Ambulatory Surgery for Pilonidal Sinus: Tract Excision and Open Treatment Followed by At-Home Irrigation.

Pilonidal sinus is a cystic disease that occurs most often in the sacrococcygeal region. Surgical excision and coverage with a skin flap require postoperative bed rest. Most affected patients are young adults who find it difficult to obtain adequate postoperative bed rest owing to their work. The purpose of this study is to review the effectiveness of our ambulatory surgery procedure for pilonidal sinus, which involves tract excision and open treatment followed by at-home irrigation. We reviewed the 9 cases of chronic pilonidal sinus treated at our out-patient clinic by ambulatory surgery consisting of open excision without skin closure. Patients were sent home after careful observation for hemostasis at the surgical site. Postoperative wound treatment and irrigation were performed at home by the patients themselves. The mean immediate postoperative follow-up period was 22.3 days (13 to 31 days), and the mean number of follow-up visits was 3.3. No serious complication and recurrence was noted during the long-term follow-up period of 26.3 months (1 to 60 months). Although the healing time following our ambulatory procedure was not short, no postoperative rest was required, and the recurrence rate was zero. We believe this procedure is useful for selected patients with pilonidal sinus. J. Med. Invest. 63: 216-218, August, 2016.

Proximal nail fold flap for digital mucous cyst excision.

The skin covering a digital mucous cyst is often very thin and is often excised with the cyst. Thus, transfer of a skin flap is needed for the defect. We have developed a proximal nail fold flap technique by which the thin skin covering the cyst can be preserved. We conducted a retrospective study to assess the effectiveness and reliability of this technique for digital mucous cyst excision. The study group comprised 26 patients treated for 28 digital mucous cysts. The flap was elevated on the nail matrix to expose the distal interphalangeal joint capsule. To preserve the skin in cases in which the skin covering the cyst was exceptionally thin, we did not excise the upper part of the cyst wall. Excision of the cyst and stalk was successful in all cases. Additional excision of the joint capsule or osteophyte(s) was achieved in 20 cases and 5 cases, respectively. No flap necrosis, skin defect or nail deformity resulted. Three of the cysts recurred and were treated successfully by reoperation involving the same flap elevation technique. We conclude that the proximal nail fold flap is useful for excision and reliable for wound coverage after digital mucous cyst excision. J. Med. Invest. 63: 278-280, August, 2016.

Risk factors for complications after reconstructive surgery for sternal wound infection.

BACKGROUND: Although the utility of flaps for the treatment of sternal wound infections following median sternotomy has been reported for 30 years, there have been few reports on the risk factors for complications after reconstruction. The objective of this investigation was to identify factors related to complications after the reconstruction of sternal wound infections. METHODS: A retrospective analysis of 74 patients with reconstructive surgery after sternal wound infection over a 5-year period was performed. Clinical data including age, sex, body mass index (BMI), comorbidities, bacterial culture, previous cardiac surgery, wound depth, mortality rate, type of reconstructive procedure, and complication rate were collected. RESULTS: The patients' BMI ranged from 15.2 to 33.6 kg/m(2) (mean, 23.1±3.74 kg/m(2)). Wound closure complications after reconstructive surgery were observed in 36.5% of the cases. The mortality rate was 2.7%. Diabetes mellitus significantly affected the rate of wound closure complications (P=0.041). A significant difference in the number of complications was seen between Staphylococcus aureus (S. aureus) and coagulase-negative Staphylococci (P=0.011). There was a correlation between harvesting of the internal thoracic artery and postoperative complications (P=0.048). The complication rates of the pectoralis major flap, rectus abdominis flap, omentum flap, a combination of pectoralis major flap and rectus abdominis flap, and direct closure were 23.3%, 33.3%, 100%, 37.5%, and 35.7%, respectively. CONCLUSIONS: Diabetes mellitus, S. aureus, harvesting of the internal thoracic artery, and omentum flap were significant factors for complications after reconstruction. The omentum flap volume may be related to the complications associated with the omentum flap transfer in the present study.