica de resorte quirúrgico. Para su tratamiento se han descrito múltiples técnicas quirúrgicas, existiendo 2 grandes grupos: las técnicas abiertas y las cerradas. El objetivo del presente trabajo es comparar y analizar los resultados quirúrgicos de 2 técnicas, una abierta (marsupialización) y otra cerrada (Karydakis). Materiales y Método: Estudio de cohorte retrospectivo de pacientes operados electivamente con diagnóstico de quiste pilonidal por un único cirujano, entre julio de 2013 y julio de 2017 utilizando estas dos técnicas. Resultados: Se incluyeron 71 pacientes. 30 pacientes con marsupialización y 41 con Karydakis. Todos hospitalizados. Todos de alta al día siguiente de la cirugía. Ningún paciente requirió rehospitalización ni cirugías adicionales. En el análisis estadístico se identifican beneficios de la técnica de Karydakis en cuanto a complicaciones, dolor postoperatorio, dolor para sentarse, incapacidad laboral y tiempo de cicatrización. Conclusiones: En este artículo la cirugía con técnica de Karydakis tiene ventajas en relación a la marsupialización, considerándola como primera opción para la EPSC simple.

Introduction: Sacrocoxygeal pilonidal disease (EPSC) is a chronic pathology of surgical solution. For its treatment, multiple surgical techniques have been described, there being 2 large groups: open and closed techniques. The aim of the present study is to compare and analyze the surgical results of 2 techniques, one open (Marsupialization) and another closed (Karydakis). Materials and Method: Retrospective cohort study of electively operated patients with diagnosis of pilonidal cyst by a single surgeon, between July 2013 and July 2017 using these two techniques. Results: 71 patients were included. 30 patients with marsupialization and 41 with Karydakis. All hospitalized. All discharge the day after surgery. No patient required rehospitalization or additional surgeries. In the statistical analysis, benefits of the Karydakis technique are identified in terms of complications, postoperative pain, sitting pain, work incapacity and healing time. Conclusions: In this study, surgery with Karydakis technique has advantages in relation to Marsupialization, considering it as the first option for simple EPSC.

Laser pilonidotomy - a new approach in management of complex pilonidal sinus disease: an exploratory study / Pilonidotomia a laser - uma nova abordagem no tratamento da doença do seio pilonidal complexo: um estudo exploratório

Abstract Background The treatment of pilonidal sinus disease still remains challenging mainly because of multiple factors responsible for wound healing and its recurrence. With recent advances in surgical field, use of laser found to be an effective technique in the destruction of a pilonidal cyst. Laser Piolonidotomy is a new promising technique. Methodology An exploratory study was planned with the Aim, to evaluate a new technique for the excision of pilonidal sinus. Objectives were to investigate its effectiveness in terms of operation time, healing time, and the duration of hospitalization, resumption of normal activity the degree of postoperative complications and rate of recurrence and patient's satisfaction. All the patients with pilonidal sinus were categorized and laser pilonidotomy was planned for patients satisfying inclusion criteria. Data collected in pre-structured, pre-tested proforma and analyzed using SPSS. Results Mean duration of Procedure was 33 min (SD = 11), mean duration of Hospital Stay was 12 h (SD = 3), resumption of normal activity within 4 days (SD = 2), mean duration for Complete Wound Healing by secondary intention 6 Weeks (SD = 1.25). Among complications, infection reported in 1.08%. The difference between the mean pre and post-operative VAS score was statistically highly significant (p < 0.0001). Recurrence rate was 3.24%. Success rate was 96.75% and Overall patient's satisfaction was 97.84%. Conclusion Laser Pilonidotomy is effective in destruction of a pilonidal cyst with good success rate, fewer complications and with high patient's satisfaction.

Resumo Justificativa O tratamento da doença do seio pilonidal ainda permanece desafiador, principalmente devido a vários fatores responsáveis pela cicatrização das feridas e sua recorrência. Com os recentes avanços no campo cirúrgico, o uso do laser mostrou ser uma técnica eficaz na destruição de um cisto pilonidal. A piolonidotomia a laser é uma nova técnica promissora. Metodologia Foi planejado um estudo exploratório com o objetivo de avaliar uma nova técnica para a excisão de seio pilonidal. Os objetivos foram investigar sua eficácia quanto aos tempos de operação, de cicatrização, de internação e de retomada da atividade normal, além do grau de complicações pós-operatórias, a taxa de recorrência e o índice de satisfação do paciente. Todos os pacientes com seio pilonidal foram categorizados, e a pilonidotomia a laser foi planejada para os pacientes que satisfizessem os critérios de inclusão. Os dados foram coletados em forma pré-estruturada e pré-testada e analisados usando o SPSS. Resultados O tempo médio do procedimento foi de 33 min (DP = 11), o tempo médio da internação hospitalar foi de 12 horas (DP = 3), o tempo médio de retomada da atividade normal foi de 4 dias (DP = 2) e o tempo médio de cicatrização completa por intenção secundário foi de 6 semanas (DP = 1,25). Entre as complicações, infecção foi observada em 1,08%. A diferença entre as médias do escore EVA pré e pós-operatório foi estatisticamente significativa (p < 0,0001). A taxa de recorrência foi de 3,24%. A taxa de sucesso foi de 96,75% e o índice de satisfação geral do paciente foi de 97,84%. Conclusão A pilonidotomia a laser é eficaz na destruição de um cisto pilonidal com boa taxa de sucesso, menos complicações e com alta satisfação do paciente.

Cáncer escamoso asentado sobre sinus pilonidal recurrente: la evolución de una patología benigna y frecuente a una causa de muerte infrecuente / Squamous cancer settled on recurrent pilonidal sinus: the evolution of a benign and frequent pathology to an infrequent cause of death

El sinus pilonidal es una patología frecuente cuya malignización es infrecuente aunque su pronóstico puede ser fatal. El objetivo de esta publicación es presentar un caso de un paciente intervenido en múltiples ocasiones de escisiones de sinus pilonidal con degeneración maligna del mismo y evolución fatal, con el fin de recalcar la importancia del examen anatomopatológico sistemático de todas las muestras de escisión quirúrgica. (AU)

The pilonidal sinus is a frequent pathology whose malignization is uncommon although its prognosis can be fatal. The objective of this publication is to present a case of a patient intervened on multiple occasions of pilonidal sinus excisions with malignant degeneration and fatal evolution, in order to emphasize the importance of the systematic pathological examination of all surgical excision samples. (AU)

Reparación plástica con colgajo de Limberg en seno pilonidal sacrococcigeo / Plastic repair with Limberg flap in sacrococcygeal pilonidal sinus

En este trabajo se presenta la técnica quirúrgica descrip-ta por Limberg para las reparaciones plásticas, su uso para el tratamiento del seno pilonidal sacro coccígeo junto con sus resultados, tasas de éxito, complicaciones y recaídas. Para ello se realizó una búsqueda bibliográfica sobre el tema y se analizaron los resultados para determinar con-clusiones sobre la misma.La elección del tema la realicé en base a mi interés sobre la patología. El mismo surge a partir de mi observación en la práctica clínica de pacientes sometidos a técnicas no resectivas, abiertas, con una alta tasa de lechos cruentos, cicatrizaciones lentas y recaídas que podrían beneficiar-se de los principios que la reparación de Limberg ofrece. La técnica se describe como algo simple y fácilmente re-producible mientras se respeten sus principios, lo cual la vuelve una opción viable y atractiva. Lo antedicho sumado al respaldo bibliográfico hallado han sido los motores de la investigación actual.

Interdigital pilonidal sinus: An occupational disease of pet groomers / The Health Sciences Journal

INTRODUCTION@#Interdigital pilonidal sinus is an acquired condition secondary to penetration of hair fragments into the skin of the web spaces of the hands commonly observed in hairdressers, and occasionally, among pet groomers. Local literature reports or guidelines to ensure practice of protective measures for this population of workers are currently lacking.@*CASE SUMMARY@#A 24-year old pet groomer consulted due to occasional white hair strands emerging from two openings in the third interdigital space of his dominant hand. Histopathologic examination of the sinus tract showed an acanthotic, hyperplastic epidermis with scale crust, and nodular dermal infiltrates composed of epithelioid histiocytes, plasma cells, lymphocytes, and eosinophils. Transepidermal extrusion of polarizable hair cortical material was also evident establishing the diagnosis of an interdigital pilonidal sinus. Sinusectomy and debridement with healing by secondary intention resulted in an optimal wound closure and full motion of the affected hand after one week and minimal scarring with no recurrence after seven months.@*CONCLUSION@#Surgical excision followed by proper wound care is essential to avoid recurrence. In conclusion, since interdigital pilonidal disease is a rare condition, awareness among physicians would lead to accurate diagnosis, optimal treatment, and proper patient education.

Brazilian and argentinean multicentric study in the surgical minimally invasive treatment of pilonidal cyst / Estudo multicêntrico brasileiro e argentino no tratamento cirúrgico do cisto pilonidal por técnica minimamente invasiva

ABSTRACT Background: The pilonidal cyst is an infection of the skin and the subcutaneous tissue, secondary to a chronic inflammation with a greater frequency in the sacrococcygeal region, and associated to the presence of hair. The treatment is eminently surgical. Aim: To demonstrate the endoscopic treatment of pilonidal cyst. Method: Prospective study with 67 patients who had as surgical indication the diagnosis of pilonidal cyst. They were submitted to a surgical procedure from June 2014 to March 2018. The equipment used was the Meinero fistuloscope, a shutter, a monopolar electrode, a brush and endoscopic forceps. Results: Of the 67 patients, 67% (n=45) were male and 33% (n=22) female, with a mean age of 25 years (17-45). Surgical time in average was 40 min (20-120) and mean healing time of four weeks (3-12). Surgical complications were presented in 7% cases (n=5) and recurrences in 9% (n=6). Conclusion: The endoscopic treatment of the pilonidal cyst is feasible and presents good surgical results.

RESUMO Racional: O cisto pilonidal é infecção da pele e do tecido subcutâneo, secundário à inflamação crônica, com maior frequência na região sacrococcígea, e associado à presença de pelos nesta região. O tratamento é eminentemente cirúrgico. Objetivo: Demonstrar os resultados do tratamento endoscópico de cisto pilonidal. Método: Estudo prospectivo, com 67 pacientes que tiveram como indicação cirúrgica o diagnóstico de cisto pilonidal. Os equipamentos utilizados foram o fistuloscópio Meinero, um obturador, um eletrodo monopolar, uma escova e pinça endoscópica. Resultados: Dos 67 pacientes 67% (n=45) eram homens e 33% (n=22) mulheres, com média de idade de 25 anos (17-45). O tempo cirúrgico teve com média 40 min (20-120) e o tempo médio de cicatrização de quatro semanas (3-12). Complicações cirúrgicas ocorreram em 7% da amostra (n=5) e recidivas da doença em 9% (n=6). Conclusão: O tratamento endoscópico do cisto pilonidal é viável e apresenta bons resultados cirúrgicos.

Comparison of Limberg Flap and Karydakis Flap Surgery for the Treatment of Patients With Pilonidal Sinus Disease: A Single-Blinded Parallel Randomized Study

PURPOSE: Pilonidal sinus disease is a common condition, which mostly affects young men. While various surgical techniques have been introduced for treating intergluteal pilonidal disease (IPD), controversies still exist regarding the best surgical approach. The purpose of this study was to compare the efficiency and the short-term outcomes of Limberg flap and Karydakis flap surgeries for the treatments of patients with IPD.METHODS: A total of 80 patients with IPD who had underwent either Karydakis flap (KF group: n = 37) or Limberg flap (LF group: n = 27) surgery between January 2015 and January 2016 at Imam Khomeini Hospital of Sari in the North of Iran were recruited for inclusion in this randomized, single-blind study.RESULTS: Compared to the KF group, the LF group showed faster complete wound healing, longer duration of surgery and hospital stay, larger wound size, and shorter period of incapacity for work. The overall patient satisfaction in the LF group was significantly higher than that in the KF group. The visual analogue scale score of pain was lower in the LF group than in the KF group. Also, the overall frequency of postoperative complications was higher in the KF group than in the LF group. Recurrence was reported in one patient from the KF group.CONCLUSION: Given the lower rate of postoperative complications and greater cosmetic satisfaction of patients, the Limberg flap procedure should be selected, instead of the Karydakis flap procedure, as the standard technique for treating patients with IPD.

Limberg flap reconstruction for sacrococcygeal pilonidal sinus disease with and without acute abscess: Our experience and a review of the literature

BACKGROUND: The efficacy of Limberg flap reconstruction for pilonidal sinus with acute abscess remains unclear. This study aimed to compare outcomes after Limberg flap reconstruction for pilonidal sinus disease with and without acute abscess. A secondary objective was to perform a review of the literature on the topic. METHODS: A retrospective chart review was conducted of all patients who underwent excision and Limberg flap reconstruction for pilonidal sinus from 2009 to 2018. Patient demographics, wound characteristics, and complication rates were reviewed and analyzed. RESULTS: Group 1 comprised 19 patients who underwent Limberg flap reconstruction for pilonidal sinus disease without acute abscess and group 2 comprised four patients who underwent reconstruction for pilonidal sinus disease with acute abscess. The average defect size after excision was larger in group 2 than group 1 (107.7±60.3 cm² vs. 61.4±33.8 cm², respectively). There were no recurrences, seromas or cases of flap necrosis postoperatively. There was only one revision surgery needed for evacuation of a postoperative hematoma in group 1. There were comparable rates of partial wound dehiscence treated by local wound care, hematoma, need for revision surgery and minor infection between group 1 and group 2. CONCLUSIONS: Limberg flap reconstruction for pilonidal sinus in the setting of acute abscess is a viable option with outcomes comparable to that for disease without acute abscess. This practice will avoid the pain and cost associated with a prolonged local wound care regimen involved in drainage of the abscess prior to flap reconstruction.

Inverse ‘D’ incision technique in treatment of pilonidal sinus disease; excision with minimal tissue loss, closure without tension and lateral location of the suture line

PURPOSE: Surgical excision is the preferred treatment modality for sacrococcygeal pilonidal sinus (PS). Notably, the desirable features of an ideal surgical intervention are excision with minimal tissue loss, closure without tension, and a lateral suture line. The present study aimed to investigate early outcomes of surgical excision through the inverse D (ᗡ) incision based on tissue loss, wound tension, and suture line location. METHODS: This prospective study was comprised of 80 patients with PS in whom excision of PS was performed through the ‘ᗡ’ incision to minimize tissue loss with a tensionless primary surgical wound closure. The suture line was located laterally in all patients. Early and late postoperative complications, duration of hospital stay, return to work, and recurrence rates were investigated. The mean duration of the follow-up period was 36 months. RESULTS: Sixty-three patients (78.8%) were male. PS in all patients was surgically removed by subcutaneous excision through a ‘ᗡ’ incision. Laterally placed surgical wounds were closed primarily with interrupted vertical mattress sutures. No general complications were encountered. Five patients (6.3%) experienced early postoperative surgical site complications. On average, the duration of hospital stay and return to work were 2.4 days and 3.8 days, respectively. Recurrence was seen in 1 case (1.3%) during the follow-up period. Satisfaction score was high in 83.8% of patients. CONCLUSION: The method of sinus excision using the ‘ᗡ’ incision with a primary suture facilitates excision with minimal tissue loss and closure without tension with an off-midline suture. It is both a simple and effective surgical technique for the treatment of sacrococcygeal PS.

Wide Excision Using Indigo-Carmine to Minimize the Recurrence of a Pilonidal Cyst: Technical Note / 대한정형외과학회잡지

The cause of a pilonidal cyst is unclear, and treatment is still under debate. In Korea, the incidence of this disease is lower than that of Western countries, and it has often been misdiagnosed as a simple abscess. When pilonidal cysts are diagnosed, the principle of treatment is not to leave a residue, and a wide excision is needed to reduce the recurrence rate. This paper introduces a wide excision technique using Indigo-carmine dye to minimize the recurrence of a pilonidal cyst.

Operación de Bascom para el tratamiento de la enfermedad pilonidal sacrococcígea abscedada: experiencia inicial / Bascom operation for the treatment of abscessed pilonidal sacrococcygeal disease: initial experience

Resumen Introducción: Una de las formas de presentación de la enfermedad pilonidal sacrococcígea (EPSC) es el absceso, para el que existen distintas alternativas de tratamiento. Objetivo: Presentar nuestra experiencia con la técnica de Bascom para el tratamiento de la EPSC abscedada. Material y Método: Serie prospectiva, consecutiva y no aleatoria. Incluye todos los pacientes mayores de 15 años que presentan un absceso o supuración masiva al momento de la cirugía. Resultados: La serie corresponde a 10 pacientes, 7 de género masculino. No se encuentran los factores de riesgo reconocidos por la literatura como riesgo de EPSC. Ocho pacientes mejoran completamente en un período máximo de 18 días y 2 presentan supuración persistente, por lo que se considera fracaso del tratamiento. Estos son sometidos a una segunda cirugía con otra técnica, con curación de la enfermedad. Conclusión: La técnica de Bascom es sencilla, segura y ofrece una curación de un 80% en un período corto de cicatrización.

Introduction: One of the form of presentation of the sacral coccygeal pilonidal disease is the abscess, for this cases there are various treatment alternatives. Objective: We present our experience with Bascom technique for the treatment of pilonidal abscess. Material and Method: Prospective, consecutive, non-randomized series. It includes all patients older than 15 years who have an abscess or mass discharge at the time of surgery. Results: The series consists of 10 patients, 7 males. They are not risk factors recognized in the literature as risk of pilonidal disease. Eight patients completely better within a maximum period of 18 days and two with persistent discharge by what is considered treatment failure. They were subjected to a second surgery treatment with another technique with good results. Conclusion: Bascom's technique is simple, safe and offers a 80% cure in a short period of healing.

Evaluation of intradermal absorbable and mattress sutures to close pilonidal sinus wounds with Limberg flap: a prospective randomized comparative study

PURPOSE: We aimed to compare skin closure techniques, standard (intermittent mattress) and continuous subcuticular sutures, following Limberg flap procedure. METHODS: From July 2013 to July 2015, 92 patients with sacrococcygeal pilonidal disease were prospectively randomized into 2 groups consisting of 46 patients for both. Patients underwent sinus excision and closure with Limberg flap; continuous subcuticular suture was used in subcuticular group (SG) and intermittent mattress sutures were used in mattress group (MG) for skin closure. Characteristics of patients, features of pilonidal disease, macerations, infections, wound dehiscence, flap necrosis, operation time, time of drain removal, wound complications, early recurrences, and time till return to work were compared between the 2 groups. RESULTS: There was no statistical difference between groups per sex, age, body mass index, smoking, number of sinuses, depth of intergluteal sulcus, distance of incision to anus, volume of extracted tissue, number of hair follicles per cm2, recurrence, operation, and mean follow-up time. Two patients showed signs of wound complications (4.4%) in SG, whereas 8 cases (17.4%) showed signs in MG (P < 0.05). One patient in SG had surgical site infection and required antibiotics (2.2%), where as there were 6 cases treated in MG (13.0%) (P < 0.05). Removal of drain tube, and time till return to work rates are lower for SG than MG (P < 0.05). CONCLUSION: In conclusion, surgical procedures which include Limberg flap method and subcuticular closure may reduce infection and maceration rates. Future studies are needed to achieve greater detailed evaluation.

Innovation in the planning of V-Y rotation advancement flaps: A template for flap design

Local flaps exhibit excellent color matching that no other type of flap can compete with. Moreover, surgery using a local flap is easier and faster than surgery using a distant or free flap. However, local flaps can be much more difficult to design. We designed 2 templates to plan a V-Y rotation advancement flap. The template for a unilateral V-Y rotation advancement flap was used on the face (n=5), anterior tibia (n=1), posterior axilla (n=1), ischium (n=1), and trochanter (n=2). The template for a bilateral flap was used on the sacrum (n=8), arm (n=1), and anterior tibia (n=1). The causes of the defects were meningocele (n=3), a decubitus ulcer (n=5), pilonidal sinus (n=3), and skin tumor excision (n=10). The meningocele patients were younger than 8 days. The mean age of the adult patients was 50.4 years (range, 19–80 years). All the donor areas of the flaps were closed primarily. None of the patients experienced wound dehiscence or partial/total flap necrosis. The templates guided surgeons regarding the length and the placement of the incision for a V-Y rotation advancement flap according to the size of the wound. In addition, they could be used for the training of residents.

Manejo quirúrgico del quiste pilonidal. Técnica cerrada con colgajo de avance / Management of pilonidal cyst with closure technique

Introducción:La técnica cerrada es cada vez más utilizada en el tratamiento quirúrgico del quiste pilonidal, ya que es simple, con periodo de corto tiempo quirúrgico, hospitalización y cicatrización, aunque en nuestro medio aún no sea la más utilizada. Objetivo: Describir la experiencia del tratamiento del quiste pilonidal con la técnica cerrada con colgajo de avance en nuestro servicio.Materiales y método:El trabajo presenta un diseño observacional, descriptivo de corte transversal. Se estudió 30 pacientes de ambos sexos con diagnóstico de quiste pilonidal, intervenidos quirúrgicamente con la técnica cerrada con colgajo de avance en la II Cátedra de Clínica Quirúrgica del Hospital de Clínicas en el periodo enero 2014 a enero 2017. Resultados: 30 pacientes, edad promedio: 27,4 conrango entre 17 a 41 años, de los cuales el 70% (21) eran del sexo masculino y 30% (9) del sexo femenino, el promedio del tiempo quirúrgico fue 39 min y la estancia hospitalaria de 6 a 12 horas post quirúrgicas, el 90% (27) de los pacientes no presentó complicación alguna, presentando buena cicatrización en 15 días, la morbilidad fue del 10% (2 infecciones del sitio quirúrgico y 1 hematoma) y mortalidad nula. Discusión: En el trabajo de Karydakis, la edad promedio fue de 24,5 años en el nuestro de 27,4; el 53% fue hombre, en el nuestro 70%; la hospitalización promedio fue de 2,5 días, el nuestro de 6 a 12 horas. La recuperación completa de la mayoría fue de 15 días en ambos trabajos.

Introduction: The closed techinique is one of the most used in the surgical treatment of the pilonidal cyst, because it is simple and reproductible, it presents a period of short surgical time, of hospital stay and cicatrizacion. Objective: to describe experience of treatment of the pilonidal cyst with the closed flap technique in our servise. Materials and methods: the study has an observational, descriptive, and transverse cut desing, 30 patients where included, they submited to this technique during the period January 2014 to january 2017 in the II service of clinical surgery in The Clinical Hospital (Paraguay) Result: 30 pacients, with a range between 17 to 41 years of age, with 70%(21) were male, and 30%(9) were female, the average surgical time was 39 minutes, and the avarege hospital stay was 6 to 12 hours post surgical procedure, 90%(27) of the patients did not present any complications, presenting good healing in an average of 15 days, the morbidity was 10% (2 surgical site infections and 1 hematoma), and mortality was null. Discussion: in a Word of Karydakis obtained similar results to our work, the average age was 24,5 years in our 27,4; the 53% was a man, in our 70%; the average hospitalization was 2,5 days, in our 6 to 12 hour period. The complete recovery of the major-ity of the patients was of 15 days in both works.