Outcomes of Unroofing with Limited Excision and Structured Postoperative Care for Pilonidal Disease

2017 ◽  
Vol 83 (10) ◽  
pp. 1045-1049 ◽  
Author(s):  
Farees Ricky Tavangari ◽  
Jennifer Amy Lee ◽  
David Garza ◽  
Talar Tejirian
Keyword(s):  
Postoperative Care ◽  
Recurrent Disease ◽  
Wound Care ◽  
Pilonidal Disease ◽  
Surgical Techniques ◽  
Complete Healing ◽  
Skin Closure ◽  
Chronic Abscess ◽  
Healing Wounds

Despite a wide variety of surgical techniques to treat chronic pilonidal disease, high rates of recurrence are common. The current study analyzes the outcome of unroofing with limited excision combined with structured postoperative wound care for pilonidal disease. We performed a retrospective review of all patients who were treated with this technique over a seven year period. Ninety-four patients aged 11 to 63 (mean age 26) received this treatment for pilonidal disease. Eighty-nine patients were treated for primary pilonidal disease and five were treated for recurrent disease after procedures such as flaps. There were 66 males (70%) and 28 females (30%). The operation was performed by unroofing the entire pilonidal sinus along with its pits and area of chronic abscess cavity. All granulation tissue was removed and the base of the sinus was completely cauterized. No wide local excisions were performed. The cavity was packed with dry gauze and the dressing was changed twice daily. Patients were seen postoperatively on a weekly basis in clinic. The area was shaved; the cavity was cleaned and often treated with silver nitrate. In the event of premature skin closure starting to form, unroofing was easily performed in the office. The median time to achieve complete healing was 53 days requiring, on average, seven visits. With a mean follow-up of 40 months, there were two recurrences (2.1%) and reoperation for two (2.1%) inappropriately healing wounds. This study demonstrates that unroofing with limited excision and structured postoperative care for pilonidal disease is a safe and effective treatment approach with a very low recurrence and complication rate.

Postoperative care

2021 ◽  
pp. 235-242
Author(s):  
Usman Latif ◽  
Tyler Concannon ◽  
Andrew Frazier
Keyword(s):  
Postoperative Care ◽  
Wound Care ◽  
Recovery Period ◽  
Operating Time ◽  
Surgical Techniques ◽  
Bone Allograft ◽  
Normal Activity ◽  
Postoperative Recovery ◽  
Short Period

This chapter discusses postoperative recommendations, including ambulation, wound care, antibiotic guidelines, and follow-up interval, for patients who have undergone open surgical SIJ fusion versus minimally invasive (MIS) SIJ fusion. Postoperative care varies widely based on the surgical approach. In particular, patients undergoing MIS are less likely to be admitted, ambulate sooner, have a shorter period of less stringent restrictions, and have faster wound healing with fewer complications. These benefits are due to a variety of factors including shorter incision length, less tissue disruption, decreased operating time, and less blood loss. This benefit is most pronounced with approaches that do not involve the use of hardware. Patients undergoing open surgery typically progress through a 4- to 5-month phased plan of progressive physical therapy. In contrast, patients undergoing MIS, particularly percutaneous SIJ fusion with bone allograft, are able to ambulate immediately and have a short period of mild restrictions followed by return to normal activity. The advent of new surgical techniques and less invasive solutions for SIJ fusion is leading the way to an easier postoperative recovery period for patients.

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.

Application of a collagen matrix dressing on a neuropathic diabetic foot ulcer: a randomised control trial

2020 ◽  
Vol 29 (Sup3) ◽  
pp. S13-S18 ◽  
Author(s):  
Gholamreza Esmaeeli Djavid ◽  
Seyed Mehdi Tabaie ◽  
Siamak Bashardoust Tajali ◽  
Mehrangiz Totounchi ◽  
Amirreza Farhoud ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Wound Care ◽  
Healing Process ◽  
Collagen Matrix ◽  
Complete Healing ◽  
Randomised Control Trial ◽  
Control Group ◽  
Study Group ◽  
Number Of Patients

Objective: Diabetic foot ulcers (DFU) are often hard-to-heal, despite standard care. With such a complicated healing process, any advanced wound care to aid healing is recommended. Chitosan/collagen composite hydrogel materials have the potential to promote the regenerative process. In this study, the efficacy of a new collagen matrix dressing including chitosan/collagen hydrogel was compared with a standard dressing of saline-moistened gauze for wound healing in patients with a hard-to-heal neuropathic DFU. Method: This is an open labelled, randomised clinical trial. After conventional therapy consisting of debridement, infection control and offloading, patients were randomly allocated to receive either a collagen matrix dressing (the study group, receiving Tebaderm manufacturer) or a saline-moistened gauze dressing (control group) for wound care. The reduction in DFU size and the number of patients with complete healing were measured throughout the treatment and in follow-up. Results: A total of 61 patients with a neuropathic DFU were recruited. Average percentage reduction in DFU size at four weeks was greater in the study group compared with the control group (54.5% versus 38.8%, respectively). Rate of complete healing rate at 20-weeks' follow-up was significantly better in the study group than the control group (60% versus 35.5%, respectively). Conclusion: The collagen matrix dressing used in this study accelerated the healing process of patients with a hard-to-heal DFU. Further research may suggest the used of this dressing to shorten the length of time to achieve complete healing.

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.

Initial Experience Using a Hyaluronate-Iodine Complex for Wound Healing

2011 ◽  
Vol 77 (3) ◽  
pp. 355-359 ◽  
Author(s):  
Robert A. Brenes ◽  
Michael S. Ajemian ◽  
Shady H. Macaron ◽  
Lucian Panait ◽  
Stanley J. Dudrick
Keyword(s):  
Wound Healing ◽  
Surgical Techniques ◽  
Antimicrobial Properties ◽  
Healing Time ◽  
Complete Healing ◽  
The European Union ◽  
Iodine Complex ◽  
Healing Agent ◽  
Lost To Follow Up

Hyaluronate-iodine complex is a wound healing adjuvant approved for use in the European Union. The objective of this study is to validate hyaluronate-iodine as a potential wound healing agent. Patients were recruited from the hospital, the outpatient clinic, and the wound healing center. Hyaluronate-iodine soaked gauze was applied to wounds either daily or every other day depending on the amount of wound exudate. Wounds were measured weekly, and progression was documented with digital photography. All wounds were debrided as needed using standard surgical techniques. Fourteen patients (19 wounds) were entered into this prospective study, and 10 patients completed treatment. Fourteen wounds progressed to complete healing with a mean healing time of 18.1 ± 15.1 weeks. Treatment was interrupted in four patients. One patient discontinued treatment due to pain related to application of hyaluronate-iodine, another patient for transportation issues, and the other two patients were lost to follow-up due to relocation out of state and noncompliance with scheduled appointments. Hyaluronate-iodine was helpful in the healing of all types of wounds treated in this pilot study. The antiadhesive and antimicrobial properties of hyaluronate-iodine create a desirable environment conducive to wound healing without apparent detrimental effects.

Porcine bladder extracellular matrix in paediatric pilonidal wound care: healing and patient experience evaluation

2019 ◽  
Vol 28 (Sup5) ◽  
pp. S12-S19
Author(s):  
Sarah B. Cairo ◽  
Jane Zhao ◽  
Minje Ha ◽  
Kathryn D. Bass
Keyword(s):  
Extracellular Matrix ◽  
Wound Healing ◽  
Patient Satisfaction ◽  
Chart Review ◽  
Wound Care ◽  
Pilonidal Disease ◽  
Site Specific ◽  
Phone Calls ◽  
Specific Tissue

Objective: Pilonidal disease (PD) with inflammation and abscess formation occurs frequently in adolescents. The management of pilonidal disease, time to wound healing, and patient satisfaction, however remains variable despite advances in wound care methods. Porcine bladder extracellular matrix (PBEM) facilitates site-specific tissue deposition/re-growth for the management of a variety of wounds. The aim was to describe the use and outcomes of PBEM in PD at a single centre. Method: A retrospective chart review of adolescent patients who underwent treatment of pilonidal disease with PBEM between 2012 and 2016 at a single institution, was undertaken. Patient demographics and clinical characteristics were collected and compared with historical controls and literature regarding traditional wound therapies. Results: We reviewed 52 pilonidal disease wounds on 41 patients. Of these 36 were treated with PBEM. The average age was 16 years old at the time of operation with 39% male. Furthermore, 85% were being treated for recurrent pilonidal disease. Follow-up was available by chart review for 89% of patients with documented complete wound healing in 78% of patients treated with PBEM at an average of two months. Subjective reports included majority positive experience with PBEM dressing, minimal pain and overall high levels of patient satisfaction. There were three patients in which pilonidal disease recurred within two years of initial treatment and underwent repeat treatment with PBEM. There was one patient who transitioned to wet-to-dry saline dressings because of difficulty keeping the PBEM dressing intact. Conclusion: Advances in wound care technology include materials such as PBEM to promote site-specific tissue deposition. Follow-up phone calls and a prospective study to compare alternative wound care with porcine PBEM in the management of pilonidal disease is underway to better quantify time to wound healing and patient satisfaction.

Surgical Treatment of Pressure Ulcers of the Heel in Skilled Nursing Facilities

2011 ◽  
Vol 101 (2) ◽  
pp. 167-175 ◽  
Author(s):  
Paul Y. Han ◽  
Ruben Ezquerro
Keyword(s):  
Lower Extremity ◽  
Pressure Ulcers ◽  
Wound Care ◽  
Nursing Home Residents ◽  
Complete Healing ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Below The Knee ◽  
Leg Amputation

Background: Chronic nonhealing pressure ulcers of the heel in nursing homes are frequent occurrences among bedridden patients with lower-extremity contractures of varying degrees of severity. Conservative local wound care for these patients can be time consuming, ineffective, costly, and may only delay an eventual major leg amputation. This study evaluates the efficacy of limb salvage surgical procedures, partial calcanectomy, total calcanectomy, and excision of the entire calcaneus and talus, for heel ulcers. Methods: We performed a retrospective review of 57 nursing home residents who had chronic infected nonhealing pressure ulcers of the heel that we had treated over 12 years. Forty-three patients underwent partial calcanectomy, nine underwent total calcanectomy, and five underwent excision of the entire calcaneus and talus. Average postoperative follow-up was 15 months. Also included in this study are representative surgical cases. Results: Forty-three patients completed follow-up. Complete healing occurred in 25 patients (58%). Failure to resolve the heel ulcer owing to persistent infection, or recurrence was seen in 18 patients (42%) who eventually had a below-the-knee or above-the-knee amputation. All of the patients with heel pressure ulcers were found to have lower-extremity contractures. Conclusions: In the nonambulatory contracted patient with a heel ulcer, partial or total calcanectomy or excision of the entire calcaneus and talus offer a viable alternative not only for resolution of infection but also for prevention of limb loss. An aggressive plan must also be instituted to address the lower-extremity contractures in order to prevent recurrence. (J Am Podiatr Med Assoc 101(2): 167–175, 2011)

Intraoperative, postoperative and long-term oncosurgical safety of therapeutic mammaplasty

2013 ◽  
Vol 154 (33) ◽  
pp. 1291-1296 ◽  
Author(s):  
László Romics Jr. ◽  
Sophie Barrett ◽  
Sheila Stallard ◽  
Eva Weiler-Mithoff
Keyword(s):  
Recurrence Rate ◽  
Tumour Size ◽  
Breast Conservation ◽  
Malignant Lesion ◽  
Surgical Techniques ◽  
Incomplete Resection ◽  
Immediate Reconstruction ◽  
Oncological Safety

Introduction: (Pre)malignant lesion in the breast requiring mastectomy conventionally may be treated with breast conservation by using oncoplastic breast surgical techniques, which is called therapeutic mammaplasty. However, no reliable data has been published so far as regards the oncological safety of this method. Aim: The aim of the authors was to analyse the oncological safety of therapeutic mammaplasty in a series of patients. Method: 99 patients were treated with therapeutic mammaplasty and data were collected in a breast surgical database prospectively. Results were analysed with respect to intraoperative, postoperative and long-term oncological safety. Results: Incomplete resection rate was 14.1%, which correlated with tumour size (p = 0.023), and multifocality (p = 0.012). Time between surgery (therapeutic mammaplasty) and chemotherapy was similar to time between conventional breast surgeries (wide excision, mastectomy, mastectomy with immediate reconstruction) and chemotherapy (mean 29–31 days; p<0.05). Overall recurrence rate was 6.1%, locoregional recurrence rate was 2% during 27 month (1–88) mean follow-up. Conclusions: Since literature data are based on relatively short follow-up and low patient number, it is highly important that all data on therapeutic mammaplasty is collected in a prospectively maintained breast surgical database in order to determine true recurrence after long-follow-up. Orv. Hetil., 2013, 154, 1291–1296.

scholarly journals Surgical Treatment of Diffuse Idiopathic Skeletal Hyperostosis (DISH) Involving the Cervical Spine: Technical Nuances and Outcome of a Multicenter Experience

2021 ◽  
pp. 219256822098827
Author(s):  
Giorgio Lofrese ◽  
Alba Scerrati ◽  
Massimo Balsano ◽  
Roberto Bassani ◽  
Michele Cappuccio ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Clinical Outcome ◽  
Waiting Times ◽  
Diffuse Idiopathic Skeletal Hyperostosis ◽  
Surgical Techniques ◽  
Rare Condition ◽  
Surgical Strategies ◽  
Bone Removal ◽  
Mild Dysphagia

Study Design: Retrospective multicenter. Objectives: diffuse idiopathic skeletal hyperostosis (DISH) involving the cervical spine is a rare condition determining disabling aero-digestive symptoms. We analyzed impact of preoperative settings and intraoperative techniques on outcome of patients undergoing surgery for DISH. Methods: Patients with DISH needing for anterior cervical osteophytectomy were collected. Swallow studies and endoscopy supported imaging in targeting bone decompression. Patients characteristics, clinico-radiological presentation, outcome and surgical strategies were recorded. Impact on clinical outcome of duration and time to surgery and different surgical techniques was evaluated through ANOVA. Results: 24 patients underwent surgery. No correlation was noted between specific spinal levels affected by DISH and severity of pre-operative dysphagia. A trend toward a full clinical improvement was noted preferring the chisel ( P = 0.12) to the burr ( P = 0.65), and whenever C2-C3 was decompressed, whether hyperostosis included that level ( P = 0.15). Use of curved chisel reduced the surgical times ( P = 0.02) and, together with the nasogastric tube, the risk of complications, while bone removal involving 3 levels or more ( P = 0.04) and shorter waiting times for surgery ( P < 0.001) positively influenced a complete swallowing recovery. Early decompressions were preferred, resulting in 66.6% of patients reporting disappearance of symptoms within 7 days. One and two recurrences respectively at clinical and radiological follow-up were registered 18-30 months after surgery. Conclusion: The “age of DISH” counts more than patients’ age with timeliness of decompression being crucial in determining clinical outcome even with a preoperative mild dysphagia. Targeted bone resections could be reasonable in elderly patients, while in younger ones more extended decompressions should be preferred.

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