Compare outcome of simple excision with primary closure vs rhomboid excision with limberg flap for pilonidal sinus

Background: Sacrococcygeal pilonidal sinus is a common condition usually affecting young-to-middle-aged men. For managing sacrococcygeal pilonidal illness, a variety of lateralizing surgical flap procedures based on this principle have been published, including the Karydakis flap, Limberg flap, modified Limberg flap, Z-plasty, and Y-V advancement flap. Aim: To compare the outcome of simple excision with primary closure versus rhomboid excision with limberg flap for sacrococcygeal pilonidal sinus. Methodology: Randomized control study conducted in Surgery Department, Ghurki Trust Hospital, Lahore. 90 patients fulfilling the inclusion criteria were selected from wards and were randomly divided in two equal groups. In group A, patients underwent rhomboid excision with limberg flap. In group B, patients underwent simple excision with primary closure. The operation was performed under spinal anesthesia. After surgery, patients were evaluated every 24 hours if they are able to move on their own then they were discharged and hospital stay was noted. Then after 10 days, patients will be called in OPD for assessment of wound healing. If wound did heal and patient complained of pain (VAS>4) and cannot sit and have fever (temp>100oF) Results: The average age in group A was 44.37±15.42 years while that in group B was 45.24±14.50 years. In group A there were 23(51.1%) males and 22 (48.9%) females whereas in group B there were 25(55.6%) males and 20(44.4%) females. There was difference significant in the mean stay in hospital in both groups (p-value=0.002). Conclusion: The conclusion of the study, that primary sacrococcygeal pilonidal sinus disease and rhomboid excision with Limberg's flap is an effective treatment. Keywords: Simple Excision with Primary Closure, Rhomboid Excision, Limberg Flap, Sacrococcygeal Pilonidal Sinus

Rare location of Universal tumor

Lipomas are one of the most common benign mesenchymal tumor in human. Lipoma occurring in the tongue is rare as tongue has paucity of normal adipose tissue. Here we present an unusual case of lipoma presented in the tongue, and removal of which comforted patient by regaining of the functional task of tongue. Fifty two year’s old Muslim women presented with painless swelling on right lateral border of tongue for 5 years for which excision was done and histopathology evaluation was performed. The histopathology was consistent with the diagnosis of Lingual Lipoma. Existence of lipoma in the tongue is very rare, which can be managed by simple excision. Histopathology is the gold standard in the diagnosis.

SURGICAL MANAGEMENT OF CORNEAL LIMBAL DERMOIDS BY SIMPLE EXCISION

Aim: To study clinical features and surgical outcomes of limbal dermoid excision in Kashmiri patients. Study Design :Interventional, Prospective Material and Methods: 20 patients with epibulbar limbal dermoid who attended the Out Patient department of Government Medical College ,Srinagar, from August 2019 to September 2020, across all age groups were included in the study. All the patients were examined for site, colour, presence of pigmentation and presence of ocular and systemic associations of the lesions and then surgically managed. Simple Excision was done with blade and scissors. Postoperative follow up was done upto 3 months Results: The age group included was 4 to 60 years with male to female ratio 3:2. All the patients had unilateral epibulbar dermoids located at infero-temporal quadrant of the limbus. Most lesions (13 cases - 65%) extended equally to cornea and sclera while a few extended more on the sclera (3 cases - 15%) or cornea (3 cases - 15%). Most (15 cases - 75%) were round. Two (10%) had Goldenhar Syndrome and both had preauricular tags and maxillary hypoplasia. Postoperatively one patient (5%) had corneal thinning and two(10%) patients had granulation tissue formation.Pigmentation of the lesion was seen in 18 cases (80%). Conclusion:Limbal dermoids in Kashmiri patients have clinical characteristics resembling those described in other parts of the world. Treatment with simple excision and supercial sclerokeratectomy gives satisfactory results.

Thyroglossal duct cyst variation in presentation: our experience of 3 years

Background: The prime objective of the present study was, to learn incidence of thyroglossal duct cyst in different age and sex groups and variation in its presentation.Methods: The present retrospective study was carried out in department of otorhinolaryngology and head and neck surgery, GMC Jammu from June 2017 to May 2020. In this retrospective study clinical records, medical records and histopathological records were thoroughly reviewed and studied. 20 patients diagnosed as thyroglossal duct cyst were included in the present study.Results: Out of 20 patients, 14 were paediatric patients and 6 were adults. 15 patients presented with cystic swelling while 5 patients presented with fistula. Out of 20 patients, 5 patients had suprahyoid presentation, 4 patients had cyst at the level of hyoid and 11 had infrahyoid presentation. 16 patients underwent sistrunk operation while 4 patients underwent simple excision. Out of 4 patients who had undergone simple excision, 2 patients developed recurrence.Conclusions: In the present study it is concluded that paediatric age group presents most commonly with thyroglossal cyst as a midline, painless swelling. The most common site observed is infrahyoid region. After proper investigations and diagnosis, thyroglossal duct cyst should be excised preferably by sistrunk operation.

Scleral Dellen: Early Complication Of Pterygium Surgery And Literature Review

Introduction : Severe Scleral Dellen is a rare and early postoperative complication of pterygium surgery. The various cases reported in the literature are mostly related to this surgical technique; simple excision of the conjunctiva, notably either without adjuvant treatment or using mitomycyine C in preoperative or otherwise beta radiation. The particularity of our case is that the scleral Dellen is associated with excision and simple suture of the conjunctiva without adjuvant treatment or cauterization of the vessels. The other particularity of this case is that it is to our knowledge the first case of scleral dellen reported in Morocco, and even at the African level. Case report This case is a 38-year-old military patient with no medical history The patient was scheduled for pterygium surgery. 16 days later, the patient came back after noticing the appearance of a blackish brown spot at the nasal side of the right eye associated with mild eye pain. The slit lamp examination of the involved eye revealed a severe scleral thining, surrounded by an oedematous conjunctiva and the visualization of the ciliary body through the fine sclera. The conjunctival sutures were no longer in place. After three days and with treatement, we observed a scleral cicatrization, followed by a gradual covering of the sclera by conjunctiva. Discussion : In our case as in that described by Garcia-Medina and collaborators, we performed a conjunctival suture with two stitches to cover the sclera. Otherwise, both of the stitches were not found later, which suggests that, like in the Garcia-Medina report; a bad handling by the patient (eye rubbing), loose stitches or even both. Thus, the sclera would have been exposed in the two cases. Regarding the treatment of this complication, the graft of a conjunctival flap was performed in two cases with favorable evolution. In all other cases, only medical treatment has been successfully initiated. In our case we opted for medical treatment only, including local antibiotic therapy, intensive lubrication with artificial tears (hourly drop) and the occlusion of the eye. The evolution was also favorable under this treatment. Hence, our case is similar to the Garcias-Medina and collaborators one, concerning the surgical technique, and also the scleral Dellen treatment. Although the difference and the particularity of our case was the absence of cauterization use during the surgical act. Conclusion: Scleral Dellen is rare complication of pterygium surgery, which occurs early after the surgical act. Its exact physiopathology remains unknown, but some factors may be incriminated; first of them is the surgical technique as a simple excision with exposed sclera. This complication can occur in patients, without any particular medical or ophthalmological history or any underlying pathology. It could also occur for primary pterygium. Medical treatment alone may be appropriate to manage this complication.

Reconstruction of Thumb Polydactily: A Case Report

Background: Polydactyly is the most common hand congenital abnormality found, next after syndactyly. The presence of these extra fingers is not merely duplication but is accompanied by abnormal hypoplastic structures, abnormal joints, tendon anomalies, and anomly of the insertion of ligaments. There are many tehniques proposed to reconstruct polydactyly, from simple excision of bones, ligaments, and tendons to complex reconstructions. We report a case of polydactily, the patient had bone exicision of the duplicates when the patient was four-month-old, but that extra metacarpal with no phalanges resulted in a greater space of finger 1 and 2. Patient and Method: A 21-year-old woman complaining of difficulty in grasping because the space between first and second fingers is too far away, and the extra metacarpal bone is protruding that causes snagging and stumbling on other objects. She had a history of surgical removal of polydactyl when she was 4-month-old. The patient has a limitation in hand activities. Result: Six months after surgery, the patient was satisfied with the results. The fingers has better mobility, good appearance. No more prominent bone, and neuropathic problems, or other disorders were found. Conclusion: Polydactyly is a common congenital hand occurrence. Understanding the anatomy to guide the reconstructive actions is important. It is not only about which digit would be preserved, but we have to concern about what our patient need, improving the quality, patient's hand function, and the aesthetic aspect.