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Ho E, Kaneko Y, Behrenbruch C, Ong E. Verrucous squamous cell carcinoma arising from recurrent chronic pilonidal disease. ANZ J Surg 2024. [PMID: 38563251 DOI: 10.1111/ans.19002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 03/25/2024] [Indexed: 04/04/2024]
Affiliation(s)
- Elise Ho
- Department of Colorectal Surgery, St Vincent's Hospital Melbourne, Melbourne, Victoria, USA
| | - Yui Kaneko
- Department of Colorectal Surgery, St Vincent's Hospital Melbourne, Melbourne, Victoria, USA
| | - Corina Behrenbruch
- Department of Colorectal Surgery, St Vincent's Hospital Melbourne, Melbourne, Victoria, USA
- The Department of Surgery, The University of Melbourne, St Vincent's Hospital Melbourne, Melbourne, Victoria, USA
| | - Eugene Ong
- Department of Colorectal Surgery, St Vincent's Hospital Melbourne, Melbourne, Victoria, USA
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Khatri H, Chuang TY, Swan D. An unusual case of pilonidal p16 positive squamous cell carcinoma-a case report. J Surg Case Rep 2024; 2024:rjae076. [PMID: 38389511 PMCID: PMC10881292 DOI: 10.1093/jscr/rjae076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 01/26/2024] [Indexed: 02/24/2024] Open
Abstract
Basaloid squamous cell carcinoma (BSCC) is a rare and aggressive variant of squamous cell carcinoma. It is commonly seen in the oropharynx and strongly associated with p16-expressivity and high-risk human papilloma virus (HPV). We report the first case of primary cutaneous p16-positive BSCC in an elderly woman, with a background of chronic inverse psoriasis of the natal cleft. P16-expressivity is a common surrogate marker for oncogenic HPV16, routinely tested for oropharyngeal/anogenital squamous cell carcinoma. This is not routinely done for primary cutaneous disease. Pilonidal disease is uncommon in the elderly population, and malignant transformation is rarer still. Surgical resection is considered the mainstay of treatment for primary cutaneous BSCC, however due to this patient's broad distribution of cutaneous field change and p16-expressivity, she was effectively treated with primary radiotherapy. This is a unique case of malignant transformation of pilonidal disease in an atypical demographic, with a rare/aggressive disease variant.
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Affiliation(s)
- Hershil Khatri
- Department of General Surgery, Ipswich Hospital, Ipswich, QLD 4305, Australia
| | - Tzu-Yi Chuang
- Department of General Surgery, Ipswich Hospital, Ipswich, QLD 4305, Australia
| | - Daniel Swan
- Department of General Surgery, Ipswich Hospital, Ipswich, QLD 4305, Australia
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Pyon RE, Mazumder A, Almajali F, Wong S. Chronic Pilonidal Cyst with Malignant Transformation: A Case Report and Literature Review. Cureus 2022; 14:e23248. [PMID: 35475045 PMCID: PMC9018021 DOI: 10.7759/cureus.23248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 11/16/2022] Open
Abstract
A 63-year-old male with a 20-year history of a chronic, recurrent sacrococcygeal pilonidal cyst was referred to our outpatient clinic. He had received multiple surgical resections in the past with benign pathology. He presented with a verrucous wart-like midline mass on the superior gluteal cleft that had grown since his last resection. The patient subsequently underwent resection of the mass with bilateral gluteal rotational flaps. Pathology showed squamous cell carcinoma with tumor-free margins, and further imaging showed no evidence of metastatic disease. It is believed chronic inflammation with subsequent genetic and impaired DNA repair mechanisms is the leading cause of malignancy. The treatment of choice for pilonidal carcinoma is surgical resection with free margins. Reconstruction methods can be utilized to repair the tissue defect. Pilonidal carcinoma has high mortality risk with surgical treatment yielding a disease-free 5-year survival rate of 55% of patients and a high recurrence rate of 50%. The role of chemoradiotherapy is currently unclear.
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Vertaldi S, Anoldo P, Cantore G, Chini A, D'Amore A, D'Armiento M, Gennarelli N, Maione F, Manigrasso M, Marello A, Schettino P, Sorrentino C, Sosa Fernandez LM, De Palma GD, Milone M. Histopathological Examination and Endoscopic Sinusectomy: Is It Possible? Front Surg 2022; 9:793858. [PMID: 35310433 PMCID: PMC8927015 DOI: 10.3389/fsurg.2022.793858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 02/08/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Although carcinomatous degeneration is a rare occurrence, some authors support the need for a histopathological examination after pilonidal cyst excision. Today, minimally invasive techniques are widely spread for the treatment of pilonidal sinus disease but opposed to standard procedures, these techniques could not allow to perform a histopathological examination because of the absence of a specimen. The aim of this two-institutions study is to evaluate whether histopathological examination of the pilonidal sinus excision material can be successfully performed after an endoscopic ablation of the cyst. Materials and Methods We identified all consecutive patients from January 2021 to September 2021 with diagnosis of pilonidal sinus disease who underwent Video Assisted Ablation of Pilonidal Sinus (VAAPS) followed by histopathological examination. Results A total of 45 patients were included in the study. All patients were Caucasians and aged below 50 years. Nine of them underwent surgery due to recurrence of PSD. No evidence of malignancy was detected in the histopathological examination of the pilonidal sinus sampling material. Discussion We were able to send pilonidal sinus sampling material for a histopathological examination in all patients who underwent minimally invasive technique for the treatment of pilonidal sinus disease. No evidence of malignancy was found in any of the 45 samples. Our findings prove that minimally invasive ablation of pilonidal sinus does not preclude histopathological examination of the cysts.
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Affiliation(s)
- Sara Vertaldi
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
- *Correspondence: Sara Vertaldi
| | - Pietro Anoldo
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Naples, Italy
| | - Grazia Cantore
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
| | - Alessia Chini
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
| | - Anna D'Amore
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
| | - Maria D'Armiento
- Pathology Unit, Department of Public Health, University of Naples “Federico II”, Naples, Italy
| | - Nicola Gennarelli
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
| | - Francesco Maione
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
| | - Michele Manigrasso
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Naples, Italy
| | - Alessandra Marello
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
| | - Pietro Schettino
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Naples, Italy
| | - Carmen Sorrentino
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
| | | | - Giovanni D. De Palma
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
| | - Marco Milone
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
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Akin T, Akin M, Ocakli S, Birben B, Er S, Tez M. Is it Necessary to Perform a Histopathological Examination of Pilonidal Sinus Excision Material? Am Surg 2021; 88:1230-1233. [PMID: 33517687 DOI: 10.1177/0003134821991974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although pilonidal sinus disease is common, development of associated malignancy is very rare. After surgical treatment, most surgeons send the excision material for a histopathological examination. The aim of this study was to examine whether it is necessary to routinely send the pilonidal sinus surgical excision material for this examination. METHOD The data of 3146 patients were retrospectively screened, and 2486 patients with available histopathological reports of the excision material were included in the study. RESULTS Of the 2486 patients included in the study, 2165 were men and 321 were women, and 94.7% of the patients were under the age of 50 years while 5.3% were 50 years or above. The rate of patients who underwent surgery due to recurrence was 1.2%. No malignancy was detected in any patient after the histopathological examination. DISCUSSION In this study, none of the pathology results was reported as malignant. This confirms that it is necessary to ask the question whether we should routinely send the surgical excision material for a histopathological examination.
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Affiliation(s)
- Tezcan Akin
- Department of General Surgery, 536164Ankara City Hospital, Ankara, Turkey
| | - Merve Akin
- Department of General Surgery, 536164Ankara City Hospital, Ankara, Turkey
| | - Serhat Ocakli
- Department of General Surgery, 536164Ankara City Hospital, Ankara, Turkey
| | - Birkan Birben
- Department of General Surgery, 536164Ankara City Hospital, Ankara, Turkey
| | - Sadettin Er
- Department of General Surgery, 536164Ankara City Hospital, Ankara, Turkey
| | - Mesut Tez
- Department of General Surgery, 536164Ankara City Hospital, Ankara, Turkey
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35-year Onset of a Squamous Cell Carcinoma Originating from Sacral Pilonidal Sinus. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 7:e2553. [PMID: 32537300 PMCID: PMC7288878 DOI: 10.1097/gox.0000000000002553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Mayol Oltra A, Boldó Roda E, Lozoya Albacar R, Morillo Macias V, Nobleja Quiles N. Squamous cell carcinoma over pilonidal chronic disease. A new therapeutic approach. Int J Surg Case Rep 2020; 70:172-177. [PMID: 32417733 PMCID: PMC7229405 DOI: 10.1016/j.ijscr.2020.04.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/08/2020] [Accepted: 04/21/2020] [Indexed: 12/02/2022] Open
Abstract
Squamous cell carcinoma can appear in chronic pilonidal disease. En bloc surgery is the main treatment. Intraoperative radiotherapy could decrease the recurrence rate.
Introduction Pilonidal sinus is a very common disease. Malignant transformation occurs in 0,1% of patients. We present a case of squamous cell carcinoma arised from recurrent pilonidal disease, managed by multimodal treatment. Presentation of case We present a 70-year-old man with chronic pilonidal sinus. Inflammation had worsened in previous months and exploration revealed a large ulcerative mass which biopsy showed a squamous cell carcinoma. CT scan and MRI imaging showed tumoral invasion of the coccyx and both gluteus major muscles. Neoadjuvant radiotherapy, chemotherapy as radiosensitizer and surgery with intraoperative radiotherapy was decided in the multidisciplinary tumor committee. Post neoadjuvant therapy MRI showed partial response with a decrease of the mass but persistence of the coccyx infiltration. Surgery consisted in en-bloc resection of the tumor with presacral tissues, coccyx and partial gluteal resection. Intraoperative radiotherapy was administered over the sacrum and in the bed of the coccyx resection. One week later, reconstructive surgery was practiced using a latissimus dorsi free flap, advancement of gluteal flaps and skin graft. Histological examination showed no residual tumor. The patient is currently asymptomatic and he has a satisfactory quality of life. Discussion Although squamous cell carcinoma is rare, it must be suspected in patients with recurrent pilonidal disease. Diagnosis is done by histological examination of biopsies. This type of tumors have a high local recurrence rate. Conclusion We propose a multimodal treatment that includes neoadjuvant radiotherapy and chemotherapy as radiosensitizer and surgery plus intraoperative radiotherapy with the aim to decrease local recurrence rate.
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Affiliation(s)
- A Mayol Oltra
- Department of Surgery, Consorcio Hospitalario Provincial of Castellón, Spain.
| | - E Boldó Roda
- Department of Surgery, Consorcio Hospitalario Provincial of Castellón, Spain
| | - R Lozoya Albacar
- Department of Surgery, Consorcio Hospitalario Provincial of Castellón, Spain
| | - V Morillo Macias
- Department of Oncology Radiotherapy, Consorcio Hospitalario Provincial of Castellón, Spain
| | - N Nobleja Quiles
- Department of Oncology Radiotherapy, Consorcio Hospitalario Provincial of Castellón, Spain
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Yuksel ME, Tamer F. All pilonidal sinus surgery specimens should be histopathologically evaluated in order to rule out malignancy. J Visc Surg 2019; 156:469-470. [DOI: 10.1016/j.jviscsurg.2019.04.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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de Azevedo JM, Gaspar C, Andresen C, Barroso M, Costa H. Negative pressure wound therapy for skin graft closure in complex pilonidal disease. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2019; 28:S24-S28. [PMID: 30925251 DOI: 10.12968/bjon.2019.28.6.s24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pilonidal disease occurs in 26 in 100 000 people, affecting mainly men aged 20-30 years. It is treated by a variety of surgical techniques; however, there is a lack of consensus on the optimal choice of treatment for complex pilonidal disease. In addition, there is no consensus regarding care of the wound after surgery. Negative pressure wound therapy applied to open wounds following pilonidal disease surgery has been suggested as a way to decrease healing times and costs and is an emerging option for complex and or recurrent pilonidal disease. This study describes a case of complex pilonidal disease managed with local excision and negative pressure wound therapy followed by a split-thickness skin graft.
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Affiliation(s)
| | - Carolina Gaspar
- Plastic Surgery Resident, Department of Plastic Surgery, Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal
| | - Carolina Andresen
- Plastic Surgery Resident, Department of Plastic Surgery, Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal
| | - Maria Barroso
- Plastic Surgery Resident, Department of Plastic Surgery, Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal
| | - Horácio Costa
- Head of Department of Plastic Surgery, affiliated to Centro Hospitalar Vila Nova de Gaia/Espinho and IBIMED Aveiro University
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Michalopoulos N, Sapalidis K, Laskou S, Triantafyllou E, Raptou G, Kesisoglou I. Squamous cell carcinoma arising from chronic sacrococcygeal pilonidal disease: a case report. World J Surg Oncol 2017; 15:65. [PMID: 28302173 PMCID: PMC5356347 DOI: 10.1186/s12957-017-1129-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 03/06/2017] [Indexed: 11/10/2022] Open
Abstract
Background Sacrococcygeal pilonidal disease is a chronic, well-recognized entity, characterized by the recurrent formation of an abscess or draining sinus over the sacrococcygeal area. It is one of the most common surgical problems. Rarely, chronic inflammation and recurrent disease leads to malignant transformation, most commonly to squamous cell carcinoma (SCC). Case presentation We describe an extremely unusual case of SCC developing in a 60-year-old patient with a chronic pilonidal sinus complicated by an anal fistula. After wide surgical excision of the pilonidal sinus and fistulas and because of the poor healing process 6 months later, colonoscopy and a percutaneous fistulography were performed, revealing an anal canal-pilonidal fistula. Patient was treated with a more radical surgical resection with a prophylactic loop colostomy, but healing was not accelerated. Multiple biopsies were then taken from the surgical site at the time, which revealed the development of SCC. CT and MRI imaging techniques revealed SCC partial invasion of the coccyx and sacrum. As a result, aggressive surgical approach was decided. Histological examination revealed moderately to poorly differentiated SCC, and the patient was treated with adjuvant radiation therapy postoperatively. Nine months later, recurrence was found in the sacrum and para-aorta lymph nodes and the patient died shortly after. We discuss the clinical features, pathogenesis, treatment options, and prognosis of this rare malignant transformation. Conclusions The development of SCC in chronic pilonidal disease is a rare but serious complication. Symptoms are usually attributed to the sacrococcygeal pilonidal disease (SPD), and diagnosis is often made late by histological examination of biopsies. Malignant transformation should be suspected in chronic SPD with recurrent episodes of inflammation, repeated purulent discharge, poor healing, and chronic complex fistulas.
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Affiliation(s)
- Nick Michalopoulos
- 3rd Department of Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, St. Kyriakidi 1, 54636, Thessaloniki, Greece.
| | - Konstantinos Sapalidis
- 3rd Department of Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, St. Kyriakidi 1, 54636, Thessaloniki, Greece
| | - Styliani Laskou
- 3rd Department of Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, St. Kyriakidi 1, 54636, Thessaloniki, Greece
| | - Evangelia Triantafyllou
- 3rd Department of Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, St. Kyriakidi 1, 54636, Thessaloniki, Greece
| | - Georgia Raptou
- Pathology Department, Aristotle University of Thessaloniki, AHEPA University Hospital, St. Kyriakidi 1, 54636, Thessaloniki, Greece
| | - Isaak Kesisoglou
- 3rd Department of Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, St. Kyriakidi 1, 54636, Thessaloniki, Greece
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Parpoudi SN, Kyziridis DS, Patridas DC, Makrantonakis AN, Iosifidis P, Mantzoros IG, Tsalis KC. Is histological examination necessary when excising a pilonidal cyst? AMERICAN JOURNAL OF CASE REPORTS 2015; 16:164-8. [PMID: 25794794 PMCID: PMC4370644 DOI: 10.12659/ajcr.892843] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Patient: Male, 77 Final Diagnosis: Pilonidal cyst Symptoms: Severe pain •bleeding mass Medication: — Clinical Procedure: Local radiation therapy • neoadjuvant chemotherapy • surgical resection Specialty: Surgery
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Affiliation(s)
- Styliani N Parpoudi
- 4th Department of General Surgery, General Hospital "G. Papanikolaou", Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios S Kyziridis
- 4th Department of General Surgery, General Hospital "G. Papanikolaou", Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Ch Patridas
- 4th Department of General Surgery, General Hospital "G. Papanikolaou", Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos N Makrantonakis
- 4th Department of General Surgery, General Hospital "G. Papanikolaou", Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Pavlos Iosifidis
- 4th Department of General Surgery, General Hospital "G. Papanikolaou", Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis G Mantzoros
- 4th Department of General Surgery, General Hospital "G. Papanikolaou", Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos C Tsalis
- 4th Department of General Surgery, General Hospital "G. Papanikolaou", Aristotle University of Thessaloniki, Thessaloniki, Greece
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Brown A, Tantcheva-Poor I, Eming SA. [Parallels between wound healing, chronic inflammatory skin diseases and neoplasia: clinical aspects]. Hautarzt 2014; 65:934-43. [PMID: 25318704 DOI: 10.1007/s00105-014-3524-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Chronic wounds, scars, burns and recalcitrant chronic inflammatory skin lesions can give rise to malignancy. These neoplasias are usually squamous cell carcinomas but basal cell carcinomas can also develop. Tumorigenesis is a severe complication of chronic ulcers as well as certain inflammatory skin diseases; early diagnosis is critical for prognosis. This article describes parallels between wound healing, chronic inflammatory skin diseases and carcinogenesis and provides advice on practical aspects of diagnosis and therapy.
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Affiliation(s)
- A Brown
- Klinik und Poliklinik für Dermatologie und Venerologie, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
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Ardelt M, Dittmar Y, Schulz B, Rauchfuss F, Scheuerlein H, Settmacher U. Suture granuloma mimicking a recurrent sacro-coccygeal pilonidal sinus after Limberg flap. Int Wound J 2014; 11:583-5. [PMID: 25124966 DOI: 10.1111/iwj.12341] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 07/06/2014] [Indexed: 11/30/2022] Open
Abstract
Sacro-coccygeal pilonidal sinus disease is classified as an asymptomatic, acutely abscess-forming or chronic subcutaneous inflammation in the sacro-coccygeal region featuring characteristic pits in the bottom cleft. Due to high rates of recurrence, two flap techniques have been established in the course of the past three decades. One of them is the Karydakis operation, the other option is a rotation flap named Limberg procedure. We report about a case of suture granuloma in the area of a Limberg flap after recurrent pilonidal sinus with extrusion of the suture material, thus mimicking recurrence. In case of recurrent pilonidal sinus following plastic coverage or primary closure, respectively, the differential diagnosis of suture granuloma should be considered.
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Affiliation(s)
- Michael Ardelt
- Department of General, Visceral and Vascular Surgery, University Hospital of Jena, Jena, Germany
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