Recurrent sacrococcygeal pilonidal disease: the efficacy of minimal subcutaneous excision of the sinus and unroofing of pseudocystic cavity.

Patients undergoing surgery for recurrent pilonidal disease are at high risk of developing re-recurrence. The present prospective analysis was performed to evaluate the outcome for recurrent pilonidal disease treatment with a technique that provides a minimal subcutaneous excision of fistula and of the skin above the cyst, with secondary healing of wounds. METHODS: 48 consecutive patients with previous surgical excision and recurrent pilonidal disease underwent surgery from January 2009 to December 2016, under local anaesthesia. The age of the patients (42 males and 6 females) at the time of our observation was 28.5 ± 10.2 years, the BMI of 26.3 ± 6.8. The average number of interventions prior to our was 2.02 ± 1.14. RESULTS: The mean operative time was 18.2 ± 5.5 minutes. All patients were discharged 2 to 4 hours after surgery, with an average healing time of 22.8 ± 15.3 days. We recorded, in the follow-up period, only 4 relapses (8.32%), all retreated with the same surgical procedure and brought to complete healing. The results of the cosmetic questionnaire, which assessed patient satisfaction and contentment, showed that 96% of patients were completely satisfied and all patients recommended surgery to others. Kaplan-Meier analysis showed that in 7 years of follow-up, 85% of patients healed without recurrence. CONCLUSIONS: Our simple procedure appears to be safe and easily reproducible, allowing a high surgical success in the treatment of recurrent pilonidal disease. KEY EORDS: Excision, Healing, Recurrent sacrococcygeal pilonidal disease.

Inguinal hernioplasty in patients with cirrhosis and ascites: what preventive measures are needed for a safe procedure?

BACKGROUND: Inguinal hernioplasty in patients with LC and ascites has been long discouraged for the incidence of postoperative complications. The aim is to evaluate the appropriateness of this elective surgical procedure in patients with LC and ascites. METHODS: Thirty consecutive LC patients with ascites and affected by inguinal hernia (LC group), who underwent elective open inguinal hernioplasty with mesh placement, have been matched with the same number of patients non-LC (non-LC group) who underwent the same surgical procedure in the same period of time. All patients in LC group received a careful hepatological assessment and were classified according to the etiology of LC and to the Child's class. Patients of both groups received an antibiotic prophylaxis and were operated under local anesthesia. RESULTS: No significant complications were observed in any patients during surgery. The hospital stay was significantly longer in LC group. During the postoperative time, 4 inguinoscrotal hematoma appeared in LC group, of which 3 in class C (LC VS non-LC p>0.05; non-LC VS Child's class C p<0.023). Ascites leakage or wound infection were not observed. CONCLUSION: Inguinal hernioplasty can be safely performed for LC patients in Child's class A and B; for patients in class C, careful attention must be paid to the hemorrhagic events. KEY WORDS: Ascites, Cirrhosis, Hernioplasty.

Necrotizing Soft Tissue Fasciitis after Intramuscular Injection.

Necrotizing soft tissue fasciitis (NSTIs) or necrotizing fasciitis is an infrequent and serious infection. Herein, we describe the clinical course of a female patient who received a diagnosis of NSTIs after gluteus intramuscular injection. We also report the results of our review of published papers from 1997 to 2017. Since now, 19 cases of NSTIs following intramuscular injections have been described. We focus on the correlation between intramuscular injection and NSTIs onset, especially in immunosuppressed patients treated with corticosteroids, suffering from chronic diseases or drug addicted. Intramuscular injections can provoke severe tissue trauma, representing local portal of infection, even if correctly administrated. Otherwise, it is important not to inject drug in subcutaneous, which is a less vascularized area and therefore more susceptible to infections. Likewise, a proper injecting technique and aspiration prior to injection seem to be valid measure to prevent intra-arterial or para-arterial drug injection with the consequent massive inflammatory reaction. Necrosis at the infection site appears to be independent of the drug, and it is a strong additional risk factor for NSTIs.