Natal Cleft Research Articles

Karydakis versus marsupialization – short-term comparative outcomes of intergluteal pilonidal disease treatment in men

Background: Intergluteal pilonidal disease (IPD) is a common chronic disease occurring in the natal cleft of the sacrococcygeal region. This disease may drastically decrease the quality of life, and lead to incapacity for work for up to several months. Various treatment methods are described in the literature, however, each of the methods has its privileges and disadvantages, and no final recommendations are available regarding a superior surgical treatment method. The present study aimed to contribute to filling the gap in the knowledge regarding the superiority of the available surgical techniques used in the treatment of IPD. Methods: The short-term outcomes of two surgical treatment options for IPD, namely the Karydakis procedure (n = 32) and the Marsupialization technique (n = 33), were retrospectively compared. The duration of complete scar formation, the rate of short-term postoperative complications, the persistence of postoperative pain and the recurrence rate during 3-month postoperative follow-up were investigated. The study was based on a retrospective analysis of data extracted from medical records of adult male patients treated for IPD. Results: The Karydakis procedure was found to be superior in terms of all the abovementioned parameters, except for the rate of short-term postoperative complications, where the two surgical techniques showed comparable results. Conclusions: The results of this retrospective study suggest that marsupialization technique could be mostly replaced by the Karydakis procedure in surgical practice. The latter appears to be associated with a faster return to daily activities and more cost effective.

Management of Pilonidal Sinus Disease with Homoeopathy: An Evidence- Based Case Report

Abstract: Pilonidal disease is an infection that occurs beneath the skin in the gluteal cleft just above the anus. It affects 7% of the population. In conventional mode of treatment there are several surgical or non-surgical treatments available but with high recurrence rate and post-surgical complications. Owing to the limited therapeutic efficacy of conventional treatment for PSD, an alternative approach is warranted. In this case, A 25years male patient attended OPD with pricking pain and oozing of foul-smelling discharge from three orifices above anus at sacral region since last 1 year. He had occasional reddish rash in sinus tract region. Based on his clinical symptoms and physical examination we diagnosed the case as Pilonoidal Sinus Disease. After thorough case taking, evaluation and analysis of the case the patient was prescribed Graphites and a marked improvement was noticed. Complain resolved within 1 and a half month and the patient was followed-up for one year with no recurrence. As this is a type of disease condition, where patient suffer due to pain and discomfort affecting his daily life leading, outcome-related to impact on daily living (ORIDL) Scale was used to evaluate the improvement. The MONARCH was used to assess the possible causal attribution.

Modern technologies in treatment of pilonidal sinus

Objective. Improvement of treatment results and reduction of the number of relapses in patients with pilonidal disease, by developing and substantiating a two-stage treatment method (with the use of laser treatment and subsequent radical surgical intervention). Materials and Methods. A prospective analysis of the treatment results of 76 patients at the clinical sites of the Rostov State Medical University was carried out. The patients were divided into three clinical observation groups: In Group I (the main group, 26 patients), two-stage treatment was carried out according to the original technique (patent № 2770283). In Group II (the first control group, 28 observations), we used the "сleft lift" procedure according to the Bascom authentic method Bascom II method modified by Karydakis). In Group III (the second control group, 22 observations), the pilonidal sinus was dissected with the traditional technique of plastic surgery of the sacrococcygeal region with "deaf" sutures along the gluteal cleft. Results. Analysis of the results showed that the postoperative period was smoother in Group I patients due to the smaller size of the surgical defect and the radical surgical stage in the absence of local inflammatory tissue reaction. There were no significant infiltrative-inflammatory complications in the patients operated on according to the original two-stage method. There were no recurrences during the one-year outpatient follow-up period. According to the VAS score, postoperative pain syndrome was significantly lower in Group I patients. The duration of hospitalization and period of disability were reduced in the patients of the main group in comparison with the same parameters in the control groups. The indicated pharmaco-economic effect in comparison with the traditional methods of surgical treatment was obtained due to early healing of the operative wounds with a smaller inflammatory reaction of the soft tissues and a reduced risk of suppurative complications. Conclusion. The developed method of two-stage surgical treatment of pilonidal sinus helps to increase the effectiveness of radical treatment, reduce the number of relapses and complications, and reduce the duration of patients' disability. The described efficacy of the technology is achieved with early healing and stable qualitative aesthetic result.

Draining Lesions in the Intergluteal Cleft

ABSTRACT Pilonidal disease typically affects the skin and subcutaneous tissue of the upper intergluteal cleft. Prompt recognition of this diagnosis is imperative to facilitate timely treatment of this disease to reduce morbidity and improve health outcomes for patients. Herein, we describe a case of a young patient with pilonidal disease and discuss the optimal management practice for this condition.

Role of Magnetic Resonance Imaging in the Screening of Closed Spinal Dysraphism.

Closed spinal dysraphism (CSD) encompasses a heterogeneous group of spinal cord deformities, which can be accompanied by several types of skin stigmata. These skin stigmata may include inconspicuous features, such as sacral dimples and deformed gluteal clefts, but the association between such mild skin stigmata and CSD is uncertain. This study aimed to reevaluate the indication for magnetic resonance imaging (MRI) in patients with skin stigmata while considering the indication for surgery. A retrospective analysis was conducted on magnetic resonance images of 1255 asymptomatic children with skin stigmata between 2003 and 2015. Skin stigmata classification was based on medical chart data. All subtypes of CSDs except for filum terminale lipomas (FTL), FTL thicker than 2 mm or with low conus medullaris, were considered to meet the surgical indication. CSD prevalence was estimated while considering the surgical indications and assessed after excluding all FTL cases. Skin stigmata were classified into seven types, dimple, deformed gluteal cleft, hair, subcutaneous mass, appendage, discoloration, and protruding bone, and included 1056 isolated and 199 complex ones. The prevalence of CSD was 19.5%, 6.8%, and 0.5% among patients with isolated dimples (n = 881) and 13.9%, 5.8%, and 0.7% among those with isolated deformed gluteal clefts (n = 136) for all cases, surgical indications, and patients without FTL, respectively. Dimples and deformed gluteal clefts had a low prevalence of CSD requiring surgical intervention, and cases without FTL were rare. Asymptomatic patients with mild skin stigmata may not require immediate MRI.

Sequential, ultrasound-guided, minimally invasive pit-picking procedure with Nd:YAG laser epilation treatment for pilonidal disease.

<b><br>Aim:</b> The aim of this retrospective study was to evaluate our treatment for pilonidal disease in adolescent patients, which uses ultrasonography, minimally invasive pit-picking, and Nd:YAG laser therapy.</br> <b><br>Material and methods:</b> We included 52 of 147 patients treated between June 2017 and December 2020. The patients underwent pit-picking procedures and 6-10 Nd:YAG treatments. The remnants of the cysts were removed by laser therapy, which provided easy epilation. Each patient underwent multiple ultrasound examinations during the therapy to uncover any potential newly formed asymptomatic sinuses. When such issues were identified, the pit-picking procedure was repeated on those sinuses.</br> <b><br>Results:</b> A total of 52 patients were included in this study with a 1-year follow-up following the procedure. There were 49 symptom-free patients (96%). One patient underwent surgery in another hospital because of a recurrence and 1 had a pilonidal disease relapse (4%). In the follow-up period, asymptomatic cysts were found in 2 other patients by ultrasound examination. They were all treated with a pit-picking procedure in the outpatient department with good results.</br> <b><br>Conclusions:</b> Combining sequentially repeated pit-picking procedures and Nd:YAG laser therapy is an effective treatment method for adolescent pilonidal disease. Simultaneous Nd:YAG laser therapy enables efficacious epilation of the intergluteal cleft. Repeatable ultrasonography examinations allow for early diagnosis of possible pilonidal sinus relapse.</br&gt.

A Single-Center Prospective Comparison of Natal Cleft Depth of 200 Patients with and without Pilonidal Sinus Disease

The etiology of primary pilonidal sinus disease (PSD) remains unclear. Current understanding suggests that sharp hair fragments from the occiput contribute to the formation of PSD. In 2009, Akinci et al. reported a correlation between PSD and a deeper natal cleft. We investigated the association between intergluteal fold (IGF) depth and PSD risk using a standardized five-step measuring protocol. Our study included 95 PSD patients and 105 non-PSD individuals, and measurements were taken from the glabella sacralis to the anus in a controlled in-house setting after obtaining informed consent from voluntary participants of a northern German population. The mean (± SD) intergluteal depth progressively increased from the intergluteal opening at the glabella sacralis at 9.1 (± 3.4) mm to a maximum of 62.6 (± 10.4) mm. Notably the deepest point was consistently observed at the anus, where PSD occurence is rare. No significant difference in intergluteal fold depth between PSD and non-PSD patients was found. Additionally, PSD predominantly developed in the proximal (cranial) third of the intergluteal fold, despite the maximum depth being in the distal region. These findings suggest that intergluteal fold depth is not a risk factor for PSD.

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

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. 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. 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. 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.

Pruritic Papules in the Perianal and Gluteal Cleft Regions.

Pruritic Papules in the Perianal and Gluteal Cleft Regions.

EFFECT OF JATYADI VARTI IN THE MANAGEMENT OF NADI VRANA W.S.R TO PILONIDAL SINUS – A CASE REPORT

Introduction (Background): Pilonidal sinus is a globally prevalent disease commonly occurring in midline gluteal cleft in young hirsute men belonging to the age group of 20 to 40 years. It is usually seen in obese people. Even though there are advanced surgical procedures that may be performed, these cause longer hospitalization, financial burden and are associated with higher recurrence and complications. Conventional Sarasota is an ideal alternative that is safe, effective and patient friendly. Main Clinical Findings: A 34-year-old female present with pain, pus discharge, induration, tenderness at the midline natal cleft area for 1 month. Diagnosis: Nadi Vrana (Pilonidal sinus). Intervention: Jatyadi Varti application after proper washed with Triphala Kwatha. Outcome and Conclusion: Marked improvement in sign and symptoms was observed along with complete healing of the track and healthy granulation tissue within a span of 2 weeks.

Evaluation of De Epithelization Technique in Management of Pilonidal Sinus Disease

Abstract Background Pilonidal sinus disease (PSD) is a common disorder of the sacrococcygeal region. The incidence is reported in 6 per 100,000 individuals, this method is defined as a flap or graft of thinned cutaneous layer. Aesthetic surgeons usually perform this method for mammoplasty. In this method, after de-epithelization of the cutaneous tissue is performed, cutaneous flap and fatty tissue are inverted to fill the dead space (1). De-epithelialized skin grafts are used for many indications. Objective To evaluate De epithelization technique as a new approach in management of pilonidal sinus disease as regard post operative complications and recurrence rate. Patients and Methods This Cohort retrospective and prospective study will include 50 cases, admitted to Ain Shams University and Agouza Police hospital from august 2019 till February 2020 who met the inclusion criteria. A total of 50 adult patients with PSD were randomly allocated intraoperatively to undergo De epithelization technique. Results According to our scale evaluating outcome, De-epithelization technique is effective and safe with least post operative complications regarding pilonidal sinus disease. Conclusion It allows a quicker return to daily activities and reduces costs. Furthermore, we believe that the risk of recurrence may be reduced by increasing the angle of the natal cleft during this technique. Also, this method has a satisfying aesthetic outcome. This preliminary report suggests that this new surgical approach seems to be a reasonable method in the treatment of PSD, especially in patients with uncomplicated primary disease, and is worth studying further.

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

ObjectiveTo 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 methodsForty 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.ResultsThe 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).ConclusionPreoperative 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 statementMRI 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.

Healing Effect of Taila Dahana after Padana in Pilonidal Sinus

Pilonidal sinus is an epithelium lined tract, situated in sacrococcygeal region, containing hairs and unhealthy granulation tissue. The treatment includes both conservative and surgical procedures. It is highly recurrent in nature, which makes this condition more difficult to treat. In Ayurveda, it can be correlated with Salyaja nadivrana and treatment are Agnikarma (cautery), Eshana (probing), Padana (incision), Taila daha (cautery with oil) and Ksharasutra. Dahana (cautery) with Swarjikadi taila which is a type of Snigdha agnikarma (unctous cautery) after incision of pilonidal sinus tract as a one time procedure was done in a 29 year old male patient with pain, swelling and pus discharge from natal cleft. Healing was assessed by parameters like pain, granulation tissue and size of wound using grading method. Pain was much lesser, granulation tissue formation was normal and healing was improved in lesser time. The present study is to evaluate the healing effect of Dahana with Svarjikadi taila in pilonidal sinus after eshana and padana (full length incision of tract).

Psoriasis seems often underdiagnosed in patient with axial spondyloarthritis

BackgroundAxial spondyloarthritis (axSpA) is known to be associated with several extra-skeletal manifestations (ESM), including the inflammatory skin disease psoriasis. It is important to recognize and diagnose psoriasis timely in axSpA in order to provide optimal treatment and outcome for both axSpA and psoriasis.MethodsIn this observational study, all patients from the Dutch Groningen Leeuwarden Axial Spondyloarthritis (GLAS) cohort included before June 2016 were sent a questionnaire with self-screening psoriasis questions including prototypical color pictures.ResultsOf the 592 questionnaires sent, 448 (75.7%) were eligible for analysis. Of these 448 respondents, 58 (13%) had a positive self-screening for psoriasis symptoms, currently or in the past. In 28 (48%) of 58 patients, psoriasis diagnosis could be verified by medical records, resulting in a psoriasis prevalence rate of 6.3%. In comparison with patients with a confirmed psoriasis diagnosis, patients reporting psoriasis symptoms without a verified diagnosis mentioned more mild than moderate-severe psoriasis symptoms (25% vs. 3%, p = 0.02), and their psoriasis lesions were less often located on the torso area (3% vs. 18%, p = 0.04), the intergluteal cleft (0% vs. 25%, p = 0.02), and legs (7% vs. 43%, p < 0.01). Of the 31 axSpA patients who reported currently active psoriasis, 74% had only mild psoriasis symptoms.ConclusionsEspecially mild psoriasis seems often underdiagnosed in patients with axSpA using a patient questionnaire with prototypical pictures of psoriasis lesions. This questionnaire could be beneficial in tracing patients with undiagnosed psoriasis in daily clinical practice. As a next step, further validation of this questionnaire is needed.

An Analysis of the Risk Factors for Postural Defects among Early School-Aged Children.

This study was conducted on a group of 141 children aged 7-10, attending the first to third grades at a primary school in Białystok (northeastern Poland). This study involved measuring the children's height and weight, assessing the children's body posture based on the FITS method (Functional Individual Scoliosis Therapy) by Białek and M'hango (the authors of this study), and administering a diagnostic survey addressed to parents and guardians of the children (n = 104) using a self-designed questionnaire. Almost all defects were more prevalent in boys, especially in the case of stature triangles (p = 0.0489) and knee alignment in the sagittal plane (p = 0.038). The age of the subjects differentiated the incidence of defects in the scapulae (p = 0.0037) and shoulder (p = 0.0129) alignment, correlating negatively with age. The risk of postural defects for knees (p = 0.0391) and abdominal arching (p = 0.0240) was significant with a higher BMI. The following lifestyle-related factors were significant: the seat for doing homework (stature triangles p = 0.0253), time spent in front of a computer (positioning of the scapulae in relation to each other p = 0.0233; vertical view of the intergluteal cleft p = 0.0324), and snacking between meals (feet p = 0.0003; shoulder positioning p = 0.0013; stature triangles p = 0.0186; positioning of the scapulae in relation to each other p = 0.0404). The body posture of the examined children was closed with the head pushed forward and drooped, rounded shoulders, hyperlordosis, and pelvic anteversion. Most exhibited various types of abnormalities related to the feet. The recognized risk factors for posture defects are overweight/obesity, the male gender, children who are older, lack of an adjustable work chair, 2 h a day or more spent using the computer, and snacking between meals.

P12 A flare of dermatitis herpetiformis precipitated by etanercept

Abstract We report the case of a 79-year-old man who presented with an acute, intensely pruritic, widespread rash, which, on examination, consisted of symmetrical, haemorrhagic nodules and vesicles with some desquamation affecting the extensor surfaces of the arms, flexor surfaces of the legs and the natal cleft. He had a history of coeliac disease (for which he had adhered to a strict gluten-free diet since 1997) and rheumatoid arthritis. He had his first dose of the anti-tumour necrosis factor (TNF) agent etanercept prior to this episode to manage his arthritis. A punch biopsy for histopathology showed subepidermal blisters with a predominance of neutrophils. Eosinophils were also present to the level of the eccrine coils within the dermis, with eosinophilic flame figures but no eosinophil spongiosis at the edges of the blister. Direct immunofluorescence showed granular IgM and IgA in the dermal papillae, and a similar reaction was seen with fibrinogen. These histological findings were strongly suggestive of dermatitis herpetiformis (DH). Owing to diagnostic uncertainty on presentation, initial treatment was with high-dose topical steroids and emollient. and a yellow card was completed. Since this presentation, he has had no further flares and has not required dapsone. Multidisciplinary team discussion decided that the patient should avoid other anti-TNF treatments, but he has found relief for multiple months with rituximab and has had no cutaneous adverse events on this agent. The aetiology of DH following anti-TNF treatment is not immediately clear. Increased immunogenicity and cytokine release have been hypothesized to be part of the pathology of many adverse reactions to anti-TNF agents. It is conceivable that the cytokine release ordinarily seen in DH is replicated by the administration of anti-TNF agents. There have been many cases of anti-TNF agents leading to worsening eczema and psoriasis. Interestingly, these conditions have been found to upregulate TNF-α, a feature that is also seen in DH. This appears to be the first case described in the literature of etanercept-induced DH. A reaction with infliximab was reported in 2008, with a similar rash and histology consistent with DH, but it differed as the patient had no prior diagnosis of coeliac disease and presented after their second dose (Marakli SS, Uzun S, Ozbek S, Tuncer I. Dermatitis herpetiformis in a patient receiving infliximab for ankylosing spondylitis. Eur J Dermatol 2008; 18:88–9).

P06 Porokeratosis ptychotropica: a rare and recalcitrant genitogluteal eruption

Abstract A 45-year-old man with a history of psoriasis presented to our male genital dermatology clinic with a several-year history of pruritic, painful, hyperkeratotic red–brown plaques on both buttocks. He had previously been treated unsuccessfully with cryotherapy and topical imiquimod and podophyllotoxin for suspected condyloma acuminata. A 4-mm punch biopsy from the left buttock showed hyperkeratosis, hypergranulosis, papillomatosis and multiple columns of parakeratin with underlying agranulosis and dyskeratosis, consistent with cornoid lamella formation. A diagnosis of porokeratosis ptychotropica was made. He was treated with Dovobet® ointment and Trimovate® cream, with little improvement. He underwent four cycles of topical photodynamic therapy to his right buttock and two cycles to his left buttock, with minimal improvement. Oral isotretinoin was also trialled, but this led to lipid derangement prior to any observed benefit, so it was stopped. Porokeratosis ptychotropica is a rare and under-recognized variant of porokeratosis, characterized by epidermal keratinization that manifests as keratotic papules in the genitogluteal region. It is often misdiagnosed as psoriasis, tinea cruris or condyloma acuminata, as in our case. Typically, multiple cornoid lamellae are seen on histology (Lucker GP, Happle R, Steijlen PM. An unusual case of porokeratosis involving the natal cleft: porokeratosis ptychotropica? Br J Dermatol 1995; 132:150–1). The aetiology of porokeratosis ptychotropica is unknown, but there is potential for malignant transformation (Mazori DR, Shvartsbeyn M, Meehan SA et al. Transformation of porokeratosis ptychotropica into invasive squamous cell carcinoma. Int J Dermatol 2017; 56:679–80). It is commonly recalcitrant to treatment, with varying reports of success with topical retinoids, keratolytics, tacrolimus, calcipotriol, topical 5-fluorouracil, imiquimod, systemic retinoids, psoralen ultraviolet A, intralesional bleomycin, cryotherapy, photodynamic therapy, excision, dermabrasion and CO2 laser.

Long-term results for pit-picking and flap procedures in primary pilonidal sinus disease

BackgroundPilonidal sinus disease (PSD), a common inflammatory condition of the natal cleft causing morbidity especially in young adults, is a heterogeneous disease group with no consensus regarding its best treatment. Our aim was to report long-term results for primary PSD surgery.MethodsWe retrospectively studied the medical records of 146 patients who underwent primary PSD surgery between November 2010 and October 2015. Of these, 113 underwent either the mini-invasive pit-picking surgery (PSS) (n = 55) or asymmetrical excision with local flap (AELF) (n = 58); we focused on the outcomes of these two subgroups.ResultsPSD patients who underwent mini-invasive PPS more often succeeded with day surgery (94.5% vs 32.8%, p < 0.001), had fewer postoperative complications (9.4% vs 36.2%, p = 0.002), and had shorter sick leave (median 14 days vs 21 days, p < 0.001) than did AELF patients. Nevertheless, at the first postoperative follow-up visit, both surgery methods healed similarly (75.0% vs 76.8%, p = 0.83). Our long-term follow-up, at a median of 9.3 years (range 5.4–10.6), revealed, however, that recurrence after PPS was markedly higher than after AELF (50.9% vs 10.3%, HR 6.65, p < 0.001).ConclusionsPPS, which is a mini-invasive surgical technique often performed under local anaesthesia, is suitable for primary PSD, despite the high recurrence rate in our study, bearing in mind that patient selection is an important factor to consider. Primary PSD with simple sinus formations may benefit from PPS. On the other hand, primary PSD with complex sinus formations may benefit from AELF regardless of the initial slow recovery in our study. Because PSD is a very heterogenous disease, and patients have different risk factors, it is mandatory for the surgeon to master several different surgical techniques. A classification system to aid the surgeon in selecting the right surgical technique for each patient is warranted.

Comparison of Limberg Flep and Adipofacial Flep in the Surgical Treatment of Pilonidal Sinus: A Prospective Randomized Clinical Study

Objective: Pilonidal Sinus Disease (PSD) encompasses inflammation localized to the intergluteal cleft, ranging from minor cyst to extensive sinus formation. The most important parameters in the treatment of the disease are early return to work, low recurrence rate, low postoperative pain, high comfort, low complication rate and low cost. In the surgical treatment of pilonidal sinus disease, there are methods such as flap methods, primary closure and unroofing and curettage. Methods: This study was planned as a prospective randomized clinical trial. Patients were operated with the diagnosis of chronic pilonidal sinus in the surgical clinic of our hospital between 2006-2008. A total of 104 chronic pilonidal sinus patients were randomized into two groups. The first group included 49 patients whom underwent Limberg flap procedure. The second group included 55 patients whom underwent adipofascial flap procedure. The two groups were compared in terms of demographic characteristics, duration of surgery, early and late complications, recurrence and follow-up time. Results: The duration of the complaint ranged from one month to four years (mean 24.5 months). While a single sinus orifice was detected in the midline in 45 cases (43.3%), two or more sinus orifices were detected in the midline in 59 cases (49.7%). The operation time was shorter in Group 2 than in Group 1. The difference was statistically significant. wound dehiscence was significantly less common in Group 2. In terms of recurrence and aesthetic satisfaction, aesthetic satisfaction was significantly higher in Group 2. Conclusion: Our study showed that adipofascial flap, which can be easily applied in the surgical treatment of pilonidal sinus disease and has no difference from other flap methods, is a method that can be safely applied in the treatment of this disease.

Ayurvedic Management of Ek-Kushtha (Psoriasis): Review Article

Ek- Kustha is a kind of Kshudra Kushtha that resembles psoriasis in its clinical presentations and is primarily caused by an imbalance of the Vata and Kapha doshas. It bears a greater resemblance with Psoriasis, which is a long-lasting autoimmune and chronic inflammatory skin disorder clinically characterized by erythematous, sharply demarcated papules and rounded plaques, covered by silvery micaceous scale predominantly affecting the skin of elbows, knees, gluteal cleft, and scalp. Some people may have severe Psoriasis is involving their entire body. The quality of life of patient with Psoriasis is often diminished because of the appearance of skin. The mainstays of psoriasis treatment include immune system suppressing drugs like methotrexate, PUVA, vitamin D3 lotion, and steroid creams. Some contemporary therapeutic methods do have serious drawbacks, particularly when used for an extended period of time. These modern treatment modalities are not devoid from grave complications mainly in long term use. Owing to these reasons, there is a need for treatment having good efficacy and no toxicity profile. So this case study was conducted considering Psoriasis as Ek-kuhstha and Ayurvedic management was planned accordingly. Drastic results were witnessed by Shodhana (Vasantik Vaman &amp; Shardik Virechana) and Shamana (Some internal herbo-mineral preparations, External oil application).