Propeller Flap Reconstruction Following Pilonidal Cyst Excision: A Single-Center Experience With Same-Day Discharge.

INTRODUCTION: Reconstruction following pilonidal cyst resection must balance risk of recurrence, healing time, and resumption of functional routine. Propeller flaps provide a reliable and effective reconstructive option. This study highlights our experience with propeller flap reconstruction following pilonidal cyst resection and demonstrates the efficacy of same-day discharge. METHODS: A single-institution retrospective chart review was performed for propeller flap reconstructions completed from March 2018 to July 2022. Patient demographics, pilonidal cyst details, operative details, and postoperative outcomes were collected. Primary outcomes included flap survival, flap complications, and pilonidal disease recurrence. RESULTS: Twenty-eight outpatient propeller flap reconstructions following pilonidal cyst resections were identified in 26 patients, with two patients receiving a second propeller flap due to recurrence. Most patients were male (n = 15, 57.7%) with a mean age at time of index operation of 25.5 ± 5.8 years and mean body mass index of 26.5 ± 4.1 kg/m2. Mean symptom duration prior to index surgery was 39.3 months. Mean skin defect size following resection was 28.3 ± 15.3 cm2, with a mean flap size of 44.7 ± 35.5 cm2. Flap survival was 100% (n = 28), with five flaps (17.9%) experiencing minor wound complications and one patient (3.8%) requiring return to the operating room. Mean time to functional improvement was 24.0 ± 22.8 days. Pilonidal disease recurrence occurred in three patients (11.5%). Mean follow-up was 4.1 ± 5.4 months. CONCLUSIONS: Propeller flaps provide a successful and reliable reconstructive option for pilonidal disease defects. Because patients in our cohort experienced favorable outcomes and functional improvement, we advocate for same-day discharge in order to reduce hospital and patient burden.

Social-ecological factors influencing loneliness and social isolation in older people: a scoping review.

There are growing calls from researchers and policy makers to redefine loneliness and social isolation (SI) as public health issues, and to move towards a transdisciplinary, systems-based approach, due to their association with significant health risks, particularly in older people. Research about loneliness and SI in older people has typically adopted a narrow focus, evaluating effects of individual and inter-personal factors on these experiences. Less is known about the community and societal influences that may be used to inform public health interventions. We conducted a scoping review applying Joanna Briggs Institute methodology and the social-ecological model framework in order to: i) identify the available evidence for the influence of the community and societal factors on loneliness and SI as experienced by older people; ii) examine how quantitative research about community- and societal-level factors of loneliness and SI in the older population is conducted; and iii) identify current knowledge gaps in relation to the use of the social-ecological model in this area. A total of 52 articles from 30 countries met the inclusion criteria, including 33 observational studies, primarily cross-sectional (88%), and 19 interventions, mostly (89%) pre-post evaluations. The majority of included articles measured loneliness only (n = 34, 65%), while 11 measured both loneliness and SI (21%). To measure these outcomes validated scales were frequently used. Eighteen community/societal factors were investigated in relation to loneliness and/or SI, most commonly neighbourhood safety, access to public third-places and cultural practices. Three societal-level interventions were found: two campaigns to reduce ageism and one which explored the impact of free public transport. Community-based interventions were either educational or enlisted volunteers to foster connections. There is a need for longitudinal studies to better understand the mechanisms through which community- and societal- level factors affect loneliness and SI, which in turn will guide interventions that utilise the social-ecological framework for these issues.

A case of necrotizing fasciitis of the breast following lumpectomy and oncoplastic closure.

BACKGROUND: NF is a life-threatening soft tissue infection that most commonly occurs in the lower extremity. While presenting symptoms such as erythema, severe pain, sepsis, and wound crepitation are well documented, diagnosis of NF of the breast often is obscured by a low clinical index of suspicion due to its relative rarity as well as by the breast parenchyma that physically separates the underlying fascia and overlying skin. Several risk factors have previously been identified, such as underlying infection, diabetes, advanced age, and immunosuppression. However, the gross morbidity and high mortality associated with NF warrant continued surveillance of contributing factors across any anatomic location. Fifteen cases in the literature document the development of NF following breast surgery. CASE REPORT: The authors of this case report aim to expand on the current literature through the presentation of a unique case of NF of the breast following right breast lumpectomy and oncoplastic closure with left reduction mammaplasty in an immunocompromised patient found to have concurrent perforated sigmoid diverticulitis. CONCLUSION: This case exemplifies how frequent postoperative surveillance, a low threshold for intervention, and efficient coordination of care are vital to minimizing the morbidity and mortality risks associated with NF of the breast.

Blunt splenic injury during colonoscopy: Is it as rare as we think?

BACKGROUND: Post colonoscopy blunt splenic injury (PCBSI) is a rarely reported and poorly recognized event. We analyzed cases of PCBSI managed at our hospital and compared them to existing literature. METHODS: We identified 5 patients admitted with PCBSI through chart review. RESULTS: There were 5 cases of PCBSI identified from April 2016-July 2017. Four of the patients were older than 65 years, three had prior surgeries, and all were women. CT scans showed splenic laceration in 4 cases, hemoperitoneum in 4 cases, and left pleural effusion in 2 cases. Three patients were treated with coil embolization, 1 had open splenectomy, and 1 was observed. CONCLUSIONS: Although blunt splenic injury is an infrequently reported complication of colonoscopy, it can result in high-grade injury requiring transfusion and invasive treatment due to significant hemorrhage. As previously reported, we demonstrate a high rate of PCBSI in women over 55 with a history of prior abdominal surgery. These data suggest that a high index of suspicion for splenic injury post-colonoscopy should be present in this population.