V-y advancement flap technique in resurfacing postexcisional defect in cases with pilonidal sinus disease-study of 25 cases.

We report our experience of technique of V-Y-plasty in treatment of pilonidal sinus. A retrospective study of 25 patients performed from 2005 to 2010 at Deenanath Mangeshkar Hospital and Sassoon General Hospitals, Pune, was performed. The unilateral or bilateral V-Y advancement flap technique was used in the management of these patients. The outcome was assessed on the basis of efficacy of flap surgery in achieving wound healing and recurrence. The follow-up ranged from 6 months to 5 years. The study included 25 cases of pilonidal sinus. Nineteen patients (76%) underwent unilateral V-Y-plasty and six patients (24%) underwent bilateral V-Y-plasty. Eighty-four percent cases were from the age group of 21-30 years. Sixty-eight percent patients were mobilized on the fourth postoperative day and 32% patients were mobilized on the third postoperative day. No recurrence was found in any of the patients. Itching and hypertrophic scar were found in two cases (8%), and decreased sensation was found in one patient (4%). The V-Y advancement flap technique for the treatment of pilonidal sinus is efficient and can reduce recurrence. Unilateral/bilateral V-Y flap achieves suture line away from midline, obliteration of natal fold and coverage of defect without tension. In follow-up none of the patients showed recurrence. This technique has distinctly less morbidity and avoids of multiple dressings, reducing the total cost of the treatment. V-Y advancement flap is distinctly better choice among the available flaps as it is less time-consuming, requires less technical expertise as compared to Z-plasty and perforator flaps, and is reliable and easy to plan.

Our experience with pectoralis major flap for management of sternal dehiscence: A review of 25 cases.

OBJECTIVE: To report our experience of the pectoralis major flap as the treatment modality for post coronary artery bypass sternal wound dehiscence. MATERIALS AND METHODS: A retrospective study of 25 open heart surgery cases, performed between January 2006 and December 2010 at Deenanath Mangeshkar Hospital, Pune, was carried out. Unilateral or bilateral pectoralis major muscle flap by the double breasting technique using rectus extension was used in the management of these patients. The outcome was assessed on the basis of efficacy of flap surgery in achieving wound healing and post-surgery shoulder joint movements to evaluate donor site morbidity. The follow-up ranged from 5 months to 3.5 years. RESULTS: Twenty-three (92%) patients were discharged with complete wound closure. One patient (4%) had wound dehiscence after flap surgery. One patient (4%) died in the hospital in the immediate postoperative period due to mediastinitis. No recurrent sternum infection has occurred till date in 24 patients (96%). For one patient (4%) who had wound dehiscence, daily dressing was done and wound healing was achieved with secondary intension. At follow-up, shoulder joint movements were normal in all the patients. CONCLUSIONS: The double breasting technique of the pectoralis major muscle flaps with rectus sheath extension is efficient in covering the entire length of the defect and can reduce the morbidity, without affecting the function of the shoulder joint.