Ultrasonography accurately evaluates the dimension and shape of the pilonidal sinus

Simplified and modified Limberg flap plus vacuum-assisted closure for treatment of sacrococcygeal pilonidal sinus disease

BACKGROUND

Pilonidal sinus disease (PSD), a chronic inflammatory disease, affects the sacrococcygeal soft tissue, especially in young adults. The ideal treatment for PSD remains divergence. This study evaluated the application of a simplified modified Limberg flap combined with vacuum-assisted closure for treating PSD.

METHODS

This prospective study was conducted from 1 June 2017 to 31 March 2022 in Changhai Hospital, Naval Military Medical University, Shanghai, China. The study included 88 male patients (91.7%) and 8 female patients (8.3%). The 96 patients ranged in age from 15 to 34 years (mean ± SD, 23 ± 4.4). Under general anaesthesia, all patients underwent simplified modified Limberg flap reconstruction with vacuum-assisted closure. The patient's weight, surgical time, extubation time, hospital stay, time to return to normal life or work, wound infection, wound dehiscence and recurrence rate were recorded. The visual analogue scale (VAS) score and the Vancouver scar score were used to score patients' pain and scars in the surgical area.

RESULTS

The volume of resected diseased tissue was 13.5-120 (mean ± SD, 34.993 ± 24.406) cm2 . The average surgical time during the treatment period was 97.68 ± 18.72 min, and the average extubation time was (6.36 ± 1.55) days, the mean hospital stay was 19.4 days; no patients were lost to follow-up. None of the patients experienced post-operative recurrence, wound infection, seroma or hematoma. Six patients (6.3%) experienced wound dehiscence at the flap tip around the natal cleft. The mean time to the resumption of daily activities was 26.3 days. The average VAS pain score was (6.00 ± 1.53) points, and the average Vancouver scar score was (5.96 ± 1.51) points, 12 patients (12.5%) were dissatisfied with their aesthetic results, and the average beauty satisfaction score is (6.64 ± 1.28) points.

CONCLUSIONS

Simplified modified Limberg flap reconstruction with vacuum-assisted closure surgery is an effective and innovative method for the treatment of PSD, with a low recurrence rate and rapid recovery.

Magnetic resonance imaging of pilonidal sinus disease: interobserver agreement and practical MRI reporting tips

OBJECTIVE

To evaluate the interobserver agreement for the features of natal cleft pilonidal sinus disease (PSD) on magnetic resonance imaging (MRI) and propose a standardized checklist for reporting PSD on MRI.

MATERIALS AND METHODS

Forty MRI studies of 39 discrete patients with PSD were retrospectively evaluated by five independent radiologists using a standardized checklist. Fleiss' Kappa (k) coefficients of agreement were used to test the agreement between categorical variables. The MRI features of the natal cleft sepsis associated with PSD were classified into four main categories: morphology, branching and extensions, external skin openings, and the relationship of the PSD to the coccyx. A survey was created and disseminated online among general surgeons who treat patients with PSD to assess the relevance of the MRI features proposed in the standardized checklist.

RESULTS

The overall agreement regarding the identification of morphology of the natal cleft sepsis was moderate (k = 0.59). Lateral and caudal extensions interobserver agreement was substantial (k = 0.64 and 0.71, respectively). However, the overall agreement regarding the individual parts of anal sphincter involved was moderate (k = 0.47). Substantial interobserver agreement was found in assessing the proximity of the PSD to the coccyx (k = 0.62).

CONCLUSION

Preoperative MRI can delineate the extensions and branching of PSD with substantial agreement. MRI is superior in describing the deep extensions of PSD with better reliability than assessing the number and locations of the external openings. Expert consensus agreement is needed to establish the MRI features necessary for optimal reporting of PSD.

CLINICAL RELEVANCE STATEMENT

MRI can offer valuable information about the extent of sepsis associated with pilonidal sinus disease, particularly in cases with involvement of critical anatomical structures such as the coccyx and anal triangle. MRI can potentially contribute to more accurate patient stratification and surgical planning.

KEY POINTS

• The interobserver agreement for assessing PSD's lateral and caudal extension on MRI is substantial. • MRI can describe deep extensions and branching of PSD with superior reliability than assessing the number and site of external openings. • Reporting the relationship between natal cleft sepsis in PSD and the anal region may influence the surgical approach and postoperative healing.

Extra-Gynecological Pelvic Pathology: A Challenge in the Differential Diagnosis of the Female Pelvis

Ultrasound technology with or without color Doppler allows a real-time evaluation of the entire female pelvis including gynecologic and non-gynecological organs, as well as their pathology. As ultrasound is an accurate tool for gynecological diagnosis and is less invasive and less expensive than other techniques, it should be the first imaging modality used in the evaluation of the female pelvis. We present a miscellany of non-gynecological pelvic images observed during the realization of gynecological ultrasound. Transvaginal and transabdominal ultrasound is the first choice among diagnostic techniques for the study of the female pelvis, providing information about gynecological and extra-gynecological organs, allowing for an orientation toward the pathology of a specific organ or system as well as for additional tests to be performed that are necessary for definitive diagnosis.

Radiological, Clinical, and Histological Findings in the Treatment of Pilonidal Sinus with Phenol Injection

Objective:

Sacrococcygeal pilonidal disease is a chronic discharging wound that causes pain and loss of quality of life. Phenol application is an outpatient procedure with low complications and low recurrence rates. We evaluated the radiological, histological, and clinical results of phenol application.

Methods:

A total of 44 consecutive patients with sacrococcygeal pilonidal disease underwent phenol application in Kocaeli University Faculty of Medicine, General Surgery Clinic between December 2015 and March 2017. Demographics, complaints, symptom duration, and the number of sinuses were recorded. Patients were examined using ultrasonography (USG) before surgery and two months after surgery. Four patients who wanted rhomboid excision and Limberg flap procedure underwent preoperative local phenol application and were excluded from the study. The excised tissues were used for pathological evaluation.

Results:

Purulent discharge was the leading symptom. All of the patients had hair in the preoperative USG evaluation, whereas five patients had still hairs in the sinuses in the postoperative USG examination. Four of these cases had recurrences on a 2-month follow-up. After phenol application, a 10% volume decrease was observed. Pathological examination was performed in four cases with phenol application, and in pathological material, the sinuses looked sclerotic and fibrotic.

Conclusions:

Our study revealed that a single phenol application achieved 90% success. However, no significant difference was observed in the cavity volume after phenol injection.

The Role of Point-of-Care Ultrasound in Pilonidal Sinus Disease

Pilonidal sinus is a common problem encountered in proctology clinics. It has a wide spectrum of clinical picture ranging from a single asymptomatic pit to a more complex disease with multiple sinuses and secondary openings. Hence, the treatment options could range from observation or simple excision to a more radical approach like flap surgeries. Ultrasonographic assessment could help in mapping the extent of the pilonidal sinus. It can also identify whether the sinus is infected or has formed an abscess. With the above-mentioned information provided by the point of care ultrasound, the surgeon can tailor the surgical approach to each individual case and improve the overall outcome. In this article, we are highlighting some examples of cases managed in our proctology unit where ultrasound was done preoperatively and guided the management.

Management of sacrococcygeal pilonidal sinus disease in children: A survey study in Turkey

Objective: Sacrococcygeal pilonidal sinus disease is common in children. The disease reduces the quality of life of patients with symptoms such as pain and chronic discharge. Variable surgical techniques have been described for the treatment of pilonidal sinus disease. This study aims to evaluate clinical approach of Turkish pediatric surgeons to children with pilonidal sinus disease.

Material and Methods: Survey questions were prepared through a literature review for controversial issues. The participants were asked pre-selected and checkbox questions. The survey was sent to 450 pediatric surgeons, members of the Association of Turkey Pediatric Surgery via a link to Google Forms.

Results: Nineteen percent (88) of the members responded. Seventy five (85.2%) of the pediatric surgeons stated that they did not perform additional preoperative imaging. Surgical excision methods were preferred more than minimally invasive procedures (102 to 46). Sixty (68.2%) of the participants preferred preoperative prophylactic single dose intravenous antibiotics and postoperative oral antibiotics. Regarding the participants’ practices, poor local hygiene, overweight, wide or deep sinus pit were stated as the most common causes of recurrence. Vast majority of the pediatric surgeons recommended laser epilation (%85.2) and slimming (59.1%) to patients.

Conclusion: Various studies have been published from Turkey for pilonidal sinus disease. As seen in the current study, Turkish pediatric surgeons do not have a common opinion in pilonidal sinus disease and prefer surgical excision methods more frequently. Prospective randomized studies with bigger number of patients are required to establish common guidelines in disease management.

US Guided Si.La.D. A new technique for minimally invasive pilonidal disease treatment, using ultrasound guided laser ablation

Background: The destruction of the pilonidal sinus with a radial laser probe has been suggested as a safe procedure with good results and low morbidity. Nevertheless, the drawbacks of this technique are: a blind technique, if the sinus has some ramifications or a non-linear development, we cannot be sure for their destruction.Methods: 17 patients (12 men, 5 women) were operated with US guided laser destruction - US guided Si.La.D. Laser destruction of the pathological tissue (cavity, sinus) was performed using a 400 μ radial optical fiber, connected and locked to a radiopaque biopsy needle 14 G, using a 12 MHz linear probe, to introduce and real-time echo guide the fiber in order to achieve laser ablation with 120-140 J /cm of pathological tissueResults: No significant complications were recorded.Conclusion: Real-time echo guided laser ablation of pilonidal sinus and cavities proved to be safe and efficient, providing controlled emission of laser energy only to the pathological tissue, increasing the accuracy of identify the right track to deliver energy, decreasing the risk of traumatic progression of surgical instrument into healthy subcutaneous tissue, accidental progression of the disease and missing in the same time tracts that need to be ablate.

Skin Ultrasound as a Diagnostic Approach for Non-melanocytic Benign Skin Tumors

Background. The diagnostic imaging techniques in dermatology, such as skin ultrasound, could improve the diagnosis of non-melanocytic benign tumor lesions, especially those of intradermal and subcutaneous nature. Objective. The general objective of this study was to evaluate the validity and diagnostic safety of high-frequency ultrasound as a diagnostic test for non-melanocytic benign skin tumor detection. The specific objectives were to measure the sensitivity and specificity of ultrasound as a measure of the validity relative to the gold-standard test – diagnostic-therapeutic biopsy. Methods. This study was carried out between January 2017 and June 2019. The patients (n = 641) included in this study comprised of 318 women and 323 men who were between 48 and 74 years. All of them underwent an ultrasound examination of the skin tumor in the dermatology clinic, the removal of the non-melanocytic tumor, and a final histopathological examination. Results. The skin ultrasound has a sensitivity and specificity of 93% and 88%, respectively. Furthermore, the positive and negative predictive values of using skin ultrasound are 84% and 94%, respectively. Conclusion. Skin ultrasound is a diagnostic technique with high sensitivity and specificity in the diagnosis of non-melanocytic skin tumors.

Topical polyphenol treatment of sacrococcygeal pilonidal sinus disease: use of ultrasonography to evaluate response to treatment - clinical case series study

Introduction

Sacrococcygeal pilonidal sinus disease (SPSD) is a common disorder and encountered more frequently in hairy young males after puberty.

Aim

To assess effectiveness of topical polyphenol treatment of SPSD by using physical examination and ultrasonography (USG).

Material and methods

Fourteen patients with SPSD diagnosis were treated by natural polyphenol products and were retrospectively included in this study. All of the patients were assessed by superficial ultrasonography before and after treatment. Demographic and clinical information of the patients was obtained from medical records.

Results

Patients were aged 18–45 years and the median disease duration was 2 years. The most common findings in physical examination were sinus openings and subcutaneous nodules and the most common ultrasonographic findings were abscess/cyst formation and presence of fistula at the pre-treatment visit. All of the patients applied topical polyphenols for a median period of 3 months. Topical polyphenol treatment was effective in 92.9% of patients. Follow-up examinations at 18.3 months post-treatment revealed that 12 (85.7%) patients were free of disease. Control physical examination and ultrasonographic assessment were completely normal in 11 (78.6%) patients.

Conclusions

Topical polyphenol therapy is a promising alternative treatment for SPSD and its effectiveness can be objectively evaluated by ultrasonography. It is advised that topical polyphenols should be tried first in every young and active patient with SPSD. Majority of these patients can avoid demanding and expensive alternative treatment methods such as complex surgical procedures. This topical therapy method makes surgical SPSD a dermatologically treatable disease.

Effects of methylene-blue staining on the extent of pilonidal sinus excision

OBJECTIVE

We aimed to examine the effects of methylene-blue staining (MBS) on the volume of specimens after excision of pilonidal sinuses.

METHOD

This was a retrospective analysis of 135 excised specimens after pilonidal sinus (PS) surgery. All patients underwent procedures at the Department of Surgery of University Hospital Jena between 2000 and 2010. All specimens were measured in three dimensions. To calculate the volumes of excised specimens, we used a model of a hemi-ellipsoid. Demographic information (age, height, weight, body mass index, smoking status) were also obtained for all patients.

RESULTS

Excised specimens with MBS had significantly larger volumes (p<0.001) as reflected in length (p=0.001), width (p=0.001), and depth (p=0.017) of the excised specimen compared with specimens that were not stained with methylene blue (MB). In addition, the volume was larger in subjects with a recurrent PS (p=0.021), which was predominantly the case in female subjects (p=0.025).

CONCLUSION

These data suggest that excised specimens with MBS had significantly larger volumes of the excised specimen compared with specimens that were not stained with MB. MBS of a fistula system could enable such a system to be marked sufficiently, thereby facilitating complete resection of a PS.

The value of superficial parts and endoanal ultrasonography in evaluating pilonidal disease and exclusion of perianal sepsis

INTRODUCTION

Pilonidal disease is a benign anorectal inflammatory disease that involves the subcutaneous adipose tissue overlying the sacrococcygeal region.

THE AIM OF THE WORK

The current study aimed to assess the value of preoperative evaluation of pilonidal disease and the exclusion of perianal sepsis using superficial parts ultrasonography and endoanal ultrasound.

METHODOLOGY

Referred 30 patients were clinically diagnosed as pilonidal disease, all were examined with superficial parts ultrasonography and if the disease was extending to the perianal region further endoanal US was performed to exclude perianal sepsis.

RESULTS

7 patients showed subcutaneous abscesses and 23 patients showed pilonidal sinus tracts. Among patients with pilonidal sinus tracts, six tracts (26 %) seen as superficially situated, short narrow tracts with straight course, no side branches and with a blind end situated away from the anal canal wall. 2 (9 %) tracts showed vertical orientation and three tracts (13 %) were wide and deeply situated reaching the presacral fascia. 7 cases (30 %) showed branching pilonidal sinus tracts, two cases of them showed more than one external opening. 5 patients (22 %) showed abnormally long tracts seen reaching the perianal region.

CONCLUSION

Ultrasonography is an available, inexpensive, safe imaging modality that yields a high degree of accuracy in evaluating pilonidal disease and in exclusion of perianal sepsis.

High-resolution ultrasound imaging of cutaneous lesions

High-resolution variable frequency ultrasound imaging is increasingly being used in the noninvasive evaluation of various cutaneous diseases. It plays a complimentary role to physical examination in the assessment of cutaneous lesions. It is the only imaging modality useful in the evaluation of superficial cutaneous lesions that are too small to be evaluated on computed tomography (CT) or magnetic resonance imaging (MRI) and is helpful in reducing invasive procedures like biopsies and fine needle aspirations. In this article, we seek to describe the relevance and basic principles of cutaneous ultrasound, imaging findings of normal skin, current applications of high-resolution ultrasound in the diagnosis and management of various dermatological conditions, along with the features of some commonly encountered lesions.

Common applications of dermatologic sonography

In recent years, there has been growing use of sonography in the dermatologic field. Thus, this review analyzes the most common dermatologic applications of sonography with some technical considerations for performing this type of examination. Moreover, the sonographic findings in common benign and malignant skin tumors, inflammatory dermatologic diseases, and ungual and cosmetic conditions, among others, are considered. Thus, this noninvasive technique may be a potent adjunctive tool in the diagnosis and management of dermatologic conditions in daily practice, delivering critical information otherwise unavailable to the clinical naked eye.