Drain or no drain in Rhomboid excision and Limberg rotational flap for pilonidal sinus

Background: Healing in Rhomboid flap for pilonidal sinus is always a problem. Different measures are applied to reduce the rate of wound infection with variable results. Objectives: To determine the effect of routine use of drain on the rate of early wound complications and additional interventions after Rhomboid flap. Methods: A retrospective chart review of all cases that underwent Rhomboid flap in five years in two tertiary care centres was done. Complication rates such as wound infection, wound disruption, and flap necrosis were evaluated. Results: A total of 38 cases of Rhomboid flap are included for analysis. Out of all cases 37 cases were done for Pilonidal sinus and one case for presacral dermoid cyst. In the first eight cases, flap was made without drain and subsequent 30 cases were done with two suction drains for five days. The rate of superficial wound infection in the group without drain was found to be significantly higher compared with flap with drain 5 (in 8) versus 2 (in 30) (62.5% versus 6.66%, p <0.5). Conclusion: Drain placement after Rhomboid flap is a good intervention to reduce wound infection.

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

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.

Application of damage control surgery in patients with sacrococcygeal deep decubitus ulcers complicated by sepsis

Objective To evaluate the clinical application of damage control surgery (DCS) in patients with sacrococcygeal deep decubitus ulcers complicated by sepsis. Methods We conducted a 3-year retrospective clinical study of 32 patients with deep sacrococcygeal bedsores and sepsis admitted from January 2018 to January 2021. According to the concept of DCS, the wound was temporarily closed with vacuum sealing drainage after primary debridement, and a local rhomboid flap was designed to repair the wound in the second stage. Finally, the clinical therapeutic effect was observed. Results Twenty-nine patients were treated with skin flap translocation and were cured clinically. Specifically, the skin flap survived in 27 of the 29 patients after the first translocation attempt (success rate of 93.1%). One patient developed incisional dehiscence, and one patient developed a hydrocele under the skin flap. Conclusions Application of DCS in patients with sacrococcygeal deep decubitus ulcers complicated by sepsis improves the therapeutic success rate and reduces the risks of the operation and complication rate. It has unique advantages and is worthy of clinical promotion.