TP7.2.1 Outcomes of Modified Karydakis flap in the surgical management of sacrococcygeal pilonidal disease: A single surgeon’s experience

Abstract Aim To determine the incidence of post-operative complications of patients with sacrococcygeal pilonidal disease who were treated with the Modified Karydakis flap with a specific management bundle. Primary outcomes assessed included the post-operative incidence of seroma, haematoma, SSI, deep SSI, wound dehiscence, re-admissions, return to theatre and flap necrosis. Secondary outcome evaluated was recurrence at 6 month follow up. Method It was a retrospective analysis of a single surgeon’s (FA’s) practice results of Modified Karydakis flaps on patients with sacrococcygeal pilonidal disease who were managed according to a specific protocol. Data was collected between June 2017 and June 2020. 96 patients were analysed, of which 9 were excluded as they had excision without closure. Pre, per and post-operative management for the remaining 87 patients was according to a standardised protocol. Data was collected from patient’s notes and from prospectively and retrospectively maintained patient data bases (Theatre System, Medway). Results Primary outcomes: • Seroma: 8/87 (9.2%) • Haematoma: 1/87 (1.2%) • SSI: 10/87 (11.5%) • Deep SSI: 4/87 (4.6%) • Superficial dehiscence: 7/87 (8.0%) • Re-admission: 4/87 (4.6%) • Return to theatre: 0 (0%) • Flap necrosis: 0 (0%) Secondary outcome: • Recurrence at 6 months: 2/87 (2.3%) Conclusions Good surgical results can be obtained with Modified Karadakis flap, provided meticulous surgical technique is applied. Placement of a suction drain for a minimum of 72 hours reduces incidence of post-operative haematoma and seroma formation. Three post-operative doses of broad spectrum intravenous antibiotics followed by 5 days of oral antibiotics helps reduce post-operative infections.

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269 Outcomes of Modified Karydakis Flap in The Surgical Management of Sacrococcygeal Pilonidal Disease: A Single Surgeon’s Experience

British Journal of Surgery ◽

10.1093/bjs/znab259.408 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

F Alam ◽

D Farooq ◽

A Theofilis ◽

H Wooler ◽

R Payne

Keyword(s):

Pilonidal Disease ◽

Wound Dehiscence ◽

Operative Management ◽

Secondary Outcome ◽

Data Bases ◽

Suction Drain ◽

Specific Protocol ◽

Intravenous Antibiotics ◽

Operative Complications

Abstract Aim To determine the incidence of post-operative complications of patients with sacrococcygeal pilonidal disease who were treated with the Modified Karydakis flap with a specific management bundle. Primary outcomes assessed included the post-operative incidence of seroma, haematoma, SSI, deep SSI, wound dehiscence, re-admissions, return to theatre and flap necrosis. Secondary outcome evaluated was recurrence at 6 months follow up. Method It was a retrospective analysis of a single surgeon’s (FA’s) practice results of Modified Karydakis flaps on patients with sacrococcygeal pilonidal disease who were managed according to a specific protocol (fig. 1). Data was collected between June 2017 and June 2020. 96 patients were analysed, of which 9 were excluded as they only had excision without closure. Pre, per and post-operative management of the remaining 87 patients was according to a standardised protocol (fig. 1). Data was collected from patient’s notes and from prospectively and retrospectively maintained patient data bases (Theatre System, Medway). Results Primary outcomes: Secondary outcome: Conclusions Good surgical results can be obtained with Modified Karadakis flap, provided meticulous surgical technique is applied. Placement of a suction drain for a minimum of 72 hours reduces incidence of post-operative haematoma and seroma formation. Three post-operative doses of broad-spectrum intravenous antibiotics followed by 5 days of oral antibiotics helps reduce post-operative infections.

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Retrospective Review of Pilonidal Sinus Patients With Early Discharge After Limberg Flap Procedure

International Surgery ◽

10.9738/intsurg-d-13-00150.1 ◽

2014 ◽

Vol 99 (1) ◽

pp. 28-34 ◽

Cited By ~ 7

Author(s):

Fatih Altintoprak ◽

Kemal Gundogdu ◽

Tolga Ergonenc ◽

Enis Dikicier ◽

Guner Cakmak ◽

...

Keyword(s):

Pilonidal Sinus ◽

Wound Dehiscence ◽

Early Discharge ◽

Long Term Results ◽

Limberg Flap ◽

Flap Necrosis ◽

Flap Procedure ◽

Short And Long Term

Abstract The aim of this study was to evaluate the results of cases with pilonidal sinus (PS) disease that underwent Limberg flap (LF) transposition and to compare the short and long-term results of early discharge cases with those in the literature. A total of 345 patients who underwent rhomboid excision and LF transposition for PS were evaluated retrospectively. No major anesthetic or surgical complications occurred. Partial wound dehiscence, localized flap necrosis, hematoma, wound infection, and seroma rates were determined as 4.0, 2.1, 1.5, 3.3, and 3.7% respectively. All patients other than those with a hematoma or localized necrosis were discharged with a drain in place 24 hours after the operation. The recurrence rate was 3.9% after a mean 33.1-month follow-up (range, 6–72 months). As a result, we found that short and long-term results of patients who underwent LF and were discharged 24 hours after the operation were similar to those in the literature. We suggest that patients without postoperative complications, such as hematoma or flap necrosis, can be discharged early.

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Frequency of Early Post-Operative Complications following Modified Radical Mastectomy (MRM) in patients with Breast Carcinoma

10.53350/pjmhs211561623 ◽

2021 ◽

Vol 15 (6) ◽

pp. 1623-1625

Author(s):

Sadia Shah ◽

Rahmat Ullah Shah ◽

Adnan Badar ◽

Monawar Shah ◽

Shabir Ahmad ◽

...

Keyword(s):

Breast Carcinoma ◽

Wound Infection ◽

Skin Flap ◽

Radical Mastectomy ◽

Wound Dehiscence ◽

Seroma Formation ◽

Flap Necrosis ◽

Modified Radical Mastectomy ◽

Operative Complications ◽

Post Operative Complications

Objective: Breast carcinoma is the commonest cancer affecting female gender and is the second major cause of mortality in females globally. Among different surgical options, modified radical mastectomy (MRM) with or without neoadjuvant therapy is the most frequent surgery carried out globally for breast carcinoma. In this study we aimed to determine the frequency of early post-operative complications following modified radical mastectomy (MRM) in patients with breast carcinoma. Material and methods: This dual setting retrospective descriptive study was conducted at General surgery departments of Kuwait Teaching Hospital and MTI-Lady Reading Hospital Peshawar between January, 2018 and June, 2019. A total of 60 patients aged >18 years with biopsy proven stage-I to stage-III breast carcinoma who underwent modified radical mastectomy were included.All patients were followed on weekly basis for six weeks at the out-patient department (OPD) and evaluated for the development of early complications such as seroma/hematoma, flap necrosis and wound infections. Results: Seroma formation found in 9 patients (15%) and wound infection seen in 5 patients (8.3%) were the commonest complications. Conclusion: In our study seroma formation was the most common complication followed by wound infection. Skin flap necrosis, wound dehiscence, hematoma formation and development of early lymphoedema were less common. None of our patients presented with muscle paralysis secondary to nerves injury. Keywords: Breast carcinoma, modified radical mastectomy, complications, seroma, wound infection.

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Outcomes of Suture-Button Fixation for Treatment of Maisonneuve Injuries

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00213 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0021

Author(s):

Rabun S. Fox ◽

Ryan G. Rogero ◽

Daniel Corr ◽

Steven M. Raikin ◽

David I. Pedowitz ◽

...

Keyword(s):

Wound Dehiscence ◽

Operative Management ◽

Exclusion Criteria ◽

Suture Button ◽

Orthopedic Surgeons ◽

Clear Space ◽

Fibular Fracture ◽

Ankle Trauma ◽

Ability Measure

Category: Ankle; Trauma Introduction/Purpose: The purpose of this study was to evaluate the radiographic and functional outcomes of suture-button devices for treatment of Maisonneuve injuries, which present unique considerations due to the proximal one-third fibular fracture, through which the distal fibular segment can potentially shorten. Methods: Patients undergoing operative management of Maisonneuve injuries from 2014-2018 utilizing suture-button devices with 2 fellowship-trained foot and ankle orthopedic surgeons were included. Exclusion criteria included use of a transosseous syndesmotic screw, fixation of the proximal fibular fracture, or less than 12 months follow-up. Medial clear space, tibiofibular clear space, tibiofibular overlap, talocrural angle, and distal fibular congruency on the injured and non-injured ankles were measured. Patients also completed the Foot & Ankle Ability Measure (FAAM)-Activities of Daily Living (ADL) and -Sports subscales and Visual Analog Scale (VAS) for pain (n/100). Thirty-three patients were included. Results: Three (9.1%) patients experienced a postoperative complication, including 1 wound dehiscence and 2 requiring hardware removal. No significant differences were demonstrated in radiographic parameters measured between 6-week and final radiographs on the injured ankle, as well between final radiographs taken of the injured and uninjured ankles (Table 1). At mean follow-up of 34.7 (range, 12-58) months, patients had a mean FAAM-ADL of 91.1, FAAM-Sports of 81.7, and VAS pain of 14.3. Conclusion: This study demonstrates that isolated use of suture-button devices for syndesmotic fixation in Maisonneuve injury patterns is effective at maintaining fibular length and reduction of the syndesmosis, as well as achieving satisfactory patient outcomes. [Table: see text]

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Outcomes of Coccygectomy Using the “Z” Plasty Technique of Wound Closure

Global Spine Journal ◽

10.1177/2192568219831963 ◽

2019 ◽

Vol 9 (8) ◽

pp. 802-806 ◽

Cited By ~ 2

Author(s):

Arvind G. Kulkarni ◽

Sandeep Tapashetti ◽

Viraj S. Tambwekar

Keyword(s):

Wound Healing ◽

Wound Closure ◽

Outcome Measure ◽

Surgical Site Infections ◽

Wound Dehiscence ◽

Secondary Outcome ◽

Secondary Outcome Measure ◽

Patient Reported ◽

The Mean

Study Design: Technical note. Objectives: Coccygectomy for chronic coccydynia has a high rate of successful clinical outcome. However, the procedure is associated with increased incidence of wound dehiscence and surgical site infection. The main objective was to evaluate the clinical outcomes of coccygectomy using the Z plasty technique of wound closure. Methods: Patients with chronic coccydynia refractory to conservative treatment underwent coccygectomy followed by Z plasty technique of wound closure between January 2013 and February 2018. Primary outcome measure was evaluation of the wound healing in the postoperative period and at follow-up; secondary outcome measure included visual analogue scale (VAS) score for coccygeal pain. Results: Ten patients (male:female 6:4) fulfilled the inclusion criteria. The mean age of patients was 40.78 years (range 19-55 years). The mean follow-up was 1.75 years (range 6 months to 5 years). All wounds healed well with no incidence of wound dehiscence or surgical site infections. The mean VAS improved from 7.33 ± 0.5 to 2.11 ± 1.2 ( P < .05). Nine patients reported excellent outcomes and 1 patient reported poor outcome with regards to relief from coccydynia. Conclusion: Z plasty technique of wound closure is recommended as procedure of choice to avoid wound healing problems and surgical site infections associated with coccygectomy. Coccygectomy remains a successful treatment modality for chronic coccydynia.

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Non-operatively managed case of contained jejunal diverticular perforation

BMJ Case Reports ◽

10.1136/bcr-2018-228811 ◽

2019 ◽

Vol 12 (7) ◽

pp. e228811 ◽

Cited By ~ 1

Author(s):

Raja Jambulingam ◽

Gayan Nanayakkara

Keyword(s):

Abdominal Pain ◽

Small Bowel ◽

Early Diagnosis ◽

Operative Management ◽

Late Diagnosis ◽

Urgent Surgery ◽

Abdominal Symptoms ◽

Intravenous Antibiotics ◽

Non Operative Management

Jejunal diverticulosis is an underdiagnosed condition due to its relatively benign existence and uncharacteristic presentation. The complications can be very severe and, due to its often late diagnosis, patients may require urgent surgery. We present a woman who initially complained of non-specific abdominal symptoms but was diagnosed with a contained jejunal diverticular perforation relatively early. We managed her non-operatively with intravenous antibiotics from which she recovered well. She was discharged 2 days later and has remained completely well. Follow-up at 3 months showed no recurrence. Our case differs from most of the literature due to the early diagnosis and successful non-operative management of the patient. We conclude that, in cases of non-specific abdominal pain with diagnostic ambiguity, a diagnosis of small bowel diverticulosis should be considered. It should be managed non-operatively where possible.

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A comparative study of excision with primary closure versus Limberg flap in pilonidal sinus

International Surgery Journal ◽

10.18203/2349-2902.isj20195194 ◽

2019 ◽

Vol 6 (12) ◽

pp. 4282

Author(s):

Omesh Kumar Meena ◽

Dheer Singh Kalwaniya ◽

Satya V. Arya ◽

Manikandan Kuppuswami ◽

Jaspreet Singh Bajwa ◽

...

Keyword(s):

Pilonidal Sinus ◽

Primary Closure ◽

Pilonidal Disease ◽

Operating Time ◽

Pilonidal Sinus Disease ◽

Limberg Flap ◽

Flap Procedure ◽

Operative Complications ◽

Post Operative Complications

Background: The term ‘pilonidal sinus’ describes a condition found in the natal cleft overlying the coccyx which is treated by excision.Methods: This study is a prospective study held in Department of general surgery, Safdarjung Hospital, New Delhi from October 2014 to April 2016 on 60 patients out of which 30 were controls (excision with primary closure) and 30 were taken as case (Limberg flap). Post-operative follow up was done till 6 months and complications were noted. The data was tabulated and SPSS version 17 was used for statistics.Results: Pilonidal sinus disease is common in age group 20 years and above and twice more common in males than females. Although operating time in Limberg flap is little more as compared to primary closure but insignificant. The post-operative pain in the long term follow up is less in the Limberg flap procedure, although in the initial post-operative period it is slightly higher as compared to primary closure. In Limberg flap procedure, post-operative complications like stitch line infection, seroma formation, wound dehiscence are low as compared to primary closure. Limberg flap require 2.27±0.52 days hospital stay as compared to 3.57±1.43 days in primary closure due to less post-operative complications. Recurrence rate is 3.33% in Limberg flap as compared to 26.67% in primary closure group.Conclusions: We recommend the Limberg flap method for primary pilonidal disease with low morbidity rates over primary closure.

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Abdominal Flap Necrosis and Wound Dehiscence following a Medical Tourist Tummy Tuck

Case Reports in Surgery ◽

10.1155/2020/8819102 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

Vladislav Pavlovich Zhitny ◽

Noama Iftekhar ◽

Peter Caravella ◽

Jake Patrick Young ◽

Barry Zide ◽

...

Keyword(s):

Skin Necrosis ◽

Wound Dehiscence ◽

The United States ◽

Abdominal Wound ◽

Flap Necrosis ◽

Aesthetic Result ◽

Self Image ◽

To Receive ◽

Medical Tourist ◽

Incision Drainage

Abdominoplasty is a major surgical procedure met with high rates of patient satisfaction and improved self-image. While many patients are lured abroad due to discounted prices for such highly requested procedures, unfortunately, there are also associated complications. A 47-year-old woman presented due to abdominal scar dehiscence due to skin necrosis secondary to a discounted abdominoplasty in Mexico. The patient had been turned away by several local surgical centers for treatment of the necrosis. The patient underwent incision, drainage, and two debridements before her abdominal wound was eventually closed. Patient recovered well postoperatively with improved aesthetic result. With the rise of social media advertisements, more patients elect to receive plastic surgery abroad. Unfortunately, many of these practices are not accurately vetted and this can complicate the postoperative care especially upon return to the United States.

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Biomarkers-based personalized follow-up in chronic heart failure improves patient’s outcomes and reduces care associate cost

Health and Quality of Life Outcomes ◽

10.1186/s12955-021-01779-9 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Antonio Leon-Justel ◽

Jose I. Morgado Garcia-Polavieja ◽

Ana Isabel Alvarez-Rios ◽

Francisco Jose Caro Fernandez ◽

Pedro Agustin Pajaro Merino ◽

...

Keyword(s):

Heart Failure ◽

Hospital Admissions ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Secondary Outcome ◽

Ventricular Ejection Fraction ◽

Number Of Patients ◽

Ed Visits ◽

The Impact

Abstract Background Heart failure (HF) is a major and growing medical and economic problem, with high prevalence and incidence rates worldwide. Cardiac Biomarker is emerging as a novel tool for improving management of patients with HF with a reduced left ventricular ejection fraction (HFrEF). Methods This is a before and after interventional study, that assesses the impact of a personalized follow-up procedure for HF on patient’s outcomes and care associated cost, based on a clinical model of risk stratification and personalized management according to that risk. A total of 192 patients were enrolled and studied before the intervention and again after the intervention. The primary objective was the rate of readmissions, due to a HF. Secondary outcome compared the rate of ED visits and quality of life improvement assessed by the number of patients who had reduced NYHA score. A cost-analysis was also performed on these data. Results Admission rates significantly decreased by 19.8% after the intervention (from 30.2 to 10.4), the total hospital admissions were reduced by 32 (from 78 to 46) and the total length of stay was reduced by 7 days (from 15 to 9 days). The rate of ED visits was reduced by 44% (from 64 to 20). Thirty-one percent of patients had an improved functional class score after the intervention, whereas only 7.8% got worse. The overall cost saving associated with the intervention was € 72,769 per patient (from € 201,189 to € 128,420) and €139,717.65 for the whole group over 1 year. Conclusions A personalized follow-up of HF patients led to important outcome benefits and resulted in cost savings, mainly due to the reduction of patient hospitalization readmissions and a significant reduction of care-associated costs, suggesting that greater attention should be given to this high-risk cohort to minimize the risk of hospitalization readmissions.

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Comparative study of intracranial access in thrombectomy using next generation 0.088 inch guide catheter technology

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2021-017341 ◽

2021 ◽

pp. neurintsurg-2021-017341

Author(s):

Devin V Bageac ◽

Blake S Gershon ◽

Jan Vargas ◽

Maxim Mokin ◽

Zeguang Ren ◽

...

Keyword(s):

Primary Outcome ◽

Primary Outcome Measure ◽

Secondary Outcome ◽

Control Group ◽

Anterior Circulation ◽

Guide Catheter ◽

Catheter Failure ◽

Catheter Technology ◽

Intracranial Vasculature

BackgroundMost conventional 0.088 inch guide catheters cannot safely navigate intracranial vasculature. The objective of this study is to evaluate the safety of stroke thrombectomy using a novel 0.088 inch guide catheter designed for intracranial navigation.MethodsThis is a multicenter retrospective study, which included patients over 18 years old who underwent thrombectomy for anterior circulation large vessel occlusions. Technical outcomes for patients treated using the TracStar Large Distal Platform (TracStar LDP) or earlier generation TRX LDP were compared with a matched cohort of patients treated with other commonly used guide catheters. The primary outcome measure was device-related complications. Secondary outcome measures included guide catheter failure and time between groin puncture and clot engagement.ResultsEach study arm included 45 patients. The TracStar group was non-inferior to the control group with regard to device-related complications (6.8% vs 8.9%), and the average time to clot engagement was 8.89 min shorter (14.29 vs 23.18 min; p=0.0017). There were no statistically significant differences with regard to other technical outcomes, including time to recanalization (modified Thrombolysis In Cerebral Infarction (mTICI) ≥2B). The TracStar was successfully advanced into the intracranial internal carotid artery in 33 cases (73.33%); in three cases (6.67%), it was swapped for an alternate catheter. Successful reperfusion (mTICI 2B-3) was achieved in 95.56% of cases. Ninety-day follow-up data were available for 86.67% of patients, among whom 46.15% had an modified Rankin Score of 0–2%, and 10.26% were deceased.ConclusionsTracstar LDP is safe for use during stroke thrombectomy and was associated with decreased time to clot engagement. Intracranial access was regularly achieved.

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