Titanium plates for primary closure of complete sternal cleft in an adult: Five-year follow-up

Aims: The purpose of this study was to evaluate excision and open granulation versus excision and primary closure as treatments for pilonidal sinus. Subjects and methods: We evaluated a group of 141 patients operated on for a pilonidal sinus between 1991 and 1995. Ninety patients were treated by excision and open granulation, 34 patients by excision and primary closure and 17 patients by incision and drainage, as a unique treatment of an infected pilonidal sinus. Results: The first group, receiving treatment of excision and open granulation, experienced the following outcomes: average length of hospital stay, four days; average healing time; 72 days; average number of post-operative ambulatory visits, 40; average off-work delay, 38 days; and average follow-up time, 43 months. There were five recurrences (6%) in this group during the follow-up period. For the second group treated by excision and primary closure, the corresponding outcome measurements were as follows: average length of hospital stay, four days; average healing time, 23 days; primary healing failure rate, 9%; average number of post-operative ambulatory visits, 6; average off-work delay, 21 days. The average follow-up time was 34 months, and two recurrences (6%) were observed during the follow-up period. In the third group, seventeen patients benefited from an incision and drainage as unique treatment. The mean follow-up was 37 months. Five recurrences (29%) were noticed, requiring a new operation in all the cases. Discussion and conclusion: This series of 141 patients is too limited to permit final conclusions to be drawn concerning significant advantages of one form of treatment compared to the other. Nevertheless, primary closure offers the advantages of quicker healing time, fewer post-operative visits and shorter time off work. When a primary closure can be carried out, it should be routinely considered for socio-economical and comfort reasons.

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Candy Closure Technique for Chronic Open Infective Lateral Malleolus Bursitis

BioMed Research International ◽

10.1155/2019/5490139 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5

Author(s):

Jin Su Kim ◽

Woo Jong Kim ◽

Ki Won Young ◽

Kyu Hwan Bae ◽

Han Hoon Kim ◽

...

Keyword(s):

Dead Space ◽

Primary Closure ◽

Complete Healing ◽

Lateral Malleolus ◽

Closure Technique ◽

Simple Method ◽

Secondary Operation ◽

Control Infection

The aim of this study was to report the effectiveness of the Candy closure technique as a treatment for chronic open infective lateral malleolus bursitis. From June 2014 to March 2018, we performed the Candy closure technique as a treatment for chronic open infective lateral malleolus bursitis in nine patients without secondary operation. We first performed infectious tissue debridement to control infection, and if primary closure was not possible, we performed the Candy closure technique for small wounds. The duration of the wound prior to surgery varied from 4 weeks to 2 years. Seven cases were due to infection on the bursa and two cases were ulcer-type bursitis. All the wounds were small (average, 3.80 cm2; range, 2.25-4 cm2) and circular. Seven wounds showed complete healing at 4 weeks after surgery, one wound showed complete healing at 8 weeks after surgery, and one wound with infected state was lost to missing follow-up. Of the seven wounds that showed complete healing, one wound recurred 6 months after surgery. The Candy closure technique is a simple method for ensuring healing and coverage of chronic open lateral malleolus bursitis, especially for small wounds with dead space.

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The kite flap for reconstructing tumour excision wounds in the middle and lower face: a retrospective study

Journal of Wound Care ◽

10.12968/jowc.2020.29.10.562 ◽

2020 ◽

Vol 29 (10) ◽

pp. 562-566

Author(s):

Ma Yan ◽

Zhou Xiaobo ◽

Yuan Zhaoqi ◽

Wang Xiuxia ◽

Jin Rui ◽

...

Keyword(s):

Primary Closure ◽

Donor Site ◽

Malignant Tumour ◽

Complete Excision ◽

Recipient Site ◽

Lower Face ◽

Kite Flap ◽

Facial Wounds ◽

Surrounding Skin

Objective: The aim of this study was to present our experience with a kite flap in reconstruction of facial wounds after malignant tumour excision. Method: From October 2008 to September 2017, patients with facial malignant tumour were treated in the Xinjiang Uygur Autonomous Region Bazhou People's Hospital with kite flaps after complete excision. The survival rate, colour, cicatrix of the flap and patient satisfaction were recorded after surgery. Results: A total of 95 patients were included in the study. During follow-up, from six months to 8 years, all the kite flaps achieved primary closure and survived well, and the colour and texture were similar to the surrounding skin with no obvious scar. Dysfunction, complications and recurrence had not been reported. Conclusion: The kite flap may be a good option in reconstructing facial wounds after malignant tumour excision (diameters 1–5cm). It is a simple surgical method with sufficient blood supply and extensive adaptability. For patients in this study, no obvious scars were formed and the recipient site matched well with the donor site.

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A decision-making guide for the closure of myelomeningocele skin defects with or without primary repair

Journal of Neurosurgery Pediatrics ◽

10.3171/2016.2.peds15702 ◽

2016 ◽

Vol 18 (2) ◽

pp. 187-191 ◽

Cited By ~ 6

Author(s):

Cemal Alper Kemaloğlu ◽

İrfan Özyazgan ◽

Ömer Faruk Ünverdi

Keyword(s):

Decision Making ◽

Primary Closure ◽

Primary Repair ◽

Patient Characteristics ◽

Wound Complications ◽

Width Ratio ◽

Skin Defect ◽

Skin Defects

OBJECTIVE The closure of the skin defect in myelomeningocele (MMC) repair is an essential step that determines the quality of the surgical result. The success of surgical results is related to the decision to use the most suitable techniques, namely flaps or primary closure. The aim of this study was to evaluate the effectiveness of a decision-making guide to determine whether to use primary repair or a flap for the closure of skin defects that occur in MMC. METHODS Fifty patients underwent surgery after neurosurgical repair and closure of the placode. A simple guide was generated according to the defect height/width and posterior axillary lines/defect width ratio. These 2 ratios were considered to determine which closure technique (with or without primary repair) should be used for the MMC defect reconstruction. RESULTS By using this decision-making guide, 20 of the defects were repaired with various flaps, and those of the remaining 30 patients were repaired with primary closure. In all patients, a successful tension-free 1-stage closure was obtained. Except for 4 patients who had flap reconstruction with partial flap necrosis or minimal flap tip necrosis, healing was uneventful without any complications. There were no additional wound complications during the mean follow-up of 6.8 years (range 5 months to 14 years). CONCLUSIONS Because of various defect sizes and patient characteristics, no single protocol exists for the reconstruction of MMC defects. The guide suggested here might be effective in deciding which method is suitable for closure of MMC skin defects.

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Outcomes of Carotid Endarterectomy with Primary Closure

International Journal of Angiology ◽

10.1055/s-0037-1601053 ◽

2017 ◽

Vol 26 (02) ◽

pp. 083-088 ◽

Cited By ~ 3

Author(s):

Ivy Cheng ◽

Krishna Vyas ◽

Santhosh Velaga ◽

Daniel Davenport ◽

Sibu Saha

Keyword(s):

Carotid Endarterectomy ◽

Primary Closure ◽

Complication Rates ◽

Short Term ◽

Specific Patient ◽

Cross Clamp Time ◽

Complication Risk ◽

Duplex Imaging ◽

Patch Angioplasty

AbstractCarotid endarterectomy (CEA) reduces the risk of stroke in patients with internal carotid artery stenosis, although the optimal surgical technique is debated. The literature suggests that patch angioplasty reduces complication risk, although primary closure shortens cross-clamp time and eliminates complications associated with grafts.The objective of this study was to assess the complication rate after CEA with primary closure.Retrospective review of 240 consecutive patients between 2002 and 2010. Of these patients, 70% returned for follow-up visits for at least 2 or more years.Primary closure was used in all patients. The average cross-clamp time was 18 minutes. Complications in the immediate postoperative period within 30 days were as follows: stroke (n = 3; 1.1%), transient ischemic attack (TIA; n = 4; 1.5%), myocardial infarction (MI; n = 3; 1.1%), and death (n = 1; 0.4%). Short-term follow-up revealed eight patients who were found to have significant restenosis (>80%) by carotid duplex imaging. Two to ten year postoperative complication rates were as follows: stroke (n = 7; 4.2%), TIA (n = 7; 4.2%), amaurosis fugax (n = 1; 0.6%), MI (n = 8; 4.8%), and death (n = 28; 17%). Mortality was due to stroke or heart attack (n = 2; 1.2%), cancer (n = 7; 4.2%), and unknown causes (n = 19; 11%).This study presents our experience with complications after primary closure after CEA. In our experience, CEA is a safe and effective surgical means of preventing stroke in the short term. Well-designed prospective studies are needed to confirm specific patient characteristics in which primary closure and patch angioplasty are indicated.

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Technique Using a Titanium Plate to Reconstruct the Inferior Sternal Cleft in Pentalogy of Cantrell: Lessons From Four Patients

10.21203/rs.3.rs-391353/v1 ◽

2021 ◽

Author(s):

Linyun Xi ◽

Chun Wu ◽

Zhengxia Pan ◽

Ming Xang

Keyword(s):

New York ◽

Heart Association ◽

Function Class ◽

Symptomatic Treatment ◽

Thoracic Wall ◽

Titanium Plate ◽

Low Cardiac Output Syndrome ◽

Pentalogy Of Cantrell ◽

Sternal Cleft

Abstract BackgroundBy reviewing the outcomes of four patients, we summarize our experience with the strategy of using a titanium plate to reconstruct the inferior sternal cleft in pentalogy of Cantrell (POC).MethodsThis was a retrospective analysis of 4 patients who visited our department between January 2000 and June 2020 concurrent with POC. All four patients underwent an operation, as well as cardiac ultrasound and thoracoabdominal computed tomography (CT). Cardiac malformations achieved satisfactory correction according to echocardiographs. A titanium plate was used to repair the sternal and supraumbilical abdominal defects. The hospital course, operative data, and outpatient records were reviewed.ResultsAll 4 patients had partial sternal clefts, and 4 patients underwent a single-stage operation. All 4 cases of ectopia cordis were eventually repositioned. The defect in the sternum and supraumbilical abdomen was repaired using a titanium plate. One patient with double-outlet right ventricle (DORV) developed low cardiac output syndrome and pulmonary infection, and symptomatic treatment was administered until discharge. The mean follow-up time ranged from 9 months to 10 years. No patient developed pectus excavatum, and there were no cases of retrosternal seroma or pneumothorax. The titanium plate was migratory in the second patient and was dislodged at another hospital 3.5 years postoperation, and a fibreboard was formed in the area where sternal cleft; the beating heart could not be observed outside the thoracoabdominal or thoracic wall. In the first patient, the titanium plate was torn with a small fissure at 2 years postoperation, but the fissure was not enlarged during follow-up. In the other two patients, the appearance of both the abdominal wall and lower sternum and cardiac function were good. The New York Heart Association function class was I in all four patients.ConclusionThe use of a titanium plate to construct the neosternum can yield a satisfactory exterior appearance of the thorax with a partial sternal cleft, but long-term outcomes need to be examined further.

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Primary Closure of a Partial Superior Sternal Cleft in a 27-day-old Neonate: Case Report with Short Review of Literature

Cureus ◽

10.7759/cureus.4653 ◽

2019 ◽

Author(s):

Mithun Sundararaaja Ravikumar ◽

Vijayanand Palanisamy ◽

Karthik Raman ◽

Ravi Agarwal

Keyword(s):

Case Report ◽

Primary Closure ◽

Short Review ◽

Review Of Literature ◽

Sternal Cleft

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Intermammary pilonidal sinus: rare location of a common condition

International Surgery Journal ◽

10.18203/2349-2902.isj20205909 ◽

2020 ◽

Vol 8 (1) ◽

pp. 385

Author(s):

Gayatri A. Deshpande ◽

Raj N. Gajbhiye ◽

Bhupesh Tirpude ◽

Hemant Bhanarkar ◽

Vikrant Akulwar ◽

...

Keyword(s):

Pilonidal Sinus ◽

Primary Closure ◽

Histopathological Examination ◽

Skin Surface ◽

Sinus Tract ◽

Complete Excision ◽

Rare Location ◽

Keloid Formation ◽

One Year

Pilonidal sinus in the intermammary region is a rare location of an inflammatory condition commonly occurring in the natal cleft. It is typically characterised by a pus and hair containing cavity in the skin lined by granulation tissue connecting the skin surface. A 22 year-old female presented with chronically discharging sinuses in the intermammary region with recurrent abscess formation for one year duration. Although a rare location, clinical diagnosis of pilonidal sinus was made. Complete excision of sinus tract with abscess cavity with primary closure was performed under general anaesthesia. Histopathological examination confirmed pilonidal sinus. On follow up, the scar was healthy with no keloid formation. Pilonidal sinus may rarely occur in intermammary region. Complete excision and primary closure is the mainstay treatment.

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First Sternal Cleft Repair Using a Porous Alumina Ceramic Prosthesis in a 9-Year-Old Child

European Journal of Pediatric Surgery Reports ◽

10.1055/s-0039-1688775 ◽

2019 ◽

Vol 07 (01) ◽

pp. e20-e23

Author(s):

Virginie Fouilloux ◽

François Bertin ◽

Emilie Peltier ◽

Jean-Luc Jouve

Keyword(s):

Porous Alumina ◽

Muscle Flap ◽

Alumina Ceramic ◽

Congenital Defects ◽

Deep Sternal Wound Infection ◽

Sternal Cleft ◽

Good Healing ◽

Rare Congenital Abnormality ◽

Sternal Reconstruction

AbstractSternal cleft is a rare congenital abnormality, often associated with other congenital defects. We present the case of a 9-year-old child with complete sternal cleft, treated with an innovative sternal prosthesis. Surgery was performed to protect the heart and also, as pulsations was visible, leading to serious esthetical concerns, to enhance school integration, which was difficult. The porous alumina device used was initially designed for sternal reconstruction after refractory deep sternal wound infection or carcinoma. Surgery and early follow-up were simple. There was no complication and the follow-up of more than 1 year reveals a good healing without breath discomfort and a correct development of the chest wall. In this rare indication, the alumina ceramic sternal prosthesis offers a reliable alternative to classical methods, such as muscle flap, autogenous tissue transfer, costal homograft, and other prosthetic materials like mesh or synthetic patch.

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Melanoma of the External Ear

Tumori Journal ◽

10.1177/030089169708300507 ◽

1997 ◽

Vol 83 (5) ◽

pp. 814-817 ◽

Cited By ~ 19

Author(s):

Aldo Bono ◽

Cesare Bartoli ◽

Andrea Maurichi ◽

Daniele Moglia ◽

Gabrina Tragni

Keyword(s):

Local Recurrence ◽

Primary Closure ◽

Wedge Resection ◽

Tumor Thickness ◽

Safe Procedure ◽

External Ear ◽

Partial Amputation ◽

Clinical Records ◽

And Cartilage

Aims and background Melanoma of the external ear is a rare disease, and its management is controversial. To address this problem, we reviewed the data concerning the patients observed at our Institution. Methods We retrospectively reviewed the clinical records of the 20 patients bearing primary ear melanoma observed over a period of about 20 years at the Istituto Nazionale Tumori of Milan. Results Initial evaluation of the patients revealed 7 stage I, 12 stage II and 1 stage III. The thickness of the tumors varied from 0.39 to 6.62 mm. Fourteen patients underwent a wedge resection of the skin and cartilage with primary closure, and 6 patients had a partial amputation of the ear. In 8 cases the section was performed at about 1 cm from the border of the tumor, in 6 cases at about 0.5 cm, and in 6 cases at more than 1 cm. The average follow-up was 57 months (range, 1-18 years). Since there was no local recurrence, it could not be related to type and extent of the local resection performed. In contrast, the development of metastases was related to tumor thickness. Conclusions A conservative excision with margins of 1 cm can be a safe procedure for invasive ear melanoma, irrespective of tumor thickness. Like melanomas of other sites, the prognosis is linked to the thickness of the tumor.

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