Dufourmentel rhomboid flap in the radical treatment of extensive, complex or recurrent sacrococcygeal pilonidal disease: Case series with follow up

2018 ◽  
Vol 22 (1) ◽  
pp. 15-22
Author(s):  
Carlos Manterola ◽  
Tamara Otzen
Keyword(s):  
Pilonidal Disease ◽  
Case Series ◽  
Radical Treatment ◽  
Disease Case ◽  
Rhomboid Flap

Dufourmentel Rhomboid Flap in the Radical Treatment of Primary and Recurrent Sacrococcygeal Pilonidal Disease

2010 ◽  
Vol 53 (7) ◽  
pp. 1061-1068 ◽  
Author(s):  
Eva Lieto ◽  
Paolo Castellano ◽  
Margherita Pinto ◽  
Anna Zamboli ◽  
Carlo Pignatelli ◽  
...  
Keyword(s):  
Pilonidal Disease ◽  
Radical Treatment ◽  
Rhomboid Flap

scholarly journals TP7.2.19 Review of bascom cleft lift and flap-procedures versus excision for pilonidal disease in a single centre (2017-2019)

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Stephen Stonelake ◽  
Pratik Bhattacharya ◽  
Christopher Thompson
Keyword(s):  
Pilonidal Disease ◽  
Surgical Techniques ◽  
Recurrence Rates ◽  
Female Ratio ◽  
Patient Demographics ◽  
Emergency Procedures ◽  
Flap Procedure ◽  
Cleft Lift ◽  
Rhomboid Flap

Abstract Introduction Pilonidal disease continues to be managed with varying surgical techniques. We review results with Bascom cleft lift comparing to other practices at our institution. Methods All elective procedures for pilonidal disease reviewed from December 2017 to December 2019. Patient demographics, previous emergency and elective procedures for pilonidal disease, follow-up, dehiscence and recurrence rates, and all-cause morbidity were examined retrospectively. Results In the study period there were 106 procedures. Average age was 27 years (range 15-64). Male to female ratio was 83:23. Procedures were excision and primary closure (48), excision and packing (19), rhomboid flap (2), Bascom cleft lift flap (31), other rotational/perforator or V to Y flaps (6). Rates of previous elective procedures in the flap procedures versus excision group were 31% and 10% respectively (P = 0.01). Rates of previous emergency procedures in the flap-procedures versus excision group were 41% and 31% respectively (P = 0.40). In 50 procedures there was a documented follow up encounter at a mean time of 55 days (median 34 days, range 2-239). Dehiscence (partial and full) in flap procedures versus excision and closure was 33% and 27% respectively (P = 0.64). Recurrence rates in flap procedures versus excision +/- closure or packing were 0% and 8% respectively (P = 0.16). Conclusion Flap procedures have a lower rate of recurrence and comparable dehiscence rates despite being performed in patients with higher rates of prior procedures for pilonidal disease. Bascom cleft lift was the simplest flap procedure most commonly performed and matches the results of more complex flaps.

scholarly journals WIDE EXCISION AND RHOMBOID FLAP RECONSTRUCTION FOR TREATMENT OF COMPLEX PILONIDAL DISEASE. CASE SERIES AND REVIEW OF LITERATURE.

2020 ◽  
Vol 4 (2) ◽  
Author(s):  
Thomas W Athisayaraj ◽  
Boby Sebastian ◽  
Justin Alberts
Keyword(s):  
Recurrence Rate ◽  
Pilonidal Sinus ◽  
Pilonidal Disease ◽  
Case Series ◽  
Wide Excision ◽  
Pilonidal Sinus Disease ◽  
Flap Reconstruction ◽  
Previous Surgery ◽  
Sinus Disease ◽  
Rhomboid Flap

Introduction: Pilonidal disease a chronic inflammatory disorder affecting the sacrococcygeal region with superimposed infection. This problem can present with acute abscess or chronic discharging sinus and often difficult to treat due to high incidence of recurrence. We are presenting our case series of wide excision and rhomboid flap reconstruction of complex pilonidal sinus disease. Methods: This is a retrospective review of our series of patients who have had rhomboid flap reconstruction done in colorectal surgery department for complex pilonidal sinus disease. The time period between   is 2003 to 2017. The review was conducted from our electronic data base in our hospital. Results: We had 50 patients in total. 30out of 50 have had previous surgery for pilonidal sinus disease. Five patients developed recurrence (10% recurrence rate). 4 out of 5 patients who had recurrence were smokers.4 out of 5 patients with recurrence had previous surgery for pilonidal disease. The median age of the patients was 28.The age ranged from 16 to 49 years. The median length of stay is about 4 days Conclusion: In conclusion Rhomboid flap reconstruction is a viable operation for complex pilonidal disease. The long term results are good. It can be safely performed by a general /colorectal surgeon with good results. It is a good option for complex pilonidal sinus and recurrent disease following multiple previous operations. The recurrence rate seems to be higher in smokers and in patients who had previous surgery in natal cleft.

Effect of Isolated Medial Patellofemoral Ligament Reconstruction in Patellofemoral Instability Regardless of Predisposing Factors

2020 ◽  
Author(s):  
Jae Ik Lee ◽  
Mohd Shahrul Azuan Jaffar ◽  
Han Gyeol Choi ◽  
Tae Woo Kim ◽  
Yong Seuk Lee
Keyword(s):  
Medial Patellofemoral Ligament ◽  
Trochlear Dysplasia ◽  
Case Series ◽  
Patellofemoral Instability ◽  
International Knee Documentation Committee ◽  
Predisposing Factors ◽  
Mpfl Reconstruction ◽  
Patellar Tilt ◽  
Case Series Study

AbstractThe purpose of this study was to evaluate the outcomes of isolated medial patellofemoral ligament (MPFL) reconstruction, regardless of the presence of predisposing factors. A total of 21 knees that underwent isolated MPFL reconstruction from March 2014 to August 2017 were included in this retrospective series. Radiographs of the series of the knee at flexion angles of 20, 40, and 60 degrees were acquired. The patellar position was evaluated using the patellar tilt angle, sulcus angle, congruence angle (CA), and Caton-Deschamps and Blackburne-Peel ratios. To evaluate the clinical outcome, the preoperative and postoperative International Knee Documentation Committee (IKDC) and Lysholm knee scoring scales were analyzed. To evaluate the postoperative outcomes based on the predisposing factors, the results were separately analyzed for each group. Regarding radiologic outcomes, 20-degree CA was significantly reduced from 10.37 ± 5.96° preoperatively to −0.94 ± 4.11° postoperatively (p = 0.001). In addition, regardless of the predisposing factors, delta values of pre- and postoperation of 20-degree CA were not significantly different in both groups. The IKDC score improved from 53.71 (range: 18–74) preoperatively to 94.71 (range: 86–100) at the last follow-up (p = 0.004), and the Lysholm score improved from 54.28 (range: 10–81) preoperatively to 94.14 (range: 86–100) at the last follow-up (p = 0.010). Isolated MPFL reconstruction provides a safe and effective treatment for patellofemoral instability, even in the presence of mild predisposing factors, such as trochlear dysplasia, increased patella height, increased TT–TG distance, or valgus alignment. This is a Level 4, case series study.

A case series of metastatic pheochromocytomas and paragangliomas: patients characteristics, therapeutic approach and follow-up

2019 ◽  
Author(s):  
Anna Angelousi ◽  
Eva Kassi ◽  
Melpomeni Peppa ◽  
Alexandra Chrysoulidou ◽  
George Zografos ◽  
...  
Keyword(s):  
Therapeutic Approach ◽  
Case Series

Long-term outcomes of lumbar microdiscectomy in the pediatric population: a large single-institution case series

2019 ◽  
Vol 24 (5) ◽  
pp. 549-557
Author(s):  
Malia McAvoy ◽  
Heather J. McCrea ◽  
Vamsidhar Chavakula ◽  
Hoon Choi ◽  
Wenya Linda Bi ◽  
...  
Keyword(s):  
Conservative Management ◽  
Functional Outcomes ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Case Series ◽  
Csf Leak ◽  
Single Institution ◽  
The Mean

OBJECTIVEFew studies describe long-term functional outcomes of pediatric patients who have undergone lumbar microdiscectomy (LMD) because of the rarity of pediatric disc herniation and the short follow-up periods. The authors analyzed risk factors, clinical presentation, complications, and functional outcomes of a single-institution series of LMD patients over a 19-year period.METHODSA retrospective case series was conducted of pediatric LMD patients at a large pediatric academic hospital from 1998 to 2017. The authors examined premorbid risk factors, clinical presentation, physical examination findings, type and duration of conservative management, indications for surgical intervention, complications, and postoperative outcomes.RESULTSOver the 19-year study period, 199 patients underwent LMD at the authors’ institution. The mean age at presentation was 16.0 years (range 12–18 years), and 55.8% were female. Of these patients, 70.9% participated in competitive sports, and among those who did not play sports, 65.0% had a body mass index greater than 25 kg/m2. Prior to surgery, conservative management had failed in 98.0% of the patients. Only 3 patients (1.5%) presented with cauda equina syndrome requiring emergent microdiscectomy. Complications included 4 cases of postoperative CSF leak (2.0%), 1 case of a noted intraoperative CSF leak, and 3 cases of wound infection (1.5%). At the first postoperative follow-up appointment, minimal or no pain was reported by 93.3% of patients. The mean time to return to sports was 9.8 weeks. During a mean follow-up duration of 8.2 years, 72.9% of patients did not present again after routine postoperative appointments. The total risk of reoperation was a rate of 7.5% (3.5% of patients underwent reoperation for the same level; 4.5% underwent adjacent-level decompression, and one patient [0.5%] ultimately underwent a fusion).CONCLUSIONSMicrodiscectomy is a safe and effective treatment for long-term relief of pain and return to daily activities among pediatric patients with symptomatic lumbar disc disease in whom conservative management has failed.

Mechanical thrombectomy in pediatric stroke: systematic review, individual patient data meta-analysis, and case series

2019 ◽  
Vol 24 (5) ◽  
pp. 558-571 ◽  
Author(s):  
Kartik Bhatia ◽  
Hans Kortman ◽  
Christopher Blair ◽  
Geoffrey Parker ◽  
David Brunacci ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Case Reports ◽  
Meta Analysis ◽  
Case Series ◽  
Neurological Outcomes

OBJECTIVEThe role of mechanical thrombectomy in pediatric acute ischemic stroke is uncertain, despite extensive evidence of benefit in adults. The existing literature consists of several recent small single-arm cohort studies, as well as multiple prior small case series and case reports. Published reports of pediatric cases have increased markedly since 2015, after the publication of the positive trials in adults. The recent AHA/ASA Scientific Statement on this issue was informed predominantly by pre-2015 case reports and identified several knowledge gaps, including how young a child may undergo thrombectomy. A repeat systematic review and meta-analysis is warranted to help guide therapeutic decisions and address gaps in knowledge.METHODSUsing PRISMA-IPD guidelines, the authors performed a systematic review of the literature from 1999 to April 2019 and individual patient data meta-analysis, with 2 independent reviewers. An additional series of 3 cases in adolescent males from one of the authors’ centers was also included. The primary outcomes were the rate of good long-term (mRS score 0–2 at final follow-up) and short-term (reduction in NIHSS score by ≥ 8 points or NIHSS score 0–1 at up to 24 hours post-thrombectomy) neurological outcomes following mechanical thrombectomy for acute ischemic stroke in patients < 18 years of age. The secondary outcome was the rate of successful angiographic recanalization (mTICI score 2b/3).RESULTSThe authors’ review yielded 113 cases of mechanical thrombectomy in 110 pediatric patients. Although complete follow-up data are not available for all patients, 87 of 96 (90.6%) had good long-term neurological outcomes (mRS score 0–2), 55 of 79 (69.6%) had good short-term neurological outcomes, and 86 of 98 (87.8%) had successful angiographic recanalization (mTICI score 2b/3). Death occurred in 2 patients and symptomatic intracranial hemorrhage in 1 patient. Sixteen published thrombectomy cases were identified in children < 5 years of age.CONCLUSIONSMechanical thrombectomy may be considered for acute ischemic stroke due to large vessel occlusion (ICA terminus, M1, basilar artery) in patients aged 1–18 years (Level C evidence; Class IIb recommendation). The existing evidence base is likely affected by selection and publication bias. A prospective multinational registry is recommended as the next investigative step.

scholarly journals Treatment Outcomes of Lesser Tuberosity Osteotomy Nonunion After Total Shoulder Arthroplasty

2018 ◽  
Vol 2 ◽  
pp. 247154921880777
Author(s):  
Zachary J Bloom ◽  
Cesar D Lopez, BA ◽  
Stephen P Maier ◽  
Brian B Shiu ◽  
Djuro Petkovic ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Shoulder Arthroplasty ◽  
Surgical Repair ◽  
Total Shoulder Arthroplasty ◽  
Case Series ◽  
Radiographic Evaluation ◽  
Lesser Tuberosity ◽  
Conservative Care ◽  
Conservative Group

Introduction Lesser tuberosity osteotomy (LTO) during anatomic total shoulder arthroplasty has a 13% nonunion rate. Treatment for LTO nonunion is controversial and poorly described in the literature. The purpose of this study was to compare the surgical and nonsurgical treatment outcomes of LTO nonunion. Methods A retrospective case series of 9 consecutive patients with LTO nonunion after primary anatomic shoulder arthroplasty at 1 institution from 2010 to 2016 were studied. Outcomes measured were radiographic evaluation of LTO on axillary X-ray, clinical range of motion (ROM), subscapularis strength, and pain at the time of LTO nonunion diagnosis and after either conservative care or surgical repair of the LTO nonunion. Results LTO nonunion was treated surgically in 4 and conservatively in 5 patients with average follow-up of 30 and 22 months, respectively. There were no significant differences in age, sex, or smoking status between groups. Treatment decision was a shared model of surgeon and patient. Displaced LTO nonunion was treated surgically in 2 and conservatively in 3 patients. There were no differences in LTO union rate of 50% in the surgical versus 60% in the conservative group. Abdominal compression test was abnormal in 50% of surgical versus 40% of conservative groups. At follow-up, ROM was lower in the surgical group with 128° forward elevation (FE) and 33° external rotation (ER) compared to 148° FE and 62° ER. Only 1 patient with LTO nonunion required conversion to reverse replacement. Conclusion LTO nonunion after shoulder arthroplasty is rare. Surgical repair of LTO nonunion does not significantly improve clinical or radiographic outcomes compared to conservative care.

Tracheocutaneous Fistula After Pediatric Open Airway Reconstruction

2021 ◽  
pp. 000348942098742
Author(s):  
Stephen R. Chorney ◽  
Joanne Stow ◽  
Luv R. Javia ◽  
Karen B. Zur ◽  
Ian N. Jacobs ◽  
...  
Keyword(s):  
Costal Cartilage ◽  
Case Series ◽  
Primary Objective ◽  
Multivariable Logistic Regression Analysis ◽  
Pediatric Airway ◽  
Surgical Closure ◽  
Laryngotracheal Reconstruction ◽  
Airway Reconstruction ◽  
Tracheocutaneous Fistula

Objectives: Tracheocutaneous fistula (TCF) is a common occurrence after pediatric tracheostomy decannulation. However, the persistence of TCF after staged reconstruction of the pediatric airway is not well-described. The primary objective was to determine the rate of persistent TCF after successful decannulation in children with staged open airway reconstruction. Methods: A case series with chart review of children who underwent decannulation after double-stage laryngotracheal reconstruction between 2017 and 2019. Results: A total of 26 children were included. The most common open airway procedure was anterior and posterior costal cartilage grafting (84.6%, 22/26). Median age at decannulation was 3.4 years (IQR: 2.8-4.3) and occurred 7.0 months (IQR: 4.3-10.4) after airway reconstruction. TCF persisted in 84.6% (22/26) of children while 15.4% (4/26) of stomas closed spontaneously. All closures were identified by the one-month follow-up visit. There was no difference in age at tracheostomy ( P = .86), age at decannulation ( P = .97), duration of tracheostomy ( P = .43), or gestational age ( P = .23) between stomas that persisted or closed. Median diameter of stent used at reconstruction was larger in TCFs that persisted (7.0 mm vs 6.5 mm, P = .03). Tracheostomy tube diameter ( P = .02) and stent size ( P < .01) correlated with persistence of TCF on multivariable logistic regression analysis. There were 16 surgical closure procedures, which occurred at a median of 14.4 months (IQR: 11.4-15.4) after decannulation. Techniques included 56.3% (9/16) by primary closure, 18.8% (3/16) by secondary intention and 25% (4/16) by cartilage tracheoplasty. The overall success of closure was 93.8% (15/16) at latest follow-up. Conclusions: Persistent TCF occurs in 85% of children who are successfully decannulated after staged open airway reconstruction. Spontaneous closure could be identified by 1 month after decannulation and was more likely when smaller stents and tracheostomy tubes were utilized. Surgeons should counsel families on the frequency of TCF and the potential for additional procedures needed for closure.

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