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PubMedDate not supplied

Congenital linear steatocystoma multiplex of the nose.

We describe a case of steatocystoma multiplex with an unusual clinical manifestation. A 5-year-old girl had 8 papulonodular lesions arranged in a linear fashion on the left side of the nose. These had been present at birth. Histologically the lesions showed the typical features of steatocystoma multiplex. There was no family history of similar lesions. This is the second case of linear steatocystoma multiplex, a rare variant of steatocystoma multiplex.

Child, Preschool↗
PubMed2007

Common anorectal problems.

Children, just as adults, have a variety of common anorectal problems that can be quite bothersome. The presentation of these problems may be age-specific. Abscesses, fistulas, and fissures appear more commonly in infants and young children, whereas hemorrhoids and pilonidal disease are more common in teens and young adults. Fissures often can be treated medically but may require surgical treatment with lateral internal sphincterotomy. Abscesses and fistulas are common in infant males, especially robust infants who are breastfed. They may resolve with medical therapy but anal fistulotomy is not infrequently required. Hemorrhoids are rare in young children but may be an issue for teenagers. Acute symptomatic lesions may require excision if local measures cannot control the symptoms. Finally, pilonidal disease is a difficult problem for the patient and the surgeon. Persistently symptomatic lesions demand some type of surgical treatment but wound healing is poor in the intergluteal cleft region. More extensive procedures requiring the transfer of fasciocutaneous flaps may be necessary to provide definitive relief. Anorectal problems in infants and children are frequent and bothersome. Although most are not associated with tremendous morbidity, they can lead to much patient and parent anxiety as well as frequent medical consultation until the problem is successfully treated or resolves.

Abscess↗
PubMed2004

Partially de-epithelialised and buried V-Y advancement flap for reconstruction of sacrococcygeal and ischial defects.

Defects in the sacrococcygeal and ischial soft tissues can be treated with gluteus maximus and posterior thigh V-Y advancement flaps. However, late complications include recurrence and dehiscence of the suture line. Increasing the amount of the soft tissues over the bony prominences and multilayered closure may have an advantage for long-term durability. We modified the V-Y advancement technique by de-epithelialising the medial parts of the flap and burying them under the opposing edge of the wound or the flap. Sixteen patients with various defects of the sacrococcygeal and ischial soft tissues were operated on using this technique. All the flaps healed well with no partial or complete loss of the flap. Three patients developed complications. The main advantage of our technique is the use of healthy tissues to obliterate the dead spaces under the edges of the wound or the opposing flap. In this way, not only the defect in the skin but the defect in the subcutaneous tissue, with its iceberg tip at the surface, is treated effectively. To have an additional layer of tissue between the bone and the superficial tissues provides an extra cushion of soft tissue and avoids putting the suture line directly over the bony prominences. We used this modification safely for both unilateral and bilateral flaps. It could also be used successfully in other parts of the body.

Adult↗
PubMed2006

Surgical site infections in day surgery settings.

BACKGROUND: Because major complications are rare in day surgery, minor morbidities such as surgical site infections, which become evident only after patient discharge, have a major impact on the perceived quality of care. We performed an audit of such infections over a oneyear period. METHODS: All procedures were performed in a multidisciplinary day surgery setting. There were 155 inguinal hernia repairs, 44 excisions of lipomas, and 27 excisions of pilonidal cysts. All patients received antibiotic prophylaxis according to a rotation protocol. RESULTS: One patient (0.65%) operated on for inguinal hernia developed a deep incisional infection caused by Staphylococcus schleiferi. The patient was treated using selective antibiotics, and complete recovery ensued. One patient (2.27%) who underwent excision of a lipoma revealed developed a deep incisional infection associated with fever (39 degrees C) caused by Staphylococcus aureus. He was treated by daily antibiotics and application of dressings for two weeks and recovered. One patient (3.7%) treated for pilonidal cyst developed a deep incisional surgical site infection. A group A Streptococcus was isolated, and he received an intravenous antibiotic for ten days. In the seven patients treated for pilonidal cyst with the wound left open, swab specimens were taken because of persisting local pain, and the following bacteria were found: Pseudomonas aeruginosa, Escherichia coli, Staphylococcus epidermidis, Proteus vulgaris, and Streptococcus constellatus. No antibiotic therapy was given, and local wound care led to complete recovery. CONCLUSION: In our day surgery unit, the rates of surgical site infection are similar to those described in the literature. Continuing audit is essential to maintain and improve the quality and standard of the surgery provided. Prevention of surgical site infection is very much the responsibility of the persons working in the operating theater. Therefore, it is vital not only to apply strict regulations concerning everyday management but also to maintain a high degree of motivation among the personnel.

Ambulatory Surgical Procedures↗
PubMed1996

Gluteus maximus musculocutaneous flap for the treatment of recalcitrant pilonidal disease.

Although conservative surgery should be the initial approach to pilonidal disease, there remains a select group of patients with recalcitrant disease who fail repeated interventions and for whom a more aggressive approach is justified. Use of a large gluteus maximus musculocutaneous flap to facilitate wide excision, to allow for primary closure with well-vascularized tissue, and to alter the anatomy of the gluteal cleft has been used in 5 patients with chronic recurrent recalcitrant disease. The use of this large muscle unit in these otherwise healthy adults has achieved control over their pilonidal disease with acceptable morbidity and no demonstrable functional sequelae.

Adult↗
PubMed1997

Squamous cell carcinoma in perineal inflammatory disease.

Four patients with squamous cell carcinoma of the perineal region were diagnosed and treated during the last 4 years in our institutions. The underlying diagnoses consisted of recurrent pilonidal disease, Crohn's disease, and hidradenitis suppurativa. In all patients, a pattern of a long-term inflammatory process was evident. Current concepts regarding the pathophysiology of a chronic inflammatory state and malignant transformation are reviewed. We conclude that regardless of the original pathology, all chronic inflammatory processes in the perineal region should be evaluated for malignant degeneration. A high index of suspicion may potentiate an early diagnosis, possibly improving the chance of cure.

Abscess↗
PubMed1975

Results of various operations for sacrococcygeal pilonidal disease.

A comparative evaluation of 4 operations designed to treat sacrococcygeal pilonidal disease is presented, to show the duration of treatment time and the recurrence rate. Case records of 112 patients (131 operations) were studied. The results indicate that the healing times with the excision and Z-plasty operation are clearly less than those obtained by incision with drainage and packing, excision with primary closure, or excision and lay open. The overall recurrence rate in this series was 28 percent, all occurring within 3 years of the first operation. With the exception of the Z-plasty operation, other methods required considerable outpatient treatment time and were more susceptible to recurrence. We suggest that by reconstructing the intergluteal cleft, the likely effect of the Z-plasty operation is to eliminate factors that may promote pilonidal disease in this region.

Ambulatory Care↗
PubMed2000

Closure of hemicorporectomy with bilateral subtotal thigh flaps.

Hemicorporectomy is typically performed with a circumferential truncal incision, and the wound is closed primarily. Wound disruption is a common complication, especially at the base of the wound closure and posteriorly at the lumbar vertebral level. We report a case of the use of bilateral subtotal thigh flaps for the closure of a hemicorporectomy wound in a patient with a defect extending up to the high lumbar region. The subtotal thigh flap is a well-vascularized thick flap that provides a firm support for the abdominal viscera and is a large flap that can be used to close even a high lumbar defect.

Adult↗