Limberg flap is better for the surgical treatment of pilonidal sinus. Results of a 767 patients series with an at least five years follow-up period.

PURPOSE: Pilonidal Sinus Disease (PSD) is an acquired condition usually seen in young adult males. This descriptive retrospective study has been performed to determine effects of primary suture, marsupialization and Limberg Flap for the management of PSD on the outcomes of return to work period, infection and recurrence rates. METHODS: 823 patients were operated by same two surgeons, wide excision was done. Some patients were primarily closed (Group 1), some marsupialized (Group 2) and to a number of patients Classic Limberg (Rhomboid) Flap (Group 3) was applied. The type of the surgery was judged by the operating surgeon. In January 2010, 767 of 823 patients could be reached, and a planned telephone interview was done. RESULTS: 767 patients (85 Female, 682 Male) with the median age of 25.8 were in the study. In "Return To Work (Days)" periods, there is statistically significant difference between groups (p < 0.001). The Return To Work Period is quite shorter in primary closure group compared with marsupialization group. In Limberg Flap Group the surgical site infection rate is the smallest with 4.7%. The highest recurrence rate is in the primary closure group. There is a statistically significant difference (p < 0.001) between the surgery types for the recurrence rates. CONCLUSION: Because of earlier healing, shorter return to work and lower rates of infection and recurrence, limberg flap is better for PSD.

Diaphragmatic injuries: a surgical challenge. Report of forty-one cases.

BACKGROUND: We present a discussion of the management of diaphragmatic injury and the factors that influence the choice of surgical approach based on our experience and a review of the literature. METHODS: Data of 41 patients with diaphragmatic injuries treated between 1996 and 2007 were analyzed retrospectively. RESULTS: A total of 29 men and 12 women between 15 and 56 years of age (mean age 34) were included in the study. Twenty-one patients had penetrating injuries and 20 patients had blunt injuries. The diagnosis was done preoperatively in 21 cases and intraoperatively in 20 cases. Thoracotomy was used in 23 cases, laparotomy in 11 cases, laparotomy-thoracotomy in 5 cases, sternotomy-laparotomy in 1 case, and sternotomy in 1 case. Emergency surgery was performed in 30 cases. Five cases were operated within 24 hours after admission to the emergency department. In 6 cases, surgery was performed 6 months to 4 years after the initial trauma. The mortality rate was 14.6 % and the operative morbidity was 2.4 %. CONCLUSION: A high index of suspect is vital for the diagnosis of diaphragmatic injuries in an emergency setting. The type of approach is closely related to the associated injuries.

Oxidative DNA damage and total antioxidant status in rats during experimental gram-negative sepsis.

Sepsis and septic shock remains as leading cause of death in adult intensive care units. It is widely accepted that gram-negative bacteria and their endotoxins cause sepsis and septic shock, predominantly. Enhanced generation of reactive oxygen species may be responsible for tissue injury in septic shock and endotoxemia. The aim of this study was to assess oxidative DNA damage and the total antioxidant status (TAS) in peripheral lymphocytes of rats during different intraperitoneal gram-negative sepsis stages. Adult male Sprague-Dawley rats were divided randomly into four groups. Control group was intraperitoneally inoculated with 2 mL of pyrogene-free saline (Group I, n = 6), and the other rats received an intraperitoneal inoculum with 2 mL of saline containing 2 x 10(8) CFU of Escherichia coli. The animals were killed at time zero (Group I, n = 6), at 6th (Group II, n = 7), 12th (Group III, n = 7), and 24th (Group IV, n = 7) hour after the E. coli inoculation. Oxidative DNA damage in peripheral lymphocytes of rats was evaluated by modified comet assay (single-cell gel electrophoresis). Formamidopyrimidine DNA glycosylase (Fpg) and Endonuclease III (Endo III) were used to detect oxidized purines and pyrimidines, respectively. Total antioxidant quantification was carried out using ABTS+ (2,2'-Azino-di-[3 ethylbenzthiazoline sulphonate]) radical formation kinetics (Randox kit) in serum samples. Significant elevations of basal levels of strand breaks (SB) in Group IV were observed as compared with Group I, II, and III. There was a significant increase in Fpg sites in Group III as compared with Group I and II. However, there was no significant difference in terms of Endo III sites in any of the groups. Although the TAS was decreased with the stages of sepsis, this moderate decrease was significant in only Group IV as compared with Group I. There was no statistically significant correlation between DNA damage and TAS for any of the groups.

W-plasty technique in tracheal reconstruction: a new technique? An experimental study.

BACKGROUND: Tracheal stenosis and dehiscence of anastomosis due to excessive tension are well-known problems after long-segment tracheal resections. The aim of this study was to evaluate the efficacy of the W-plasty technique to prevent these two complications. METHODS: Animals were divided into a study and a control group. Each group consisted of 6 animals. In the control group, we performed a 5-cm tracheal segment resection, and then reconstruction was performed with an interrupted technique with 6/0 Prolene sutures. In the study group, we used the W-plasty technique with 6/0 Prolene interrupted sutures. The animals were sacrificed on the 30th day postoperatively and tracheal resection including the entire anastomosis site was performed. The traction and pullout test was applied to each specimen and all the specimens were analysed histopathologically. The intraluminal diameter and the thickness of the tracheal wall at the level of anastomoses were measured by using a micrometer. The pattern of the reaction and localization were recorded. RESULTS: The traction and pullout test results were 131.6 +/- 4.3 g and 187.5 +/- 6.4 g in the control and the study group, respectively, which was a significant difference (p = 0.004). The intraluminal diameters were 3.3 +/- 1.2 mm and 4.3 +/- 0.9 mm in the control and study group, respectively (p = 0.134). In contrast to the control group, early inflammatory and late fibroblastic reactions were negative in the study group. CONCLUSION: Considering the outcomes of this study, we think that the W-plasty technique has much more advantages than the standard techniques in terms of anastomosis durability and development of stenosis.