[Results of the Limberg flap procedure in acute and chronic pilonidal abscesses]. / Ergebnisse des Limberg-Plastik-Verfahrens bei akuten und chronischen Pilonidalabszessen.

BACKGROUND: A number of different treatment algorithms are recommended for the treatment of an acute pilonidal abscess and a chronic pilonidal sinus. While a 1-stage surgical procedure using excision or plastic reconstruction according to Limberg or Karydakis is suggested for chronic pilonidal sinus, a 2­stage procedure is recommended for an acute pilonidal abscess. The aim of this study was to compare the results of the 1­stage surgery with plastic reconstruction according to Limberg for acute pilonidal abscess and chronic pilonidal sinus in terms of recurrence, disorders of wound healing, inpatient length of stay and patient satisfaction. METHODS: From 2009 to 2014 a total of 39 patients were included in this prospective observational study: 21 patients with acute pilonidal abscess and 18 patients with chronic pilonidal sinus. All patients were surgically treated with a 1­stage procedure using the Limberg flap method. The groups were compared in terms of postoperative complication rates and frequency of recurrence. RESULTS: Both groups were basically comparable with respect to demographic characteristics and risk factor profiles. Analysis of the postoperative results showed a comparable rate of postoperative wound healing disorders (10% vs. 17%, p = 0.647). In the group with acute pilonidal abscesses there was no recurrence during the observational period, while in the chronic pilonidal sinus group there were 2 (11%) recurrences (p = 0.206). CONCLUSION: The results of the Limberg flap procedure regarding acute pilonidal abscesses were comparable to those of chronic pilonidal sinus. The results of this study show a trend to a lower risk of recurrence. The use of the Limberg flaps therefore also seems to be an adequate treatment option in an acute infection situation.

[Post-traumatic bursitis--histological expert assessment and insurance medicine aspects]. / Posttraumatische Bursitis--histologische Begutachtung und versicherungsmedizinische Aspekte.

Concerning insurance medical reports on posttraumatic bursitis the histological findings hold an important position. 20 operation preparations of bursae with a known trauma have been studied. Thereby criterion for the histological characterization of posttraumatic bursitis have been set up and furthermore the findings have been correlated with the posttraumatic time interval. Sector-like fiber necrosis, defects of the top-cell layer, new erythrocyte extravasations, beginning inflammatory reactions and ensilages of foreign bodies in the histological preparation confirm the results of the medical opinion in the acute stage until 24 hours after the trauma occurred. The traumatic genesis of bursa alternations can be verified up to two weeks after the trauma through defects of the top-cell layer, fiber necrosis in all layers of the bursa wall, and erythrocyte extravasations. Preparations of which the trauma is dated back more than two weeks can be classified as posttraumatic bursitis because of their numerous chronifying processes only by their fiber continuity or by their granulation zone which reaches to the synovial surface. Four weeks after a suitable trauma it becomes more difficult to differentiate definite posttraumatic bursa findings from the morphological presentation of the so-called chronic-unspecified polyetiological bursitis. In the late posttraumatic stage the pathologic-anatomical differential diagnosis is only possible with considerable reservations. The clinical data on the course of disease gain particular importance for the insurance medical judgement in such late medical reports.