Sacrococcygeal Area Research Articles

Efficacy and safety of RD2 Ver.02, a whole blood clot therapy, coupled with a minimally invasive procedure in pilonidal sinus: a phase II study.

PNS is caused by an infection in the sacrococcygeal area triggered by hair particle accumulation in skin tunnels, resulting in infection. Surgical options range from simple excision to complex flap constructions. Primary wound healing failure and recurrence rates contribute to the burden of PNS. RD2 Ver.02, a novel autologous whole-blood clot product, demonstrated safety and efficacy in treating complex cutaneous wounds and was investigated for the management of PNS. A Phase II open-label, pilot, single-arm prospective study was conducted from May 2021 to May 2023 (Ethics Committee approval #7952-20). Patients with PNS underwent a minimally invasive trephine procedure under local anesthesia followed by RD2 Ver.02 instillation into the cavity. Primary healing was assessed at 3, 6, and 12 months. Secondary outcomes included the collection of adverse events. Overall, 51 patients participated in the study. At 3 months, 42/51 healed (82.4%), 7/51 (13.7%) were granulating but not completely healed, and 2/51 (3.9%) failed to heal. At 6 and 12 months, 46/51 (90.2%) and 42/51 (82.4%) achieved complete healing, respectively. At 6 months, two PNSs recurred after initial healing and an additional four instances of PNS recurrence observed in 12months, so a total of recurrence in six patients (11.8%). There were five adverse events (AEs) with no severe adverse events. RD2 Ver.02 is a safe and effective treatment of PNS when coupled with a minimally invasive trephine PNS procedure. Further comparative studies are needed to fully assess the role of this novel therapy for PNS.

Congenital cervical teratoma

: Teratoma, originating from the Greek word "teras" meaning "monster," reflects its diverse tissue composition, often containing ectodermal, mesodermal, and endodermal tissues. These embryonic germ layers contribute to the rarity of teratomas in the neck, though they are more commonly found in the sacrococcygeal area. Notably, teratomas occurring in the cervical region can lead to life-threatening symptoms due to their mass effect.: A 26-year-old multiparous woman highlighted the challenges of managing cervical teratomas. During her 38th week of gestation, an ultrasound revealed a tumour on the foetus's neck, measuring 5.2 x 4.7 cm with doppler, neovascularization, and solid parts suspected to be a teratoma. The patient, despite no prior illness, had not taken prescribed vitamins during pregnancy. She underwent a caesarean section, delivering a baby girl weighing 3100 grams with an Apgar score of 8, who was found to have a solid mass in the posterior neck. The baby underwent surgery three days later, where 200-gram mass was removed and identified as a mature teratoma through anatomical pathology examination. The successful surgery allowed the mother and baby to return home in good condition.: Teratomas emphasized their diverse nature, with cervical teratomas mostly affecting females and originating from early aberrant germ cells. These tumours, often neuroepithelial, rarely become malignant. Diagnosis involves prenatal ultrasonography, aiding in intervention planning, while postnatal imaging guides surgical approaches.: Congenital teratomas pose challenges in prenatal diagnosis and management, requiring a multidisciplinary approach. Early detection through antenatal imaging, surgical excision, and meticulous follow-up are crucial for optimal outcomes, emphasizing the importance of comprehensive care and collaboration across medical specialties.

A Rare Case of Giant Epignathus (Teratoma) of Left Palatine Tonsil: A Case Report.

Teratomas are rare tumors that originate from all three primary germinal layers and can develop anywhere along the body's midline, most commonly in the sacrococcygeal area. Within the head-and-neck region, they are infrequent, especially in the oropharyngeal area, and predominantly occur in infants. This case report presents an unusual instance of a teratoma in the left palatine tonsil, also known as giant epignathus, of a 25-year-old female. The patient experienced a progressively enlarging mass over six to seven months without recurrent sore throat, fever, respiratory difficulties, or weight loss. Clinical and imaging assessments revealed a 2cm x 3cm irregular mass in the left palatine tonsil, which was surgically excised. Histopathology confirmed a mature teratoma. The patient was followed up for six months without evidence of recurrence. This case underlines the importance of considering teratomas in the differential diagnosis of tonsillar masses, even in adults, and highlights complete surgical excision as the treatment of choice to minimize recurrence risks and achieve optimal patient outcomes.

Understanding the Mechanical Forces on the Sacrum Can Help Optimize Flap-based Pilonidal Sinus Reconstruction.

Pilonidal sinus can be treated with excision and flap reconstruction, but treatment is often complicated by wound dehiscence, infection, and recurrence. Understanding the mechanical forces on the sacrococcygeal area during posture change could help guide optimal flap choice. Sixteen volunteers underwent measurements of skin-stretching, pressure, and shear stress on the sacrum when sitting relative to standing. Skin-stretching was measured by drawing a 4 × 4 cm square on the sacrum and measuring the vertical, horizontal, and diagonal axes. Pressure and shear stress was measured at six sacral points with a device. The data analysis highlighted the potential of the superior gluteal artery perforator (SGAP) flap for dissipating mechanical forces. Ten pilonidal sinus cases treated with SGAP flaps were retrospectively reviewed for 6-month outcomes. Sitting is associated with high stretching tension in the horizontal direction [estimated marginal mean (95% confidence intervals) = 17.3% (15.4%-22.6%)]. The lower sacrum experienced the highest pressure [106.6 (96.6-116.5) mm Hg] and shear stress [11.6 (9.7-13.5) N] during sitting. The transposed SGAP flap was deemed to be optimal for releasing the horizontal tension and providing sufficient subcutaneous tissue for ameliorating pressure/shear stress during sitting. It also has high blood flow and can therefore be used with large lesions. Moreover, its donor site is above the high-pressure/stress lower sacrum. Retrospective analysis showed that no patients experienced complications. Sitting is associated with high mechanical forces on the sacrococcygeal skin. The transposed SGAP flap may ameliorate these forces and thereby reduce the risk of complications of pilonidal sinus reconstruction for large defects.

Changes of transcutaneous oxygen pressure in compressed areas of surgical patients: A prospective study of influencing factors

ObjectiveTo compare the transcutaneous oxygen pressure (tcpO2) measurement values and changes in compressed areas of surgical patients before and after surgery and to explore the related factors influencing the tcpO2 changes before and after surgery. MethodsResearchers selected 100 patients who underwent elective surgery in a tertiary comprehensive hospital from November 2021 to September 2022. A self-designed general information questionnaire was used to collect patient general information and disease-related data, including gender, age, smoking and drinking history, hypertension, diabetes, local skin temperature and humidity, related biochemical indicators, and activities of daily living score. Researchers used a transcutaneous oxygen pressure meter to measure and record the tcpO2 of the compressed areas (sacrococcygeal area, scapula area, and heel area) before and after surgery. ResultsAmong the 100 patients, 37.00 % (37/100) developed type I/II pressure ulcers after surgery, and 30 patients (81.08 %) showed regression within 2 h after surgery. There was no statistically significant difference in the preoperative tcpO2 measurement values of the scapula and heel areas between the group with and without pressure ulcers, but the preoperative tcpO2 measurement value of the sacrococcygeal area in the group without pressure ulcers was higher than that in the group with pressure ulcers (P < 0.01). The factors affecting the preoperative tcpO2 measurement value of the sacrococcygeal area were smoking and surgical type. After surgery, the tcpO2 measurement values of the three areas in the group with pressure ulcers were significantly lower than those in the group without pressure ulcers (P < 0.01). Comparing the tcpO2 values of different areas, it was found that the tcpO2 value was lowest in the sacrococcygeal area, followed by the heel area, and the tcpO2 value in the scapula area was highest both before and after surgery (P < 0.01). The main factors affecting the postoperative tcpO2 measurement value were diabetes, Glassgow score, surgical time, and intraoperative red blood cell transfusion. ConclusionThe measurement of tcpO2 is related to the incidence of surgically acquired pressure ulcers, and this technology may become an important tool for quantitative assessment of the risk of pressure ulcers.

Antenatal teratoma sacrococcygeal in a three month old children in Indonesia: a rare case report

Sacrococcygeal teratoma is a type of germinal cell tumor in children, usually observed in the prenatal or antenatal phases. In either phase, sacrococcygeal teratoma may cause complications that lead to increased risk of morbidity and mortality. A proper screening and management for sacrococcygeal in children are mandatory for the best outcome. Currently, surgical resection is the most promising treatment to manage antenatal sacrococcygeal teratoma in children. Three-month-old female children were brought to the hospital with a growing 8.4 cm mass since birth in her groin. The mass was painless and soft in consistency. Computed tomography (CT) scan revealed a dominant solid lesion accompanied by multiloculated fluid density arising from right gluteal muscle. The patient planned for surgical excision. Hyperkalemia was observed prior to the operation; hence an appropriate correction was needed before surgery. Germ cell tumors, though uncommon, may develop beyond the gonadal region, such as in the brain, neck, mediastinum, and retroperitoneum. In neonates and fetuses, these tumors frequently originate in the sacrococcygeal area, possibly resulting from the migration of primordial cells and the proliferation of totipotent stem cells in that region. Optimal disease burden outcomes for sacrococcygeal teratoma are often achieved through surgical resection. Sacrococcygeal teratoma, although rare, might possess a mortal threat to patient, hence proper diagnosis and treatment must be done to ensure the best clinical outcome.

Sacrococcygeal pilonidal cyst with the disease onset as an anterior perianal abscess: a clinical case

The aim. To analyze the clinical case of surgical treatment of a patient with a pilonidal cyst (PC) of the sacrococcygeal area, which manifested as an anterior perianal abscess, and to justify the need for an in-depth differential and diagnostic search in patients with corresponding clinical manifestations of perianal pathology. Description of a clinical case. The article describes a clinical case of successful treatment of a 24-year-old patient with a pilonidal cyst of the sacrococcygeal area and a purulent secondary fistula that mimicked a perianal abscess with an incomplete external fistula of the rectum. Data are given on the step-by-step performance of the diagnostic process and the choice of optimal surgical treatment tactics. Results and discussion. The described clinical case is interesting for specialists and its detailed coverage due to: a) the presented atypical course of PC; b) selected diagnostic tactics; c) the selected method of operative treatment of the patient. The points mentioned above are described in detail in the section, with coverage and visualization of possible alternative options for the patient's diagnosis and the use of various tactics for surgical treatment. Conclusions. Conducting an extended differential diagnostic search using additional instrumental imaging methods is justified in patients with pilonidal disease with an atypical or blurred course. Performing a complete perioperative set of examinations allows for choosing the correct surgical tactics for treating such patients. The use of a full-fledged invasive examination of the perianal area using methods of regional or general anesthesia is reasonably justified in case of suspicion of insufficient informativeness of clinical-instrumental, laboratory, and imaging methods of examination

Pilonidal disease: comparative analysis of leading professional organizations clinical guidelines

pilonidal disease is an inflammatory disease that is most often localized in the sacrococcygeal area and is characterized by the formation of a cyst or abscess with the possible secondary formation of fistulas. Pilonidal disease is a fairly common disease, according to individual studies, the incidence ranges from 26 cases per 100,000 people (USA) to 48 per 100,000 people (Germany). Men are three times more likely to suffer than women. Most often, the disease manifests itself between the ages of 18 and 30. The risk factors for developing the disease are: excess weight, increased hair growth, chronic trauma to the sacrococcygeal area and anatomical features of the gluteal cleft (its shape, depth, configuration). The occurrence and development of the disease in persons of working age often leads to a sharp decrease in work capacity and quality of life. There is still no single, generally accepted classification of pilonidal disease in the world. Today, there are 3 clinical guidelines created by professional associations (USA, Germany, Italy), based on the principles of evidence-based medicine. The purpose of the study is to perform a comparative analysis of the main points of the clinical guidelines of leading professional organizations (German National Guideline on the management of pilonidal disease, The American Society of Colon and Rectal Surgeons' Clinical Practice Guidelines for the Management of Pilonidal Disease, Consensus statement of the Italian society of colorectal surgery: management and treatment of pilonidal disease) regarding the clinical-diagnostic approach and the choice of optimal treatment tactics for patients with certain forms of pilonidal disease. In the study, a review and comparative analysis of literary sources from the scientific databases of medical literature PubMed Central (U.S. National Institutes of Health's National Library of Medicine), ScienceDirect (Elsevier publishing house), Wiley online library, Springer Link, Cochrane library, materials of the 3rd International Pilonidal Conference ( 2023, Copenhagen, Denmark) and clinical guidelines of specialized organizations of the USA, Germany and Italy. The following issues of diagnosis and treatment of diseases are selected for comparative analysis: choice of prevention method and non-surgical procedures that reduce the risk of disease recurrence; choice of treatment method and assessment of its necessity for asymptomatic pilonidal cysts; the choice of a surgical method of treatment for symptomatic pilonidal cysts; the choice of a method of surgical treatment for a recurrent form of PC. According to the performed analysis, it can be concluded that the diagnostic and therapeutic strategies reflected in the clinical guidelines are based on the evidence base and the analysis of research data conducted in the field of treatment of pilonidal disease, which leads to the existence of an essential correlation between the recommendations related to the choice of a method of prevention and non-surgical procedures that reduce the risk of recurrence of the disease, the method of treatment and assessment of its necessity for the asymptomatic form of the disease, methods of surgical treatment of the recurrent form of the disease. There are differences between clinical guidelines due to varying general consensus structures and main questions chosen to form a list of general provisions.&#x0D;

Beyond the Crib: Unraveling the Enigma of Neonatal Nasopharyngeal Mass

Germ cell tumours that develop at birth are rare, with teratomas most frequently occurring in the sacrococcygeal area. Nasopharyngeal teratomas are also rare, occurring in less than 10% of head and neck teratomas. Immature Nasopharyngeal Teratoma (INT) in neonates presents a rare yet challenging clinical scenario. It can manifest with significant respiratory distress and airway compromise, necessitating prompt recognition and intervention. Diagnostic modalities such as imaging studies and biopsy aid in accurate diagnosis and treatment planning. Surgical resection remains the cornerstone of management, with complete excision being essential to optimise outcomes. The present case report highlights the importance of multidisciplinary collaboration and continued research efforts to refine therapeutic approaches and improve patient outcomes. Here, the authors present a rare case of INT in a 51-day-old male child. A 51-day-old male child, normal vaginal delivery and cried immediately after birth with complaints of respiratory distress from 8th day of life, for which he was treated with antibiotics and started on mechanical ventilation. In view of failure of extubation, bronchoscopy was done which revealed a nasopharyngeal mass. Magnetic Resonance Imaging (MRI) showed a heterogeneous mass measuring 2.3×3.9×3.1 cm (anteroposterior x transverse x craniocaudal) involving the parapharyngeal space and carotid space, extending into the retropharyngeal space, with no evidence of intracranial extension. Histopathology showed features of an immature solid teratoma. Nasopharyngeal teratomas are extremely rare congenital tumours, with only a few cases reported in the medical literature. INT in neonates represents a rare yet clinically significant entity that requires prompt recognition and intervention. Multidisciplinary collaboration and comprehensive management strategies are essential to optimise outcomes for affected neonates.

Giant sacrococcygeal teratoma in an infant: a case report with a literature review.

A sacrococcygeal teratoma (SCT) is a rare embryonal tumor that emerges in the sacrococcygeal area. It affects one in every 35000-40000 live births. Herein, we report a case of a substantial SCT in a neonate. A neonate girl from consanguineous parents was delivered by cesarean section with a large mass (18×17cm) in the sacrococcygeal area. The baby's birth weight was 5kg, of which 2.5 belonged to the mass. The vital signs were within normal ranges and she had weak movement with bluish peripheral limbs. Oxygen saturation was around 85% for a short period after birth. According to the American Academy of Pediatric Surgical Section, the tumor was type I. After the fifth day of delivery, a complete resection was done through a chevron incision. The patient was put on 'nil by mouth' for about 24h and given intravenous fluid. The histopathological examination of the surgical specimen confirmed extragonadal immature teratoma. The histological classification of SCT is divided into three types: malignant teratomas (consisting of malignant germ cells); immature teratomas (incompletely differentiated structures with a high risk of malignancy or embryonal components); and mature teratomas (fully differentiated tissues). SCT has rarely been reported as a giant mass. Radiologic examinations in the early stages of pregnancy may be essential to the early diagnosis of the condition.

Rotational V-Y Fasciocutaneous Advancement Island Flap to Cover Deep Sacrococcygeal Defects due to Pilonidal Disease, Pressure Ulcers, and Other Inflammatory Conditions.

The sacrococcygeal area supports the lower body and endures mechanical forces during movement. However, current treatment methods for deep caudal sacrococcygeal defects have limitations, resulting in insufficient tissue for deep pocket obliteration and considering only the two-dimensional advancement plane in a three-dimensional defect topology. Our study proposes using a rotational V-Y fasciocutaneous advancement island flap to reconstruct deep caudal sacrococcygeal defects. By considering the three-dimensional nature of the defect, we distinguish a coccygeal plane of the V-Y flap from a sacral plane and set different directions and depths of movement for each plane. From March 2016 to July 2022, 12 patients underwent successful treatment with this surgery, and no complications or recurrences were observed in the study group. Our research found that patients in our study exhibited a smaller intercoccygeal angle than the average angle of the general Korean population, as previously reported. This implies a more pronounced curvature between the sacral and coccygeal planes. Therefore, our methods, which consider the three-dimensional structures of sacrococcygeal pathology, are significant. This technique provides a mechanically robust reconstruction after resecting deep sacrococcygeal pathology, with well-padded tissue to prevent dead space and wound disruption.

Перший прижиттєвий випадок діагностики і лікування гігантської тератоми крижово-куприкової ділянки, яка переважала масу тіла новонародженого в 1,5 раза

Purpose - is to analyze and present the experience of perinatal diagnosis and treatment of giant terato-dermoid tumor (TDT) of the sacrococcygeal area, which exceeded the body weight of a newborn on 1.5 times. Clinical case. The article presents a unique clinical case of a giant teratoma of the sacrococcygeal area (SCT), which exceeded the weight of a newborn child on 1.5 times. Features of perinatal support, hypoxic-ischemic damage of internal organs, and surgical intervention for giant SCT in a premature low-weight newborn child are described, which are important elements of optimizing the treatment of children with this life-threatening pathology. Conclusions. Diagnosis and treatment of giant SCT in fetuses and newborns require scientifically based perinatal support, which includes early (up to 22 weeks of gestation) prenatal diagnosis, rational pregnancy management tactics, fetal examination, delivery by caesarean section, postnatal diagnosis and early (within 1 days) emergency radical tumor removal. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting studies. No conflict of interests was declared by the authors.

The study on the prevalence of Mongolian spots in the neonates.

Mongolian Spots (MS) generally exist at the time or under the first few weeks of the neonate life-cycle, often considered a birthmark, characterized by hyper-pigmented marks especially bluish-black hue that cannot vanish easily and are generally found on the lumbosacral region. As this MS is reminiscent of bruises and appears to be caused by abuse, this may raise questions about the possibility of abuse. Hence, it is significant to identify MS bruises. The objective of the study was to assess the prevalence of MS in neonates by using the parameters like location, method of delivery, gestational age, and, weight at birth. 500 neonates were enrolled in the study for the evaluation of the prevalence of Mongolian spots. The study design was cross-sectional, observational, and conducted for two and a half years. The neonate's whole skin surface, including the hand palms, scalps and soles, mucous membranes, genitalia, hair, and nails, was inspected in adequate light. The changes were seen (physiological and pathological) over the skin, so the details were reviewed, analyzed, and documented. Photographic records were kept to document the study. Descriptive statistics were analyzed by t-test and Chi-square test and the inferential statistics were analyzed by proportions and Chi-square test. From the 500 neonates, 408 (81.6%) were reported to have Mongolian spots. Based on the site of locations 337 (82.60%) neonates were found with spots maximum on the sacrococcygeal area and rarely on the extremities 4 (0.98%). 221 (54.1%) were found with normal vaginal delivery, and males have more predominance 247 (60%). Based on the gestational age full term was 366 (89.71%), with the birth at a weight of more than 2.5 kg found in 349 (85.54%). The study concluded that the maximum number of neonates had been found with Mongolian spots and it is very common among neonates. This study will enlighten the awareness of the physician to distinguish the other lesions from other cutaneous skin conditions. The only drawbacks of this research study are a smaller sample size and limited study duration. The study of diameter, size, and dimensions of spots are not included. More intervention studies are required to compare MS with other skin conditions and their therapies. Further research is required for the study of the dimensions of marks on the neonate's body.

Advances in Diagnosis, Treatment, and Prognosis of Yolk Sac Tumors: A Comprehensive Review

Yolk sac tumor, also known as endodermal sinus tumor, is a rare and malignant germ cell tumor that typically arises in the gonads (testes and ovaries) but can also occur in extragonadal sites, such as the sacrococcygeal area or mediastinum. Yolk sac tumors arise from germ cells, which are the precursors of eggs in females and sperm cells in males. During normal embryonic development, germ cells migrate to the gonads (testes or ovaries) and differentiate into mature reproductive cells. Clinical mass-effect signs are the typical presentation of yolk sac tumours. These signs include rapid belly expansion, ascites, early satiety, and abdominal pain, among others. Children with testicular yolk sac tumours frequently appear with large, painless testicular lumps. Yolk sac tumours can be deadly or very damaging if left untreated. Depending on the characteristics of the tumour and its stage, a combination of surgery, chemotherapy, and radiation therapy is usually employed to treat yolk sac tumours. Regular follow-up visits and imaging studies are typically conducted to monitor the patient's response to treatment, detect any recurrence, and manage potential late effects of therapy. Close collaboration between the healthcare team and the patient is essential to ensure the best possible outcomes. FDG PET/CT staging of YST in paediatric patients was only marginally better than traditional imaging. Keywords: Yolk sac tumor, Alpha-fetoprotein, F-fluorodeoxyglucose

Role of Vaccum Dressings In Open Wounds of Pilonidal Sinus

Pilonidal sinus is an acute suppurative condition occurring beneath the sacrococcygeal area presenting as an abscess acutely while as intermittent discharge in its chronic form. Objective: To determine the role of NPWT in the management of pilonidal sinus in a tertiary care hospital in Karachi, Pakistan over 6 months. Methods: 50 patients were divided into two groups; control and NPWT. It was an open-label randomized trial. The patients in the control group were being managed by wet dressing compared to the NPWT group where VAC therapy was used for wound healing. Both groups were followed for 14 days. Healing was measured by VAS score, wound size, and number of complications. Results: Wound size post-operatively was measured in both groups and was 36.33 squared centimeters in the control group with 30. 97 squared centimeters in the intervention group showed no statistical significance. On the 14th day of the trial, the wound size was compared again and in the control group, the size was found to be 24.4 cm2 and 14.9 cm2 in the intervention group. However, no statistical significance was shown. On the visual analog scale for pain after 14 days, both groups demonstrated a steep decline falling to nearly 1.5 from 9 on the first postoperative day however showing no significant difference across the two groups. Conclusions: There was no significant difference between the two methods and similar time was required in both groups before resuming daily life activities.

Treatment of a Chronic Open Wound Related to Sacrococcygeal Pilonidal Cyst and Squamous Cell Carcinoma: A Case Report

Pilonidal sinus disease is a cystic lesion or draining sinus tract involving the sacrococcygeal area. A long-standing sinus tract can lead to squamous cell carcinoma in the tract and overlying skin. We present the case of a 56-year-old female patient who had undergone pilonidal cyst excision whose postoperative pathologic report indicated squamous cell carcinoma. The sinus tract did not heal for 3 months, and the patient was then transferred to our clinic. Our team conducted a thorough resection of the cystic lesion and the overlying skin, followed by the relocation of two flaps to restore the skin and soft tissue defect. The patient recovered after a 1-month wound healing period. Postoperative fluid collection or discharge did not occur, and the patient achieved the ability to perform daily activities such as walking and eating meals in the sitting position. Adequate resection of cystic lesions is necessary when treating pilonidal sinus disease. A benign cyst can turn into a malignant lesion, and additional wide excision followed by tissue restoration is a therapeutic option for curative treatment.

A Case of Giant Dermoid Cyst at Sacrococcygeal in Adult at “X” Hospital in Bandung

Dermoid cysts are benign tumors that can be found anywhere in the body. There is no dermoid cysts clear data yet in Indonesia. In the spine, these tumors generally occur in the lumbar region and are often accompanied by congenital spinal dysrafism and/or dermal sinus passages. Dermoid cysts arise from abnormal growth of the ectodermal folds during pregnancy. Its incidence is 0.7 – 1.8% of all central nervous system tumors. The aim of reported this case is to highlight the role of a diagnostic and evaluate the surgical outcome. A 47 year old female patient with a lump in the sacrococcygeal area measuring 20 x 18 x 16 cm, with hard and soft consistency. MRI images show a hypo and hyperintense mass without spinal deformity. After the tumor was removed, the patient was allowed to go home for the 2nd day without complications. In conclusion, extraspinal dermoid cyst is a rare case that requires special diagnostic and surgical modalities to provide better clinical results.

Pilonidal sinus of external auditory canal as unpredicted lesion: rarest case presentation and review of literatures

BackgroundPilonidal sinus (PNS) is considered as a benign lesion of hair-bearing areas, particularly at the sacrococcygeal area. It is presented as a hole or tunnel in the skin. It may be filled with fluid or pus resulting in the formation of a cyst or abscess. Although PNS is a well-established lesion in general surgery as well as dermatology specialties by its occurrence at the sacrococcygeal region, but the surprising presentation of PNS is that at ENT specialty by its appearance at the external auditory canal (EAC), which is deemed unpredicted lesion at this particular region.Case presentationNine years female Libyan child has been presented with a history of persistent offensive bloody stained yellowish discolored left ear otorrhea a few months before her presentation. The local examination including the microscopic examination revealed evidences of a grayish-pinkish pedunculated polypoidal mass raised from the junction of the superior wall with the anterior wall of the EAC, at the site of the junction between the cartilaginous and bony portions of EAC. The temporal bone CT scan revealed evidences of radiolucent soft tissue density mass arising from the wall of the EAC at its anterior-superior junction, with the intact tympanic membrane as well as the middle ear cavity. This was most probably in favor of the suggestion of granulation tissue or aural polyp. The mass was completely excised as one piece from its pedicle and sent for histopathological evaluation, which was in favor of the diagnosis of PNS.ConclusionWe consider this case for reporting because of its scarcity and unexpected lesion at EAC. To the best of our knowledge, our case constitutes the second case of the EAC specifically, and the third case of external ear generally reported in the world. Thus, we tried to illustrate this unique and rare EAC lesion concerning how it is clinically as well as pathologically presented. In addition, we tried to review the literatures to elucidate whether this rare lesion has been reported before.

Comparative Study on Short-Term Outcome in Patients Undergoing Pilonidal Sinus Surgery in Tertiary Care

ABSTRACT Background: Pilonidal sinus is a disease that affects young men commonly arising from the hair follicles of the sacrococcygeal area. At present, there is no standardized surgical management available for chronic pilonidal sinus. The purpose of this study is to evaluate wound healing and short-term outcomes in pilonidal sinus patients undergoing modified Limberg flap surgery and lay open for secondary healing after excision in a tertiary care hospital. Patients and Methods: This is a nonrandomized comparative observational study performed at Apollo Hospitals, Chennai, during January 2021 to August 2021. Group A included 25 participants who opted off-midline primary closure using modified Limberg rhomboid flap procedure. Group B included 25 participants who underwent excision of pilonidal sinus and laying the wound open for secondary healing. All patients, in both groups, were seen on the 3rd, 5th, 7th, 15th, and 30th post-operative day. They were followed until complete wound healing. Results: The study showed that the modified Limberg flap closure group had a shorter period of complete wound healing in comparison to the excision and lay-open group but at a cost of prolonged duration of hospitalization. This study shows the significant difference in the period to return to daily activity between Group A and Group B. Postoperative wound complications such as infection and recurrence were seen in Group A. Conclusions: Conventional wide excision of pilonidal sinus and laying it open for secondary healing is advisable in pilonidal sinus disease and be performed as a day-case surgery. For the success of modified Limberg flap closure, prone nursing is recommended.

The place of the Suchorski method in the contemporary treatment of extensive pilonidal sinus disease – a literature review

Pilonidal sinus disease (PSD) is a chronic inflammation of the sacrococcygeal area. It is more prevalent among men, mainly those in their 20s and 30s. Many patients develop an abscess in this region as the first sign of the disease. In such cases, abscess incision and drainage are necessary. Surgery is the only effective treatment for pilonidal cyst. Many surgical techniques have been developed, with each of them having specific indications. Regardless of the surgical strategy, the essence of each method should be to lift and flatten the gluteal cleft to prevent recurrence. The Suchorski method, which is also referred to as oblique excision in the literature, is a method with proven high efficiency and low recurrence rates. Cases where the external opening remains in close proximity to the anal canal are a particular indication for this technique. In such cases, it allows for the total excision of the cyst, while maintaining sphincter continuity. In this paper, we review papers on the efficacy of the Suchorski method compared to other techniques. Despite excellent treatment outcomes, the Suchorski technique still seems to be an underestimated method.