Intergluteal Sulcus Research Articles

Kite excision in complicated pilonidal sinuses: A retrospective cohort study of a tissue-sparing technique

Background/Aim: Pilonidal sinus (PS) is a benign chronic condition that primarily affects young people and can have a significant impact on their social life and work. Treatment options range from minimally invasive methods to surgical interventions involving wide excision. This study evaluates the outcomes of Kite excision, which aims to preserve healthy tissues, in cases of complicated PS extending along the natal cleft line. Methods: This retrospective cohort study included cases of complicated PS extending along the intergluteal sulcus. Patients with minimally extended PS, sinus openings extending laterally, or patients in whom the defect area was closed using other methods (e.g., rotation flap or Limberg flap) were excluded. Patient data were obtained from medical records and the hospital information system: patient age, gender, body mass index (BMI), length of hospital stay, duration of drainage, follow-up period, presence of flap necrosis or flap edema, wound dehiscence, and presence of seroma, hematoma, or surgical-site infections. Results: A total of 41 patients were included in the study; five (12%) were female. Twenty-three patients (56%) had recurrent PS; 18 patients (44%) underwent surgery for the first time. The mean age of the cohort was 28.5 years (standard deviation: 5.1 years). The mean BMI of the group was 30.2 kg/m2 (standard deviation: 2.9 kg/m2), and the mean hospital stay was 1.3 days (standard deviation: 0.6 days). Wound dehiscence was observed in two patients (4.9%), and hematoma beneath the flap was observed in one patient (2.4%). Seroma was detected in one patient (2.4%). A surgical-site infection was identified in two patients (4.9%). The overall postoperative complication rate was 14.6%, and recurrence was observed in one patient (2.4%). Conclusion: Kite excision performed along the natal cleft line in cases of complicated PS is a safe, effective, and minimally invasive procedure that preserves healthy tissues. It is a recommended surgical treatment option in cases of complicated PS with vertical extension, and it will reduce the incidence of recurrence and increase patient comfort.

The role of collagen type I/III ratio in the etiology of sacrococcygeal pilonidal.

The purpose of this study is to investigate whether there was a difference between the midline skin and the healthy skin in the lateral by means of total amount of collagen and Type I/III ratio which was the indicator of the collagen structure. Fifty patients with pilonidal sinus disease were enrolled. Samples were prepared from the midline skin of the sinus where the holes were located and lateral skin of the resected material. It was determined that the lateral line had significantly more collagen intensity and a higher collagen Type I/III ratio (p < 0.001). One of the reasons why hair mostly pricks into the midline in the intergluteal sulcus in pilonidal sinus disease is the fact that the amount of total collagen and collagen Type I/III ratio of the midline are lower than those of the lateral tissue. Complications are more common in cases with low Type I/III ratio and low total collagen rates.

Comparison of excision and primary closure vs. crystallized phenol treatment in pilonidal sinus disease: A comparative retrospective study

Background/Aim: Pilonidal sinus is an inflammatory condition that affects the intergluteal sulcus. Since there is no standard treatment for pilonidal sinus, comparative studies are needed. Our study aimed to comparatively evaluate the treatment success, postoperative complications and recurrence in excision/primary repair surgery and crystallized phenol application in pilonidal sinus disease. Methods: A total of 376 pilonidal sinus patients over the age of 18 years who visited our general surgery clinic between January 2017-January 2020 were included in this retrospective cohort study. They were divided into two groups based on whether they underwent phenol treatment or surgery. The patients' age, body mass index (BMI), gender, number of pits, length of stay in the hospital, return to normal life, mean follow-up times, complications, and satisfaction data were recorded. At the end of the follow-up period, all patients were contacted by telephone and the recurrence rates were noted. Results: Both groups were similar in terms of age, gender, and BMI (P>0.05 for all). The mean age of 374 patients included in the study was 23.38 (4.9) years. The mean follow-up time was 25.47 months. Patients in the crystallized phenol group did not require hospitalization. In the primary repair group, the median length of hospital stay was 1.15 days. Complications such as wound infection, hematoma, and wound dehiscence were significantly less in the phenol group. The recurrence rates in the phenol and primary repair groups were 8% and 10%, respectively (P=0.326). Return to normal life was significantly faster in the phenol group. The success rate in the phenol group was 92%. Conclusion: Although the recurrence rates are similar, crystallized phenol therapy is superior to primary repair due to better wound healing rates, ease of application, and fewer complication rates. More than one application is recommended in phenol treatment.

Crystallized phenol treatment vs excision and primary closure in pilonidal sinus disease: A randomized clinical trial in adolescent patients

IntroductionPilonidal sinus is a chronic inflammatory disease seen in the intergluteal sulcus. A wide variety of treatment modalities have been described for the management of this disease, however optimal therapy remains controversial. The study aims to compare phenol treatment, a minimally invasive method used in the treatment of pilonidal sinus disease, with the commonly practiced surgical methods of excision and primary closure in the adolescent age group. Patients and MethodsAdolescent patients who presented with pilonidal sinus disease between January 2018 and December 2018 were randomized into 2 groups as phenol treatment and surgical treatment (after obtaining consent for the study). Early complications and recurrence rates after 24 months of follow-up were the two main endpoints of the study. ResultsA total of 100 patients (phenol group n = 50, surgery group n = 50) were included in the study. Both groups were similar in terms of age, gender, and BMI. The mean duration of the procedure was 12.4 ± 2.84 min in the phenol group and 42.3 ± 7.22 min in the surgery group (p = 0.00). There was no difference in postoperative complications between the groups (p = 0.22). After 24 months of follow-up, recurrence was found in 8% (n = 4) of the cases in the phenol group and 10% (n = 5) of the cases in the surgery group (p = 0.5). ConclusionIn our study, phenol treatment and excision/primary closure methods for pilonidal sinus disease have similar complication and recurrence rates. However, phenol treatment seems to be the method of choice in the adolescent age group as it has the advantage of being a minimally invasive method and it does not affect subsequent surgical treatments.Level of evidence: Level II treatment study

Dyspareunia Secondary to a Clitoral Pilonidal Sinus: A Case Report and Literature Review

Dyspareunia is a general term used to describe painful sexual intercourse. It can occur due to a variety of reasons ranging from structural problems to psychological concerns. Dyspareunia frequently occurs due to pelvic inflammatory disease, endometriosis, absence of lubrication and previous trauma. Additionally, eczema, hidradenitis or other skin diseases of the vulva may cause pain with intercourse. Pilonidal sinus is a common skin disease presenting with hair-nests and sinus tracts occurring in deep skin folds such as the inter-gluteal sulcus. A 30-year-old dark haired Asian housewife, gravid 1 para 1 was seen at the general surgery outpatient clinic with complaints of foul smelling thick umbilical discharge and dyspareunia. Dyspareunia due to clitoral pilonidal sinus can successfully be cured with early diagnosis, appropriate antibiotics and wide surgical excision of the lesion. Delay in diagnosis and treatment is associated with development of complications such as abscess formation, prolongs time to definitive treatment and affects the prognosis of the disease. In cases of swelling at the mons pubis, vulvar pain and unexplained dyspareunia observed in menstrual aged women, clitoral pilonidal sinus should be kept in mind as a potential cause. Herein, we present a young woman with dyspareunia secondary to clitoral pilonidal sinus.

Complete natal cleft removal with kite incision in the treatment of extensive sacrococcygeal pilonidal sinus.

Pilonidal sinus (PS) is a benign disease for which different treatment modalities are used, varying from non-surgical treatments to surgical treatments with flap use for big defects. High recurrence is the main problem in complicated cases. We presented complete natal cleft excision with kite incision and fasciocutaneous flap (CNCEF with kite incision) in extensive sacrococcygeal PS. Seventy-six patients who underwent CNCEF with kite incision because of extensive PS extending through intergluteal sulcus to the anus, with multiple sinus tracts and recurrent PS were retrospectively analysed. A special incision involving natal cleft and all sinus tracts completely and fasciocutaneous flap, lateralizing median line, was used in all cases. Post-operative complications and recurrence was recorded. Sixteen (21.1%) patients were operated because of recurrence. The mean age and body mass index were 33.04 ± 6.78 and 29.86 ± 5.46, respectively. The mean hospital stay period and mean operation time was 2.95 ± 0.76 days and 64.33 ± 8.64 min, respectively. The mean drain removal time was 2.78 ± 0.7 days and mean follow-up was 13.46 ± 4.31 months. There were flap oedema and seroma in one (1.3%) and four (5.3%) of the patients, respectively. Surgical site infection necessitating antibiotic treatment developed in three (3.9%) patients. The overall post-operative complication rate was 10.5% and there was recurrence in one patient on follow-up period (1.3%). CNCEF with kite incision method, which shifts midline, is a safe and reliable method with acceptable post-operative complication and recurrence rates in extensive sacrococcygeal PS patients.

Safe Gluteal Fat Graft Avoiding a Vascular or Nervous Injury: An Anatomical Study in Cadavers.

Fat grafting for gluteal augmentation is one of the most popular aesthetic surgery procedures. It has an associated mortality to fat embolism of 0.2%. The authors of this study sought to describe which technique for synthetic graft application was least likely to cause a fat embolism. Ten fresh bodies were obtained and 4 groups arranged with 5 buttocks each randomly assigned. Group 1 was infiltrated through the upper medial intergluteal sulcus (upper medial intergluteal sulcus) with an angulation of -30°, -10°, and 0°. Group 2 was infiltrated through the middle lower gluteal sulcus with an angulation of -30°, 0°, and +15°. Group 3 was infiltrated through a peritrochanteric (PT) access at the level of the femur head at 0° and +10° and in the middle of the buttock at the level of the posterior superior iliac crest at -30° toward the trochanter (lateral direction). Group 4 was infiltrated in the same manner as group 1 without -30°. A complication occurred when the graft was in contact with the vascular or nervous bundle, within the gluteus medius muscle, or both. Group 1 had 3 buttocks with a complication (UMIGS -30°). Group 2 had complications in all the injection techniques. Group 3 had 5 buttocks with a complication (PT at 0°). Group 4 had no complications. The injection of the fat graft through the UMIGS at 0° and 10° angles, and through the middle of the buttock at the level of posterior superior iliac crest a -30° angle, reaches the surface needed for gluteal augmentation. The group 2 techniques should be avoided because they have a high risk of complication.

Evaluation of intradermal absorbable and mattress sutures to close pilonidal sinus wounds with Limberg flap: a prospective randomized comparative study.

PurposeWe aimed to compare skin closure techniques, standard (intermittent mattress) and continuous subcuticular sutures, following Limberg flap procedure.MethodsFrom July 2013 to July 2015, 92 patients with sacrococcygeal pilonidal disease were prospectively randomized into 2 groups consisting of 46 patients for both. Patients underwent sinus excision and closure with Limberg flap; continuous subcuticular suture was used in subcuticular group (SG) and intermittent mattress sutures were used in mattress group (MG) for skin closure. Characteristics of patients, features of pilonidal disease, macerations, infections, wound dehiscence, flap necrosis, operation time, time of drain removal, wound complications, early recurrences, and time till return to work were compared between the 2 groups.ResultsThere was no statistical difference between groups per sex, age, body mass index, smoking, number of sinuses, depth of intergluteal sulcus, distance of incision to anus, volume of extracted tissue, number of hair follicles per cm2, recurrence, operation, and mean follow-up time. Two patients showed signs of wound complications (4.4%) in SG, whereas 8 cases (17.4%) showed signs in MG (P < 0.05). One patient in SG had surgical site infection and required antibiotics (2.2%), where as there were 6 cases treated in MG (13.0%) (P < 0.05). Removal of drain tube, and time till return to work rates are lower for SG than MG (P < 0.05).ConclusionIn conclusion, surgical procedures which include Limberg flap method and subcuticular closure may reduce infection and maceration rates. Future studies are needed to achieve greater detailed evaluation.

Randomized prospective comparison of midline and off-midline closure techniques in pilonidal sinus surgery

Pilonidal sinus is a chronic inflammatory disorder of the intergluteal sulcus. The disorder often negatively affects patients' quality of life, and there are numerous possible methods of operative treatment for pilonidal sinus. The aim of our study was to compare the results of 3 different operative procedures (tension-free primary closure, Limberg flap, and Karydakis technique) used in the treatment of pilonidal disease. The study was conducted via a prospective randomized design. The patients were randomized into 3 groups via a closed envelope method. Patients were included in the study after admission to our clinic with pilonidal sinus disease and operative treatment already were planned. The 2 main outcomes of the study were early complications from the methods used and later recurrences of the disease. A total of 150 patients were included in the study, and the groups were similar in terms of age, sex, and American Society of Anesthesiologists scores. The median follow-up time of the study was 24.2 months (range, 18.5-34.27) postsurgery. The recurrence rates were 6% for both the Limberg and Karydakis groups and 4% for the tension-free primary closure group. Therefore, there was no substantial difference in the recurrence rates. The search for an ideal treatment modality for pilonidal sinus disease is still ongoing. The main conclusion of our study is that a tension-free healing side is much more important than a midline suture line. Also, tension-free primary closure is as effective as a flap procedure, and it is also easier to perform.

Alternative method for the reconstruction of meningomyelocele defects: V-Y rotation and advancement flap.

Skin grafts, skin flaps, fasciocutaneous flaps, muscle flaps, and musculocutaneous flaps have been used for closure of large meningomyelocele (MMC) defects that cannot be closed primarily. The V-Y rotation advancement flap technique has been used successfully for the reconstruction of defects in different areas of the body. In the present study, the authors report on their novel use of this technique in both a binary and a quadruple (butterfly) flap manner for closure of large MMC defects. They also present an algorithm that they developed for the evaluation of MMC defects. Between January 2011 and November 2013, 17 patients (13 girls and 4 boys) with extremely large MMC defects that could not be repaired by direct primary closure underwent reconstruction of the defects with binary and quadruple V-Y rotation and advancement flaps. With the patient prone, the axillary apices, the most craniad point of the intergluteal sulcus, and the posterior axillary lines were marked, and a rectangular area on the back was designed. Edges of the rectangular area and the transverse and longitudinal diameters of the defect were measured and the presence of kyphosis was noted. These measurements and their proportions were used to develop an algorithm for patient assessment. While binary flaps were planned over the transverse diameter of the defects, quadruple flaps were planned over the bisectors of the defects, which were closed by elevating fasciocutaneous flaps. For patients whose defect diameter to back width ratio was between 0.30 and 0.50 and whose mean ratio of defect area to donor area was between 0.09 and 0.15, binary V-Y rotation and advancement flaps were used. When these values were in the range of 0.50-0.66 and 0.16-0.35, respectively, quadruple V-Y rotation and advancement flaps were preferred. The mean duration of postoperative follow-up was 10.4 months. With the exception of minor complications, such as partial necrosis of 0.5 × 0.5 cm in a quadruple flap, all the flaps healed uneventfully. With this study, closure of MMC defects with V-Y rotation and advancement flaps has been defined for the first time in the literature. The use of this technique with multiple flaps is an effective alternative to other flap options for the closure of large MMC defects. The algorithm developed in the course of this study should facilitate evaluation and reconstruction planning for patients with MMC defects.

Does Sacrococcygeal Angle Play a Role on Pilonidal Sinus Etiology?

The predisposing factors for the development of sacrococcygeal pilonidal disease (SPD) still remain undetermined. Here, we investigate the sacrococcygeal angle as a possible predisposing factor for the development of disease. Consecutive male patients admitted to our clinic with the diagnosis of SPD were included. Sex, age and BMI matched healthy controls without SPD were enrolled to the study. The predefined sacrococcygeal angles of patients and controls were measured on lateral pelvic radiographs by a single experienced radiologist. Thirty patients were included in each group. Sacrococcygeal angles of patients and control group were measured as 37.3±14.5 and 36.81±10.23 in patients and controls, respectively. The difference with respect to sacrococcygeal angle was not statistically significant between two groups. Sacrococcygeal angle which is the main skeletal determinant of intergluteal sulcus is not a predisposing factor for the development of sacrococcygeal pilonidal disease.

Results of Modified Dufourmentel Rhomboid Flap in Patients with Extensive Sacrococcygeal Pilonidal Disease

Purpose: The aim of our study was to assess our modified Dufourmentel flap outcomes in a standardized patient group (a symptom duration of equal to or greater than 60 months, presence of equal to or more than 3 sinus ostia or presence of sinus ostia fistulized equal to or greater than 2 cm laterally, and a normal body mass index) with extensive pilonidal sinus.Methods: Patients who were diagnosed with chronic pilonidal sinus disease and gave consent to surgical repair with modified Dufourmentel flap were enrolled. Patients were assessed with respect to age, sex, body mass index, presenting symptom, symptom duration, number of previous operations, number of sinus ostia, length of flap rims, depth of inter-gluteal sulcus, distance of sinus from anus, duration of operation, time of drain removal, length of hospital stay, early postoperative complications, postoperative pain, loss of labor, length of follow-up, and recurrences. Results: A total of 42 patients were enrolled. Average duration of presenting symptoms was 64.4 ± 4.7 months and average length of follow-up was 29.4 ± 3.6 months. Average length of hospital stay was 4.2 ± 0.8 days, and time to return to work was 16.3 ± 2.1 days. Two patients (4.7%) developed postoperative wound infection, one patient (2.4%) developed seroma, and three patients (7.1%) had wound dehiscence. There was no recurrence.Conclusion: Modified Dufourmentel flap application can be safely used in the treatment of extensive pilonidal sinus disease.

Treatment of adolescent pilonidal disease with a new modification to the Limberg flap: Symmetrically rotated rhomboid excision and lateralization of the Limberg flap technique

Background/PurposePilonidal disease is a common and frustrating problem among adolescents due to its high recurrence rate. The rhomboid excision and Limberg flap techniques promise successful results, but the lower part of the incision left on the intergluteal sulcus is prone to recurrences. Consequently, we have developed a new modification to this technique and have designed a descriptive prospective study to evaluate its efficiency. MethodsWe conducted this prospective study between March 2011 and March 2012. All of the patients who were operated on for sacrococcygeal pilonidal disease were included in this study. The surgical procedure primarily consisted of symmetrically rotated (clockwise) rhomboid excision and lateralization of the Limberg flap in order to keep the inferior corner of the suture line apart from the intergluteal sulcus. ResultsA total of 15 adolescents (8 boys and 7 girls) were included in the study group. Of the patients, 47% were normal, 13% were overweight, and 40% were obese. Five patients were operated on under general anesthesia, and 10 were operated on under spinal anesthesia. The length of the flap margins ranged from 2.5 to 7cm (median=4cm). The median duration of hospitalization was 5days, and the median duration of suction drainage was 4days. The median postoperative follow-up period was 4months (ranging from 1 to 12months), and we did not encounter any wound infection or recurrent disease during this period. Only one patient had wound hematoma as a result of drain breakdown and was treated with wound care without any additional complications. ConclusionAlthough the number of patients in this study was small and the follow-up period was short, we obtained satisfactory results without any recurrence by performing a symmetrically rotated rhomboid excision and lateralized Limberg flap procedure.

Anatomical relation between sciatic nerve and piriformis muscle and its bifurcation level during fetal period in human

The aim of this study is to determine the morphometric development, location and variant formations of the sciatic nerve using anatomic dissection method during the fetal period. Sciatic nerves of 200 human fetuses (103 males and 97 females) aged between 9 and 40 weeks of gestation were studied bilaterally. The bifurcation level of the sciatic nerve to its terminal branches was evaluated with respect to popliteal fossa. Then the length of the sciatic nerve, starting from where it leaves the piriformis muscle till the bifurcation point of the nerve, and its width at the point where it leaves infrapiriforme foramen and its width at the bifurcation level were measured. We also measured the distance of the sciatic nerve to the ischial tuberosity, the greater trochanter and the intergluteal sulcus. Mean values and standard deviations of all parameters according to trimesters were calculated. We found that all parameters increase with age during the fetal period (P < 0.05). Parameters do not show any significant differences between sexes (P > 0.05). In our analysis, we observed that in 98 % of the cases (on the right and the left side) the sciatic nerve leaves the pelvis below the piriformis muscle. The remaining cases (2 %) are variant formations. We believe that our study will be useful for better understanding of sciatic nerve development and it may contribute to future studies in obstetrics, orthopedics and fetal pathology. Knowledge of variant formations of the sciatic nerve, its bifurcation level and its relation with neighboring structures may be important for blockade of the nerve in newborn surgeries.

Modification of the Bascom cleft lift procedure for chronic pilonidal sinus: results in 141 patients

There is no definitive consensus on the best treatment for pilonidal sinus. The Bascom cleft lift technique has been reported to produce successful results. This study presents the results of a modified cleft lift procedure in which the sinus tissue was excised and the lower end of the incision was kept outside the intergluteal sulcus by extending the lower end of the incision laterally. Between August 2010 and January 2012, 141 consecutive patients who presented with primary or recurrent pilonidal sinus disease were included in the study, which was conducted at a single tertiary academic medical centre. Prospectively collected data were recorded, including complications, pain score, satisfaction level, primary healing rate, length of hospital stay and early recurrence. The mean operating time was 30min and the mean length of hospital stay was 1.2days. The most common surgical-site complication was a collection followed by partial wound dehiscence and superficial infection. The primary healing rate was 88%, the mean time for functional recovery was 13days and the mean follow-up time was 14months. No recurrence was observed within this follow-up period. The modified Bascom cleft lift technique is effective and reliable. It is applicable to all pilonidal sinus cases and has low complication rates, high satisfaction scores, rapid early recovery and low recurrence rates.

Reconstrução do sulco interglúteo: relato de caso

INTRODUÇÃO: O conceito de beleza feminina tem mudado ao longo dos anos, porém a forma e a projeção das nádegas permanecem como símbolos de máxima feminilidade. A exposição corporal, especialmente da região glútea, tem proporcionado aumento da procura pela cirurgia de gluteoplastia. OBJETIVO: O propósito deste relato é demonstrar a correção cirúrgica de uma deformidade do sulco interglúteo, utilizando a preservação do ligamento sacrocutâneo. RELATO DO CASO: Paciente do sexo feminino, com queixa de deformidade do sulco interglúteo e nádegas hipoplásicas. O tratamento cirúrgico consistiu na reconstrução do sulco interglúteo por meio de preservação do ligamento sacrocutâneo, implantação de prótese de silicone glútea no plano intramuscular e lipoaspiração das ancas. CONCLUSÃO: O entendimento dos princípios da técnica XYZ, em particular do ligamento sacrocutâneo, possibilitou a correção da deformidade do sulco interglúteo e o remodelamento do contorno posterior da paciente.

Sacrococcygeal pilonidal disease: analysis of previously proposed risk factors

PURPOSESacrococcygeal pilonidal disease is a source of one of the most common surgical problems among young adults. While male gender, obesity, occupations requiring sitting, deep natal clefts, excessive body hair, poor body hygiene and excessive sweating are described as the main risk factors for this disease, most of these need to be verified with a clinical trial. The present study aimed to evaluate the value and effect of these factors on pilonidal disease.METHODPreviously proposed main risk factors were evaluated in a prospective case control study that included 587 patients with pilonidal disease and 2,780 healthy control patients.RESULTSStiffness of body hair, number of baths and time spent seated per day were the three most predictive risk factors. Adjusted odds ratios were 9.23, 6.33 and 4.03, respectively (p<0.001). With an adjusted odds ratio of 1.3 (p<.001), body mass index was another risk factor. Family history was not statistically different between the groups and there was no specific occupation associated with the disease.CONCLUSIONSHairy people who sit down for more than six hours a day and those who take a bath two or less times per week are at a 219-fold increased risk for sacrococcygeal pilonidal disease than those without these risk factors. For people with a great deal of hair, there is a greater need for them to clean their intergluteal sulcus. People who engage in work that requires sitting in a seat for long periods of time should choose more comfortable seats and should also try to stand whenever possible.

Pure cutaneous Langerhans cell histiocytosis resembling varicella

A 5-month-old boy presented with multiple, pinkish-yellow, umblicated, varicelliform vesicles on his trunk. The lesions first appeared on his scalp 2 months earlier. There was also an erythematous, moist and erosive eruption on both axillae, inguinal regions and intergluteal sulcus. He had been treated with topical antibacterial and antiviral therapies. Histopathological investigation of the lesions revealed the diagnosis of Langerhans cell histiocytosis. Systemic involvement was not detected, although detailed investigation was performed. We present our case because he had a varicelliform and intertriginous eruption but did not have internal organ and haematological involvement.

Superiority of Asymmetric Modified Limberg Flap for Surgical Treatment of Pilonidal Disease

Cases treated surgically using wide excision plus classic Limberg flap or wide excision plus asymmetric modified Limberg flap were compared with respect to complications and patient comfort in the postoperative period. In this prospective, randomized study, 68 of 70 patients were followed for a mean of 29.22 (range, 6-44) months after wide excision plus classic Limberg flap (Group 1, n=35) and after asymmetric modified Limberg flap closure (Group 2, n=33). There were significantly more macerations in Group 1 (P<0.001). All macerations were detected on the lower part of the incision left on the intergluteal sulcus, and infections occurred subsequent to maceration. The infection rate was statistically higher in Group 1 than in Group 2 (P=0.028). We noted that as a result of these complications, time to suture removal (P=0.001), discharge from hospital (P=0.001), and time off from work (P=0.001) were significantly longer for Group 1 than for Group 2. There were two recurrences in the inferior part of the suture line in Group 1 and none in Group 2, which showed no statistical difference (P=0.493). The deep intergluteal sulcus and midline gap were slightly flattened over the anococcygeal region. The vacuum effect was decreased, and there were less macerations and fewer infections. Time off from work and discharge time from hospital were shortened by eliminating the moisture effect and reducing complications by lateralizing the lower part of the suture line.

Morphology of the Gluteal Region in the Female Population 5 to 83 Years of Age

This study evaluated the development of gluteal region morphology in the female population 5 to 83 years of age. For the study, 132 female subjects were placed into four groups: prepubertal (ages 5 to 8 years; n = 10), pubertal (ages 9 to 14 years; n = 38) postpubertal (ages 15 to 41 years; n = 34), and menopausal-postmenopausal (older than 42 years; n = 29). The age, weight, and height of the subjects were routinely recorded, and body mass index was estimated. In addition, 11 measurements were performed on the gluteal region. The data were analyzed by Pearson and Spearmen correlation analyses using SSPS 11.0 for Windows. In the prepubertal group, the intergluteal sulcus and infragluteal sulci did not actively change. Weight gain was the major factor influencing the shape of the gluteal region, whereas age had no effect. In the puberty group, the gluteal region expanded in all directions. During this period, it was difficult to determine any specific relation between measurements because of significant correlation involving all parameters. However, it should be mentioned that among the four groups, only in pubertal group did age significantly affect the shape of the gluteal region. In other three groups, weight seemed to be a major determinant. In the pospubertal and menopausal-postmenopausal groups, the buttocks sagged with weight gain, contrary to the belief that this happens with aging. This causes movement of the infragluteal sulci in downward and lateral directions as well as lengthening of intergluteal sulcus. Although the gluteal shape is open to the effects of demographic factors such as ethnicity, feeding habits, and lifestyle, according to these findings, it might be advised that in the assessment of the gluteal region morphology, it would be better to consider its dynamic nature. Reshaping its only one part, which can be devastating unless the whole gluteal region and upper limb are addressed.