Sacrococcygeal Sinus Research Articles

Combined application of gluteus maximus muscle flaps and random pattern skin flaps in repairing sacrococcygeal sinus tracts: a prospective study and technical note.

Sacrococcygeal sinus ulcers are caused by pressure sores, trauma, or surgery. Several surgical techniques have been developed for its treatment; however, studies are ongoing to develop the ideal method. The present study aims to introduce an innovative application of gluteus maximus muscle flaps (GMMFs) packing combined with local random pattern skin flaps (RPSFs) in repairing sacrococcygeal sinus tracts (SSTs). This was a prospective analysis study conducted on the patients (n = 26) with SSTs underwent an innovative repairing surgery in Qilu Hospital of Shandong University, China between December 2015 and December 2020. The repairing surgery was GMMFs combined with RPSFs. The demographic information and the clinical parameters including operative time, postoperative healing time, and recurrence rate were used to evaluate the efficacy of the operation. Except one case of partial necrosis at the edge of the flap due to severe fibrosis, which was cured after dressing change, all the other cases showed effective healing after the operation. The combined application of GMMFs and RPSFs for the treatment of sacrococcygeal sinus tracts gains the advantages of short operative time, quick postoperative recovery, and low postoperative recurrence rate.

Treatment of Patients with Uncomplicated Sacrcoccygeal Sinus

Introduction. Despite the progress made in the treatment of patients with sacrococcygeal sinus, the number of complications in the early postoperative period does not decrease below 23%; 12% of operated patients experience relapses of the disease, 14% of patients develop rough scars and discomfort in the area of surgical intervention.The aim of the study was to improve clinical outcomes of patients with uncomplicated sacrococcygeal sinus.Materials and methods. The study included 152 patients who underwent surgical interventions: 79 (52,0%) - with sacrococcygeal sinus in the stage without clinical manifestations and 73 (48,0%) - in remission. In addition to the standard laboratory and instrumental examination, the following parameters were studied: predisposition to the development of excessive scarring, the importance of acute-phase inflammation proteins in predicting the development of pathological scars. A group of patients prone to excessive scarring was identified, measures were taken to prevent its development. The authors proposed options for surgical treatment of sacrococcygeal sinus using an intradermal suture. Results. When comparing long-term clinical outcomes of conventional treatment of patients with uncomplicated sacrococcygeal sinus and an integrated approach, there was revealed a decrease in the development of gross cicatricial deformity in the area of ​​surgical intervention by 2,7 times, discomfort in the sacrococcygeal region by 3,7 times, the number of the disease relapses by 2,4 times.Conclusion. To predict the development of pathological scarring after surgery, it is necessary to study the dynamics of changes in the concentrations of acute-phase inflammation proteins in the peripheral blood of patients. To improve clinical outcomes in patients tending to excessive scar formation, it is necessary to include anti-scar therapy in the complex of postoperative measures. An integrated approach can significantly improve clinical outcomes of patients with sacrococcygeal sinus.

WAYS OF IMPROVE THE TREATMENT EFFECTIVENESS OF PATIENTS WITH SACROCOCCYGEAL SINUS AND ANAL FISSURE

The anal fissure and the sacrococcygeal sinus in the structure of coloproctological pathology take third and fourth places after hemorrhoids and paraproctitis. The results of their treatment do not satisfy coloproctologists: the frequency of postoperative complications and relapses of the disease is high, rough scars and discomfort in the area of surgical intervention are formed. Aim - to improve the treatment results of patients with sacrococcygeal sinus and anal fissure. Materials and methods: 152 patients were operated on: 79 (52.0%)-with a sacrococcygeal sinus in the stage without clinical manifestations and 73 (48.0%) – with a chronic anal fissure. In addition to the standard laboratory and instrumental examination, the following were studied: predisposition to the development of excessive scarring; anal sphincter contractility. The importance of acute-phase inflammatory proteins in predicting the pathological scars formation was studied; measures were taken to prevent their occurrence. Surgical treatment methods of the sacrococcygeal sinus using an intradermal suture are proposed. Result. Long-term results comparison of traditional treatment patients with uncomplicated sacrococcygeal sinus and an integrated approach, a decrease was revealed: the development of gross scar deformation in the surgical intervention area – by 2.7 times; discomfort in the sacrococcygeal region - by 3.7 times, the number of relapses of the disease – by 2.4 times. In the chronic anal fissure treatment, the relapses number of the disease was reduced by 3.3 times. Conclution. 1. To predict the pathological scarring formation after proctological operations, it is necessary to study the changes dynamics in the concentrations of acute-phase inflammatory proteins in the patients peripheral blood sample. 2. To improve the treatment of patients with a tendency to excessive scarring it is necessary to include anti-scar therapy in the complex of postoperative measures

Congenital spinal dysraphism with infected sacrococcygeal sinus tract: need for improved awareness amongst clinicians.

Spinal dysraphism (SD) includes a group of developmental anomalies resulting from failure of fusion of parts along dorsal aspect of midline structures lying along spinal axis from skin to vertebrae and spinal cord. There are two types of SD, open and closed. Close SD, also known as spina bifida occulta, can present with diagnostic challenges in resource limited settings where awareness regarding the condition and specialist radiological investigations, including Magnetic Resonance Imaging (MRI), may not be easily available. Undiagnosed cases can potentially lead to long term morbidities. We report the case of a 13-year old boy with closed SD presenting with recurrent infections of the sacrococcygeal sinus tract which were treated with oral antibiotics for what was considered to be localized infection. Following neurosurgical assessment and spinal MRI a diagnosis of SD was made. He underwent surgical excision of the sinus tract and closure of the defect with good outcome. The case emphasizes the need for awareness regarding SD in children who have sinus tracts in the intergluteal fold with symptoms of recurrent discharge and infection.

Use of Otoscope as a Diagnostic and Therapeutic Aid in Umbilical Pilonidal Sinus: A Novel Technique

Introduction:Umbilical disorders are frequently encountered in general surgical practice. Although the sacrococcygeal region is the most common site for pilonidal sinus disease, it can be seen occasionally in periumbilical area. Treatment is mostly conservative for umbilical pilonidal sinus in contrast to the sacrococcygeal sinus where it is always surgical. In the era of endoscopy and minimally invasive surgery, we describe the use of otoscope as a novel technique for the diagnosis and treatment of umbilical pilonidal sinus.Subject and Method:In this prospective study, patients with a clinical suspicion of umbilical pilonidal sinus were included and diagnosis was confirmed on the basis of otoscopic finding. All patients were planned for conservative management i.e. extraction of hair fragments with the help of an otoscope followed by oral antibiotics treatment. On follow-up, response of treatment was noted by evaluation of symptoms and otoscopic examination.Result:Total 15 patients were included in this study. By using otoscope for removal of hair fragments from umbilical sinus, we found successful result in all patients with conservative treatment.Discussion:In umbilical pilonidal sinus, the success of conservative treatment depends on the effective extraction of hair and maintenance of personal hygiene by the patient. Our study showed 100% successful result of conservative treatment, probably due to proper and complete extraction of hair fragment with the help of the otoscope.Conclusion:Otoscopic examination and hair extraction for umbilical pilonidal sinus is a simple, cost-effective, and easy treatment that can be done in the outpatient department and does not require any formal training for its use.

Sacrococcygeal sinus angle: as a new anatomic landmark for the posterior approach of presacral lesions

We have discussed the importance of sacrococcygeal sinus angle (SSA), which is a new anatomical landmark in the surgery of presacral lesions. Because of its anatomical structure, the sacrum limits the surgical exposure like a compact barrier for the posterior surgical approach. The main aim of this paper is to explain the anatomical description and clinical importance of SSA in the surgery of presacral lesions. Three groups were designated, consisting of ten patients in each group, as early childhood (group 1), late childhood (group 2) and adulthood (group 3). Patients were selected randomly. The degree of SSA measurement was performed between the line tangent to the anterior margin of the first sacral vertebra and the line from the promontorium to the tip of the coccyx. The measurement of SSA was performed on patients' lumbosacral magnetic resonance images. When the SSA forms a triangle via a parallel line starting from the inferior tip of the sacrum and running parallel to the ground, the area of the triangle also covers the field of view of the presacral region. In addition, the sacral region needed to be resected for maximum exposure is also within this area. The mean SSA was measured to be 53.9±11.4° in group 1, 77.8±11.2° in group 2 and 74.5±12.5° in group 3. Intergroup comparisons revealed a significant difference between group 1 and the other two groups statistically. It was found that the SSA was 20° less in group 1 as compared to the other age groups (p=0.0005). The area of a triangle is calculated using the sine area formula, and according to this formula the area of a triangle increases when the degree of the angle increases, thus comprising larger part of the sacrum. This condition requires more and wide sacral resection to obtain maximum exposure in the presacral zone. We have observed that the SSA is significantly smaller during early childhood compared with the other age groups. This feature provides an anatomical superiority in this age group for the posterior approach in the surgical treatment of presacral masses.

Clinical analysis onsacrococcygeal pilonidal sinus

：Objective To investigatethe clinical features and treatment of sacrococcygeal pilonidal sinus. Methods Aretrospective analysis of 28 patients with sacrococcygeal pilonidal sinus from 2000 to2010 in our hospital was carried out, referring to the relevant literature. Results 28patients with sacrococcygeal pilonidal sinus were confirmed by surgery and relevantancillary diagnosis. Clinical characteristics of patients in this group: discharged pusagain and again from sacrococcygeal, and left the sacrococcygeal sinus. Some patientscontained hair in sinus. Sinus angiography showed no reaching to rectum, there is norelationship with sacrococcygeal bone. 18 patients were diagnosed as the disease beforeoperation, and cured by surgery. Conclusion The diseases were misdiagnosed easily byclinicians because of low incidence.Sinus angiography is very meaningful in diagnosis.Surgery is the only radical way. Specific: operation method should follow the sinuscircumstances.

Epstein–Barr virus-related plasmablastic lymphomas arising from long-standing sacrococcygeal cysts in immunosuppressed patients

Epstein–Barr virus-related plasmablastic lymphomas arising from long-standing sacrococcygeal cysts in immunosuppressed patients

A NEW X-LINKED RECESSIVE SYNBECME WPM BRAIN, HEART AND GENITAL MALFORMATIONS

The proband, a 2.9 kg term male, was live-born and died on day 5 of life following cardiopulmonary arrest. Autopsy revealed aqueductal stenosis with hydrocephalus; agenesis of the septum pellucidum, olfactory bulbs and tracts; focal cerebellar dysplasia; cystic lesions of the ganglionic eminence; acute and remote cerebral infarcts; aortic coarctation with a dysplastic, bicuspid aortic valve; ASD; VSD; severe hypospadias; sacrococcygeal sinus; left foot equinovarus deformity; simple low set ears; fifth finger clinodactyly; and abnormal palmar creases. The proband's half brother through a common mother was a pre-term infant who expired at age 13 days. Autopsy revealed aqueductal stenosis with hydrocephalus; cerebral and cerebellar dysplasia with neuronal and glial heterotropias; intraventricular hemorrhage; aortic dextroposition; pulmonary valve atresia; VSD; PDA; severe hypospadias; thoracic spina bifida occulta; low set ears; and unusual finger overlap. Both infants were 46,XY. Their mother had a maternal uncle with a large head and abnormal genitals who was stillborn, and a maternal aunt delivered a hydrocephalic stillborn male. Autopsy records are unavailable on these latter individuals. There have probably been four affected males in three generations of this family. This syndrome, which is of unknown embryologic pathogenesis, appears to be inherited as an X-linked recessive disorder.

Anal, perianal, perineal and sacrococcygeal sinuses

In accordance with the accepted definitions of “sinus” and “fistula” an attempt has been made to indicate those lesions which are true fistulas and those which are true sinuses in the anal, perianal, perineal and sacrococcygeal regions. Inasmuch as the great majority of socalled “draining sinuses” in the anal, perianal and perineal skin are in reality the secondary openings of true anal fistulas, an effort has been made to clarify the pathogenesis of anal fistula. It is hoped that a proper understanding of this mechanism will lead to more accurate diagnosis and to adequate management. Pilonidal cyst is the most common “developmental” lesion dorsal to the sacrum and coccyx. The essential differential diagnostic features of anal, perianal, perineal and sacrococcygeal sinuses have been briefly stated.