[Pilonidal sinus: Secondary wound closure vs. Limberg flap : Cost and satisfaction analysis]. / Sinus pilonidalis: Sekundäre Wundheilung vs. Limberg-Lappenplastik : Eine Zufriedenheits- und Kostenanalyse.

BACKGROUND: After excision of a pilonidal sinus, several treatment options are possible, but no gold standard has been established. A literature review revealed no study comparing the costs and time off work after either secondary wound closure or treatment with a Limberg transposition flap. The aim of this study was to focus on these aspects by analysing the patients treated at the KlinikumStadtSoest. METHOD: Sixty patients with pilonidal sinus after excision were treated either by secondary wound closure or Limberg transposition flap at the KlinikumStadtSoest between 2011 and 2012. The authors analysed retrospectively the patients' demographics, cost, and satisfaction with both techniques and compared them. RESULTS: For secondary wound closure (group 1) 19 out of 31 patients and for Limberg transposition flap (group 2) 21 out of 29 met the inclusion criteria. Time off work following the final surgery (group 1: 69 day vs. group 2: 30 days, p = 0.046) and the number of dressing changes (group 1: 107 times vs. group 2: 16 times, p = 0.000) were significantly lower in the group of Limberg transposition flap (group 2) as well as the associated costs. The surgery-related costs were lower when treated by secondary wound closure. DISCUSSION: Plastic reconstruction with Limberg transposition flap (group 2) provides a chance to reduce the period of incapacity for work due to a shorter treatment period. With that said, patients should nonetheless be offered both techniques as the current literature does not reveal a clear benefit for either procedure.

[Sacral Skin Elasticity - Establishing a Non-Invasive Mechanical Method for Measurement]. / Sakrale Hautelastizität - Etablierung einer noninvasiven mechanischen Messmethode.

OBJECTIVE: Some patients with sacral scars, e. g. those developing after pilonidal sinus surgery, report discomfort when sitting or putting strain on the scars. In order to establish objective criteria for the assessment of this kind of discomfort and for the evaluation of scar quality after various types of surgical interventions, it is of interest to provide a method which enables physicians to assess skin quality in the sacral region. For this purpose, we developed a mechanical, non-invasive, fast and cost-neutral method for the measurement of skin distensibility and mobility. We examined a healthy sample of 100 study participants to establish benchmark values for scar-free skin in the sacral region and to identify the factors which impact skin quality, e. g. age, weight and sex. METHOD: With the participant in a standing position, 4 vertically arranged measurement points, which are exactly spaced in cranial to caudal direction by 10 mm-100 mm-10 mm, are marked in the lumbar and sacral region, respectively. The participant is then asked to bend forward and - with arms and legs fully stretched on both sides - to touch both their patellae with the balls of their hands so that the distance between the measurement points can be measured in this position as well. Then, with the participant standing upright again, another measurement is taken to establish the distance by which the lowest point can be manually moved in cranial direction. RESULTS: The sacral-lumbar skin distension quotient (lumbar skin distension / sacral skin distension×100), which can easily be calculated from the measurements, is independent of age and BMI and has a standard range of about 80-93%. Sacral skin mobility ranges from 11 to 18 mm, but is slightly negatively influenced by a high BMI. CONCLUSION: By comparing lumbar and sacral skin distension in the same study participant, we are able to obtain intraindividually valid findings about possible changes in skin and scar quality. Owing to the lack of known published data about sacral skin elasticity, the proposed measurement method, while restricted to a number of special cases, seems to be practicable and independent of the patient's general condition. Compared with devices that have been used for the measurement of elasticity in other skin areas, our procedure is generally available and cost-neutral.

[Comparison of Treatments for an Infected Pilonidal Sinus: Differences in Scar Quality and Outcome Between Secondary Wound Healing and Limberg Flap in a Prospective Study]. / Therapievergleich bei infiziertem Sinus pilonidalis - Unterschiede von Narbenqualität und Outcome nach Sekundärheilung oder Limberglappenplastik im Rahmen einer prospektiven Studie.

OBJECTIVE: There are various options for wound treatment after the excision of a pilonidal sinus. The aim of our study was to compare secondary healing to Limberg flap wound closure, with a focus on scar quality and patient complaints, rate of recurrence, period of absence from work as well as functional and aesthetic results one year after surgery. METHOD: 33 out of 55 patients who underwent pilonidal sinus excision in our department (KlinikumStadtSoest, Soest, Germany) between 2011 and 2012 were enrolled in the study. 16 of these 33 patients had chosen secondary wound healing and 17 were treated with a Limberg flap for defect coverage. First and foremost, we aimed to objectify scar quality and elasticity by measuring the parameters of skin distensibility and mobility. To this end, we used a self-developed method to ascertain the sacral lumbar skin distension quotient (SL quotient) as well as sacral skin mobility. 100 healthy volunteers served as a control group. Also we collected information about pain, time of absence from work and frequency of recurrence and asked patients about their satisfaction with the functional and aesthetic results. RESULTS: The results for the sacral lumbar skin distension quotient were significantly better after Limberg flap wound closure compared with secondary wound healing. As regards distensibility, there was a marked trend to more favourable values in the Limberg group. No differences in distensibility and mobility were observed between the Limberg group and the control group, whereas skin distensibility was significantly reduced (p=0.001) in secondary healing compared with the control group. Time off work was significantly longer in secondary healing (mean 63 days) than after Limberg flap (mean 29 days). No differences were identified regarding patient satisfaction, pain scores and frequency of recurrence. CONCLUSION: Wound closure via Limberg flap after the excision of an infected pilonidal sinus not only helps to reduce absence from work, but also produces a scar which is more distensible and movable compared with secondary healing. Patient satisfaction and pain scores were very good in both groups, with no differences observed by us. We are planning to collect more data with a bigger sample of patients and a longer follow-up period in future studies. For the time being, we will continue to provide both treatment methods to our patients.

[Pelvic reconstruction after tubular rectumresection (extended abdominoperineal resection combined with extended transpelvic myocutaneous M. rectus abdominis flap (extended VRAM) in low rectum cancer - case series)]. / Perineale Rekonstruktion nach zylindrischer Rektumexstirpation (Defektdeckung durch erweiterte, myokutane vertikale M. rectus abdominis Lappenplastik (extended VRAM) nach zylindrischer Rektumexstirpation beim tiefsitzenden Rektumkarzinom - Fallserie).

In advanced lower rectal cancer tubular abdomino-perineal resection (APR) in combination with simultaneous extended distally pedicled vertical rectus abdominis muscle flap (VRAM) facilitates a more radical tumor resection. Additionally a prolapse of small intestine into the pelvis can be blocked and a perineal defect coverage can be achieved. 4 patients have been treated with an interdisciplinary one stage combined tubular APR and extended VRAM. In all cases a R0 resection and a complete defect closure could be achieved.The extended VRAM is an appropriate technique to close the pelvic defect because it originates from a non irradiated area, has a monitor island, and the donor site does not handicap the patient as much as local flaps. This interdisciplinary approach facilitates a more radical tumor resection and thus reduces the risk of recurrence.