scholarly journals Candy Closure Technique for Chronic Open Infective Lateral Malleolus Bursitis

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.

scholarly journals Does closure of chronic pilonidal sinus still remain a matter of debate after bilateral rotation flap?(N-shaped closure technique)

2006 ◽  
Vol 39 (02) ◽  
pp. 157-162
Author(s):  
M. Saad Khaled ◽  
M.S. Awad Mohamed
Keyword(s):  
Pilonidal Sinus ◽  
Suture Line ◽  
Complete Healing ◽  
Random Pattern ◽  
Closure Technique ◽  
Rotation Flap ◽  
Suction Drain ◽  
Closed Suction Drain ◽  
Mean Time

ABSTRACT Background:Controversy still exists about the exact cause of pilonidal sinus either acquired or congenital, and also about what is the best surgical technique for the treatment of the disease. We successfully treated chronic pilonidal sinus with a new flap technique {N-shaped bilateral rotation flap} for closure of the defect.Materials and Methods:Thirty-two patients (30 men and two women) were treated by eccentric elliptical excision of the diseased tissues down to the postsacral fascia and closure of the defect with our flap [which is a random pattern flap], then a closed suction drain was placed at the base of the wound, with its tip being brought out in the gluteal region at least 5 cm lateral to the lower end of the suture line. Results: All our patients healed completely without recurrence during a period of average follow-up of two years. Mean hospital stay was 1.5 days (range 1-5 days). Mean time to complete healing was 11.9 days (range 6-18 days). Mean time off work was 13.7 days (range 10-21 days). Two patients had wound infection and one patient a partial breakdown. The recurrence rate was 0%.Conclusions:A tension-free suture via bilateral rotation flaps with a good suction at the button of the wound for drainage of blood from the bottom of the wound is the key to the success of repair without recurrence.

scholarly journals Outcomes of Redivac Drain in Primary Closure of Pilonidal Sinus

2021 ◽  
Vol 15 (7) ◽  
pp. 1557-1559
Author(s):  
Samina Karim ◽  
Ahmad Shah ◽  
Ahmad Raza Nsar
Keyword(s):  
Wound Healing ◽  
Comparative Study ◽  
Study Design ◽  
Pilonidal Sinus ◽  
Primary Closure ◽  
Complete Healing ◽  
Provincial Hospital ◽  
Group I ◽  
Group Ii

Aim: To determine the effectiveness of redivac drain in primary closure of pilonidal sinus. Study Design: Comparative study Place and Duration of Study: Department of Surgery Unit-1, Sandeman Provincial Hospital Quetta from 1st January 2020 to 31st December 2020. Methods: Ninety patients of both genders were presented in this study. Patient’s details demographics age, sex and BMI were recorded after taking written consent. Patients were divided into two groups; group I and group II. Group I had 45 patients and underwent for redivac drain and group II was without redivac drain and had 45 patients. Complete follow up was done in duration of 6 months. Outcomes wound healing, infection of wound and recurrence of pilonidal sinus in both groups were observed. Results: Majority of the patients 66 (73.33%) were males and 24 (26.67%) were females. Mean age of the patients in group I was 28.52±6.88 years with mean BMI 24.16±7.33 kg/m2 and in group II mean age was 29.68±7.45 years with mean BMI 25.14±3.16 kg/m2. In group I 36 (80%) cases showed complete healing, partially healing was observed among 7 (15.55%) and 2 (4.44%) showed non-recurrence and in group II complete healing was among 26 (57.8%) patients, partially healing was found in 14 (31.11%) and non recurrence was among 5 (11.11%) patients. Rate of recurrence in group I was 3 (6.67%) less than that of group II (8.9%). Conclusion: The redivac was more effective as compared to primary closure of pilonidal sinus without redivac. Keywords: Redivac drain, Primary closure, Pilonidal sinus, Recurrence

Pilonidal Sinus: How to Choose Between Excision and Open Granulation Versus Excision and Primary Closure?

Swiss Surgery ◽  
2002 ◽  
Vol 8 (6) ◽  
pp. 255-258 ◽  
Author(s):  
Perruchoud ◽  
Vuilleumier ◽  
Givel
Keyword(s):  
Hospital Stay ◽  
Pilonidal Sinus ◽  
Primary Closure ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Healing Time ◽  
Incision And Drainage ◽  
The Mean ◽  
Primary Healing

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.

scholarly journals Excision of Lower Lip Mucocele Using Injection of Hydrocolloid Dental Impression Material in a Pediatric Patient: A Case Report

2021 ◽  
Vol 11 (13) ◽  
pp. 5819
Author(s):  
Gianluca Botticelli ◽  
Marco Severino ◽  
Gianmaria Fabrizio Ferrazzano ◽  
Pedro Vittorini Velasquez ◽  
Carlo Franceschini ◽  
...  
Keyword(s):  
Minor Salivary Gland ◽  
Surgical Techniques ◽  
Surgical Excision ◽  
Complete Healing ◽  
Surgical Removal ◽  
Clinical Approach ◽  
Lower Lip ◽  
Impression Material ◽  
Dental Impression

Oral mucocele is a benign cystic exophytic lesion affecting the minor salivary gland and is especially present in pediatric patients (3% under 14 years). It is characterized by an extravasation or retention of fluid or mucus in the submucosal tissue of the minor salivary glands. Several surgical techniques have been proposed over the years, including the excision of the mucocele by using the injection of a hydrocolloid impression material in the light of the cyst to prevent the collapse of the cystic wall and solidify the lesion, resulting in a better cleavage plan. The combined clinical approach between the combination of Shira’s technique and the surgical excision of the cystic lesion results in a conservative surgical removal of the lesion. Here, we reported the removal of a labial mucocele in a 14-year-old male patient, using the injection of a hydrocolloid impression material. At a 12 months follow up, the patient showed complete healing of the surgical site, showing a pinkish lip lining mucosa without scarring or recurrence of the primary lesion. The combined therapeutic approach between Shira’s technique and surgical excision allows a safe and predictable excision of the labial mucocele, minimizing the risk of recurrence.

Staged Management of Severely Displaced Calcaneal Fractures With Transarticular Pinning: A Damage Control Strategy

2021 ◽  
pp. 107110072110130
Author(s):  
Kyeong-Hyeon Park ◽  
Chang-Wug Oh ◽  
Joon-Woo Kim ◽  
Hee-June Kim ◽  
Dong-Hyun Kim ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Internal Fixation ◽  
Kirschner Wire ◽  
Wound Complications ◽  
Calcaneal Fractures ◽  
Simple Method ◽  
Wire Fixation ◽  
The Mean ◽  
Radiographic Union

Background: Severely displaced calcaneal fractures can result in considerable morphology derangement and may be accompanied by soft tissue compromise. Delayed operative restoration of the calcaneal morphology may result in acute retensioning of the damaged soft tissue with associated wound-related complications. In this study, we describe a staged treatment of displaced intra-articular calcaneal fractures that uses temporary transarticular Kirschner wire (K-wire) fixation and staged conversion to definite fixation. Methods: We identified all of the patients who were treated at our institution for calcaneal fractures between 2015 and 2019. A total of 17 patients with 20 calcaneal fractures were selectively treated with 2-stage management. Temporary transarticular K-wire fixation was performed 24 hours after the injury to restore calcaneal morphology and the surrounding soft tissue. After the soft tissue was considered safe, delayed open reduction and internal fixation was performed. The time to definite surgery, radiographic alignment, wound complications, time to radiographic union, and hindfoot American Orthopaedic Foot & Ankle Society (AOFAS) scores were recorded. Results: The average follow-up period was 17 months (range, 12-43). The average Böhler angle increased from a mean of −22 degrees (range, −109 to 25) to 25 degrees (range, 0 to 47) after temporary transarticular K-wire fixation. The mean time from temporary pinning to conversion to definite internal fixation was 20 (range, 10-32) days. There were no immediate postoperative complications. The average time to radiographic union was 13.7 (range, 10-16) weeks. The mean AOFAS score was 87 (range, 55-100). No infections or wound complications were reported during the follow-up period. Conclusion: Temporary transarticular pinning for staged calcaneal fracture treatment is safe and effective in restoring the calcaneal morphology. This novel and relatively simple method may facilitate delayed operation and decrease wound-related complications. Level of Evidence: Level IV, retrospective case series.

scholarly journals Comparing Patient and Endoscopist Perceptions of the Colonoscopy Indication

2010 ◽  
Vol 24 (11) ◽  
pp. 656-660 ◽  
Author(s):  
Maida J Sewitch ◽  
Dara Stein ◽  
Lawrence Joseph ◽  
Alain Bitton ◽  
Robert J Hilsden ◽  
...  
Keyword(s):  
Kappa Statistic ◽  
Cross Sectional Study ◽  
Routine Screening ◽  
Self Report ◽  
Administrative Databases ◽  
Screening Colonoscopy ◽  
Cross Sectional ◽  
Simple Method ◽  
Patient Questionnaires

BACKGROUND: Determining whether a colonoscopy is performed for screening or nonscreening purposes can facilitate clinical practice and research. However, there is no simple method to determine the colonoscopy indication using patient medical files or health administrative databases.OBJECTIVE: To determine patient-endoscopist agreement on the colonoscopy indication.METHODS: A cross-sectional study was conducted among staff endoscopists and their patients at seven university-affiliated hospitals in Montreal, Quebec. The study participants were 50 to 75 years of age, they were able to understand English or French, and were about to undergo colonoscopy. Self- (endoscopist) and interviewer-administered (patient) questionnaires ascertained information that permitted classification of the colonoscopy indication. Patient colonoscopy indication was defined as the following: perceived screening (routine screening, family history, age); perceived nonscreening (follow-up); medical history that implied nonscreening; and a combination of the three preceding indications. Agreement between patient and endoscopist indications was measured using concordance and Kappa statistic.RESULTS: In total, 702 patients and 38 endoscopists participated. The three most common reasons for undergoing colonoscopy were routine screening/regular check-up (33.8%), follow-up to a previous problem (30.2%) and other problem (24.6%). Concordance (range 0.79 to 0.85) and Kappa (range 0.58 to 0.70) were highest for perceived nonscreening colonoscopy. Recent large bowel symptoms accounted for 120 occurrences of disagreement in which the patient perceived a nonscreening colonoscopy while the endoscopist perceived a screening colonoscopy.CONCLUSIONS: Patient self-report may be an acceptable means for rapidly assessing whether a colonoscopy is performed for screening or nonscreening purposes. Delivery of patient-centred care may help patients and endoscopists reach a shared understanding of the reason for colonoscopy.

scholarly journals Conservative Management of Medication-Related Osteonecrosis of the Jaws (MRONJ): A Retrospective Cohort Study

Antibiotics ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 195
Author(s):  
Elena M. Varoni ◽  
Niccolò Lombardi ◽  
Giulio Villa ◽  
Alberto Pispero ◽  
Andrea Sardella ◽  
...  
Keyword(s):  
Conservative Management ◽  
Prognostic Score ◽  
Clinical History ◽  
Osteonecrosis Of The Jaw ◽  
Pharmacological Therapy ◽  
Complete Healing ◽  
High Rate ◽  
Secondary Outcome ◽  
Severe Side Effect

Background: Medication-related osteonecrosis of the jaw (MRONJ) is a severe side effect of bisphosphonates and anti-resorptive drugs prescribed for treatment of severe osteoporosis, Paget’s disease, and bone malignancies. The aim of this study was to evaluate the clinical outcome of a combined pharmacological and surgical management strategy on patients affected by MRONJ. Materials and methods: Medical records of patients with MRONJ were retrospectively examined to collect clinical history data. Conservative management included an initial pharmacological phase with antibiotics and antiseptic agents, followed by surgical intervention to remove bone sequestrum. Primary outcomes were healing from MRONJ at short term (1 month after surgery) and at longer term (3 months after surgery). Secondary outcome was assessment of recurrences at longer-term follow-up. Results: Thirty-five patients were included in the study with mean follow-up of 23.86 ± 18.14 months. Seven cases showed spontaneous exfoliation of necrotic bone during pharmacological therapy, which in one case did not require any further intervention. At 1-month posttreatment, 31 out of 35 (88.5%) patients showed complete healing. The 25 patients who were followed for at least 3 months revealed a healing rate of 92% (23/25). Recurrences occurred in 7 patients out 23 who showed the long-term healing, after a mean period of 7.29 ± 3.45 months. The prognostic score (University of Connecticut Osteonecrosis Numerical Scale—UCONNS) was significantly higher (p = 0.01) in patients with poor healing as compared to complete healing, both at 1 and 3 months posttreatment. Conclusions: A MRONJ treatment approach based on a combined pharmacological and surgical treatment strategy showed a high rate of healing and few recurrences.

Outcomes More Than 2 Years After Meniscal Repair for Longitudinal Tears of the Lateral Meniscus Combined With Anterior Cruciate Ligament Reconstruction

2021 ◽  
pp. 036354652098197
Author(s):  
Akira Tsujii ◽  
Yasukazu Yonetani ◽  
Kazutaka Kinugasa ◽  
Tomohiko Matsuo ◽  
Kenji Yoneda ◽  
...  
Keyword(s):  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Lateral Meniscus ◽  
Complete Healing ◽  
Control Group ◽  
Study Group ◽  
Meniscal Extrusion ◽  
Second Look ◽  
Anterior Cruciate

Background: Meniscal function after repair of longitudinal tears of the lateral meniscus (LM) with anterior cruciate ligament reconstruction (ACLR) has not been comprehensively investigated. Purpose: To evaluate not only the clinical outcomes and radiographic findings of patients who underwent repair of longitudinal tears of the LM combined with ACLR but also the healing status of the repaired meniscus and changes in chondral status with second-look arthroscopy. Study Design: Case series; Level of evidence, 4. Methods: Among 548 patients who underwent primary anatomic ACLR at our institution between 2010 and 2017, 39 who had concomitant longitudinal tears of the LM and underwent repair were studied. During follow-up for more than 2 years, all patients were evaluated clinically (pain, range of motion, swelling, and knee instability) and with imaging (plain radiograph and magnetic resonance imaging [MRI]), and compared with a matched control group (based on age, sex, body mass index, and follow-up period) without any concomitant injuries who underwent ACLR. Measurements on MRI were recorded preoperatively, immediately after surgery, and at final follow-up, and the change in the values over time was assessed. Of the 39 patients in each group, 24 were assessed by second-look arthroscopy with hardware removal 2 years postoperatively. Results: The mean follow-up times of the study and control group were at a mean of 42.4 and 45.4 months, respectively. There were no significant differences in clinical findings, lateral joint space narrowing on radiographs, and chondral status at the lateral compartment between groups, whereas lateral and posterior meniscal extrusion on MRI progressed significantly in the study group (0.43 ± 1.0 mm vs -0.29 ± 1.1 mm, P = .003; 1.9 ± 1.9 mm vs 0.14 ± 1.1 mm, P < .0001, respectively). Second-look arthroscopy revealed complete healing in 12 patients (50%), partial healing in 9 (37.5%), and failure in 3 (12.5%) in the study group, and no new tear in the control group. Conclusion: The clinical and imaging outcomes after repair of longitudinal tears of the LM combined with anatomic ACLR were successful and comparable with those after isolated ACLR without any other injuries at 42 months postoperatively, although meniscal extrusion showed progression on coronal/sagittal MRI. Based on the MRI findings and the result that only half of patients achieved complete healing, meniscal function could not be fully restored even after repair. Although degenerative changes were not apparent, longer-term follow-up is needed.

Preference for Fasciocutaneous Flap Over Musculocutaneous Flap as a First-Line Option for Ischial Pressure Wound Reconstruction: A Review of 64 Cases

2021 ◽  
pp. 153473462110387
Author(s):  
Jaehoon Choi ◽  
Kyubeom Kim ◽  
Junhyung Kim ◽  
Woonhyeok Jeong ◽  
Taehee Jo ◽  
...  
Keyword(s):  
Dead Space ◽  
Postoperative Bleeding ◽  
Significant Risk ◽  
Distal Portion ◽  
Complete Healing ◽  
Fasciocutaneous Flap ◽  
Musculocutaneous Flap ◽  
First Line ◽  
Fasciocutaneous Flaps ◽  
Significant Difference

The ischial pressure wound usually comprises a large, extensive defect and involves the repair of more than a small opening. Most surgeons have used a musculocutaneous flap to fill the large dead space of an ischial pressure wound. However, sacrificing muscle tissue has a potential risk of postoperative bleeding. The transferred muscle ultimately loses function as a cushion to absorb pressure. Conservation of muscle structures may be beneficial for use in future recurrence, which is common with ischial pressure wound. We compared the difference in outcome between musculocutaneous and fasciocutaneous flaps and analyzed factors affecting complications with the flaps in ischial pressure wound reconstruction. This study reviewed the results of 64 flaps in 44 patients with ischial wounds. The wounds were reconstructed with 34 musculocutaneous flaps (53%) and 30 fasciocutaneous flaps (47%). Twenty-three cases (36%) had complete healing, and 41 (64%) had complications. There was no significant difference in outcomes between fasciocutaneous and musculocutaneous flap groups. Crude logistic regression analysis showed no significant risk factors for occurrence of major complications. When fasciocutaneous flaps were used, the neighboring perforators and muscle tissues could be conserved. With a perforator-based fasciocutaneous flap, a de-epithelized distal portion of the flap could be used to fill the dead space. Therefore, the fasciocutaneous flap may have priority over the musculocutaneous flap as a first-line option for ischial pressure wound reconstruction.

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