Subcutaneous Abscess Research Articles

Virulent Staphylococcus aureus colonizes pediatric nares by resisting killing of human antimicrobial peptides

BackgroundThe nasal carriage of Staphylococcus aureus introduces risks for subsequent infections, the rate of which is particularly high in children. The colonization mechanisms of S. aureus are not fully understood. MethodsThe epidemiological characteristics of nasal colonizing strains from pediatric patients undergoing liver transplantation and healthy pre-school children were analyzed first. Phenotypes, including biofilm formation and hemolytic activity, were tested for all the isolates. Bacterial pathogenicity indicated by a mouse skin abscess model and resistance to antimicrobial peptides (AMPs) was compared between the predominant genotypes from each group. ResultsThe ST188 clone dominated in healthy children, whereas ST59 was prevalent for the pediatric patients. Although ST22 was the second most abundant genotype in the patient group, it was rarely found in healthy children. Interestingly, the colonizing ST59 and ST22 genotypes were more virulent, as indicated by the increased ability for hemolysis in vitro and severe subcutaneous abscesses in the mouse model, compared with ST188. We observed that the virulent ST59 and ST22 displayed higher resistance to antibiotics compared with ST188. Most of the ST59 and ST22 were methicillin-resistant S. aureus (MRSA), and all of the ST188 strains were methicillin-susceptible (MSSA). Moreover, we observed that the virulent ST59 and ST22 can resist killing by human antimicrobial peptides (AMPs). Mechanically, upon stimulation by AMPs, the virulent S. aureus can induce high expression of a phenol-soluble modulin transporter (Pmt) system. ConclusionPediatric patients can be colonized by virulent S. aureus clones, which are able to resist AMPs’ killing through the Pmt system. The residence of virulent strains necessitates the continuous monitoring of potential infections, as well as annealing, to take protective decolonization measures.

A Subcutaneous Abscess Caused by Candida Krusei Infection: A rare Manifestation

Candida is considered a normal microbiota of the gastrointestinal and genitourinary systems with a tendency for an invasive disease if the predisposing conditions exist. Mucocutaneous manifestations of Candida infection include the commonly encountered oropharyngeal thrush, vulvovaginitis, balanitis, intertrigo, paronychia, diaper dermatitis, and the rare chronic mucocutaneous candidiasis. Subcutaneous abscess due to Candida (albicans and non-albicans) is rare, with the literature available only in case reports. We report the first case of a subcutaneous perineal abscess due to C. krusie in a patient with poorly controlled diabetes without immune compromised conditions or a hematologic malignancy.

Macrophage-targeting bioactive glass nanoparticles for the treatment of intracellular infection and subcutaneous abscess.

Staphylococcus aureus (S. aureus) can survive phagocytosis and gain shelter from macrophages in some cases, and the clinical treatment of the intracellular bacterium also encounters the difficulty of traditional antibiotics in entering mammalian cells. In this work, we use mannose-modified bioactive glass nanoparticles decorated with silver nanoparticles (BGNs-Man/Ag) to treat the S. aureus-induced intracellular infection of macrophages. The results showed that BGNs-Man/Ag could target macrophages, elevate the intracellular ROS levels and drive them toward the M1 phenotype, which was crucial to activate the cell autonomous defence in disposing the intracellular infection. Attractively, BGNs-Man/Ag exhibited higher intracellular bacterial killing efficiency than free vancomycin. For the in vivo treatment of subcutaneous abscess, BGNs-Man/Ag significantly increased the population of M1 macrophages at the early stages of the infection site, resulting in enhanced bactericidal activity and improved regeneration of skin tissues. In short, BGNs-Man/Ag can be a promising antibacterial material in treating the S. aureus-induced intracellular infection of macrophages and subcutaneous abscesses.

Diverging Artifact in a Subcutaneous Abscess Derived from Spatial Compound Imaging.

Diverging Artifact in a Subcutaneous Abscess Derived from Spatial Compound Imaging.

外傷後に頬部皮下膿瘍を呈した小児例

外傷後に頬部皮下膿瘍を呈した小児例

A Case of Subcutaneous Abscess Formation Due to Transverse Colon Penetration of a Migrated Biliary Stent

A Case of Subcutaneous Abscess Formation Due to Transverse Colon Penetration of a Migrated Biliary Stent

Innate and mild Th17 cutaneous immune responses elicited by subcutaneous infection of immunocompetent mice with Cladosporium cladosporioides

Cladosporium cladosporioides is a dematiaceous hyphomycete that is pathogenic in the superficial and deep tissues of both immunodeficient and immunocompetent humans and animals. Our aim was to evaluate the antifungal immune responses elicited by C. cladosporioides in immunocompetent mice.Hence, we subcutaneously injected suspensions of C. cladosporioides spores into immunocompetent mice to investigate the anti-fungal immune responses in the skin. We collected skin tissue samples for histopathological examination, immunofluorescence staining, and quantitative real-time polymerase chain reaction analysis.We observed subcutaneous abscesses in mice after subcutaneous injection of C. cladosporioides. A large number of inflammatory cells, including dendritic cells, macrophages, and neutrophils, infiltrated the focal abscess, with comparatively few infiltrating inflammatory cells in the epidermal and dermal layers of the skin. We detected the expression of CD54 in the abscesses and the skin. Gene expression of the pattern recognition receptors Dectin-1 and TLR-2 was higher in infected mice than in controls. Gene expression of the cytokines IL-6, IL-1β, and IL-17A also increased after infection, suggesting that the Th17 signaling pathway may be involved in the anti-fungal response. Although the pathogenicity of C. cladosporioides in healthy mice was weak after subcutaneous infection, resulting in few serious pathological phenomena, it appears that innate and Th17 immune responses play important roles in the cutaneous host response to C. cladosporioides. These findings lay a foundation for further study of the pathogenic mechanism and treatment of C. cladosporioides infection.

A subcutaneous abscess following anti‐programmed cell death 1/programmed death‐ligand 1 antibody treatment for lung cancer

Immune checkpoint inhibitor targeted programmed cell death 1/programmed death-ligand 1 or CTLA4 develops immune cell-mediated anti-cancer treatment showing a beneficial impact on the clinical outcomes. On the other hand, these treatments sometimes enhance an undesirable immunological adverse reaction to various organs. Herein, we experienced a case of subcutaneous abscess located in the previously received appendectomy following atezolizumab for lung cancer.

Extirpación quirúrgica de absceso en conejo (Oryctolagus cuniculus): Reporte de caso

An adult male rabbit (Oryctolagus cuniculus), weighing 3.3 kg, presenting a firm looking mass located in the ventral thoracic region, apparent bite wounds in the same region and history of recent fight with another rabbit, received veterinary medical attention. The initial clinical suspicion was subcutaneous abscess, based on the anamnesis and physical examination, and it was confirmed through cytological examination. The treatment was surgical, using the marsupialization technique. After ten days postoperatively, it was found that this treatment did not achieve satisfactory results, because there was no reduction of the abscess. Therefore, it was decided to perform a surgical excision of the abscess. This second treatment had satisfactory results, as it was possible to completely remove the abscess and there was no recurrence. The patient was discharged after fifteen days. Based on the literature and our observations of the case described here, we conclude that surgical excision is the most suitable treatment for subcutaneous abscesses in rabbits. The abscess marsupialization surgery was not effective due to the extent and location of the abscess, and this technique is recommended for cases in which the abscess is deeply attached to subcutaneous structures and its complete excision is not possible, and when it is located in the perineal region or at the base of the ear, otherwise there are great chances of recurrence and treatment failure.

A comprehensive study to evaluate the wound healing potential of okra (Abelmoschus esculentus) fruit

Ethnopharmacological relevanceOkra fruit (Abelmoschus esculentus (L.) Moench) has been extensively used for the treatment of skin damage and subcutaneous tissue abscess for many years in Turkish folk medicine. Aim of studyIn this study, we aimed to investigate the wound healing potential of okra fruit by in vitro and in vivo experimental models in detail. Furthermore, based on the results of experiments, a wound healing formulation was developed and its activity profile was studied. Materials and methodsFor this purpose, the phenolic, flavonoid and proanthocyanidin contents and chemical profile of aqueous and ethanolic extracts prepared from okra fruits cultivated in two different locations of Turkey, i.e. Aegean and Kilis regions, were comparatively determined and the tryptophan levels, which is known to be an influential factor in wound healing, were measured. Antioxidant activity of the okra fruit extracts was determined by DPPH test, ABTS radical scavenger activity, iron-binding capacity, total antioxidant capacity and copper reduction capacity assays. Moreover, antibacterial activity potentials of the aqueous and ethanolic extracts of okra fruits were determined. The protective effect of the extracts against H2O2-induced oxidative stress and anti-inflammatory activity were assessed in HDF (human dermal fibroblast) cells and in RAW 264.7 murine macrophages, respectively. The biocompatibility of the gel formulations prepared with the best performing extract were evaluated by human Epiderm™ reconstituted skin irritation test model. Wound-healing activity was investigated in rats by in vivo excision model and, histopathological examination of tissues and gene expression levels of inflammation markers were also determined. ResultsAccording to our findings, the aqueous and ethanolic extracts of okra fruits were found to possess a rich in phenolic content. Besides, isoquercitrin was found to be a marker component in ethanolic extracts of okra fruits. Both extracts exhibited antioxidant activity with significant protective effect against H2O2-induced damage in HDF cells by diminishing the MDA level. Also, the highest dose of ethanolic extracts has displayed a potent anti-inflammatory activity on LPS-induced RAW264.7 cells. Besides, both water and ethanolic extracts were shown to possess antimicrobial activity. On the other hand, the formulations prepared from the extracts were found non-irritant on in vitro Epiderm™-SIT. In vivo excision assay showed that tissue TGF-β and IL-1β levels were significantly decreased by the 5% okra ethanolic gel formulation. The histopathological analysis also demonstrated that collagenisation and granulation tissue maturation were found higher in 5% (w/v) okra ethanolic extract-treated group. Conclusion5% of okra ethanolic extract might be suggested as a potent wound healing agent based on the antimicrobial, antioxidant and anti-inflammatory tests. The proposed activity was also confirmed by the histopathological findings and gene expression analysis.

Transdermal Photothermal Sterilization and Abscess Elimination Research of BSA-CuS Nanoparticles in vivo.

The treatment of subcutaneous abscess caused by drug-resistant bacteria is facing great difficulties and receiving more attention. In this work, we employed BSA-CuS nanoparticles as a photothermal reagent to apply photothermal therapy (PTT) to combat drug-resistant bacteria in vitro and subcutaneous abscess in vivo. The BSA-CuS nanoparticles were found to be stable and biocompatible without cytotoxicity toward NIH3T3 and 4T1 cells. In vitro experiments showed that three species of drug-resistant pathogens, including Escherichia coli, Staphylococcus aureus, and Candida albicans, could be effectively sterilized under co-incubation with BSA-CuS nanoparticles and then irradiation with 1064 nm NIR laser via tissue penetration. BSA-CuS nanoparticles together with 1064 nm NIR laser irradiation could also effectively diminish subcutaneous abscesses caused by drug-resistant bacteria on mice under PTT and depth PTT without causing any serious side effects and organic damage in vivo.That is OK, thank you!

Retrospective Analysis of 10 Cases of Disseminated Nontuberculous Mycobacterial Disease with Osteolytic Lesions.

PurposeDisseminated nontuberculous mycobacterial (DNTM) infection can involve multiple organs, including the lungs, skin and soft tissues and lymph nodes. However, NTM infection leading to osteolysis has been rarely reported. Here, we analyzed the clinical features, osteolytic mechanisms, treatment and prognosis of patients with DNTM disease with osteolytic lesions.Patients and MethodsThis retrospective study was conducted between January 1, 2011, and December 31, 2020, at the First Affiliated Hospital of Guangxi Medical University and the Fourth People’s Hospital of Nanning City. Patients who had culture and/or histopathological proof of DNTM disease with osteolytic lesions were included.ResultsTen HIV-negative patients with DNTM disease with osteolytic lesions were enrolled. Five of these patients had underlying diseases. Seven and three of the patients were positive and negative for anti-interferon-γ autoantibodies (AIGAs), respectively. The AIGA positivity rate was 70% (7/10). Ostealgia and anemia were the most common symptoms, followed by fever, emaciation, cough, expectoration, anorexia, subcutaneous abscesses and lymphadenopathy. Leukocyte and neutrophil counts were increased. The most common sites were the vertebrae, sternum, clavicle and ribs, although the femur, ilium, humerus, and scapula were also involved. Radiography and computed tomography (CT) showed moth-eaten or irregular destruction of bone, bone defects, pathological fracture, periosteal proliferation and surrounding abscesses. Emission CT (ECT) bone scans showed significantly increased uptake in many skeletal regions. Positron emission tomography(PET)/CT showed metabolic activity in multiple bones. All patients received anti-nontuberculous therapy, and five underwent surgery. Two died during treatment.ConclusionDNTM infection of bone and leading to osteolysis usually occurs in patients with AIGA-positive antibodies. DNTM disease with osteolysis is characterized by increased leukocytes and neutrophil counts, focal suppurative granulomas, and multiple areas with moth-eaten or irregular destruction of bone with increased radioactive concentrations. Early diagnosis and timely, effective combination anti-NTM therapy can improve the prognosis.

SP9.1.1 The Impact of Anaesthetic Use on Healing in Sub-cutaneous Abscess Management: A Retrospective Before and After Cohort Study

AimsDespite being the most common surgical procedure, there is wide variation that exists in the management of simple subcutaneous abscesses with no national guideline describing best practice. During the COVID-19 Pandemic national guidelines promoted the use of regional or local anaesthetic (LA) instead of general anaesthesia (GA) to avoid aerosol generating intubation associated with GA. This study aimed to assess the impact of anaesthetic choice in outcomes following incision and drainage of subcutaneous abscesses.MethodsTwo cohorts of patients undergoing abscess incision and drainage at St. James’ University Hospital Leeds were retrospectively identified over a 14-week period before and after the introduction of the new COVID-19 anaesthetic guidelines. Wound healing surrogate endpoints were used: i) total number of follow up appointments and ii) attendance to healthcare services after 30 days from I&D.Result133 patients were included. Significantly more procedures were performed under LA after the intervention (84.1% vs 5.7%; p < 0.0001) with a significant reduction in wound packing (68.3% vs 87.1%. p=0.00473). Follow up data found no significant difference in the average number of follow-up appointments (7.46 vs 5.11; p = 0.0731) and the number of patients who required ongoing treatment after 30 days (n = 14 vs n = 14, p = 0.921). ConclusionDrainage of simple subcutaneous abscess under 5 cm is safe under local anaesthetic with no significant difference in surrogate endpoints of wound healing observed in this patient cohort. Recurrent packing may not be required. Future work should explore patient reported measures such as pain management and the health economics of this intervention.

886 Healing Hands and Thrifty Plans! A Prospective, Cost-Effective Trial in Abscess Management

Abstract Aim Cutaneous abscesses are ubiquitous presentations requiring surgical drainage in most cases. There is a wide variation across the UK in the surgical practice dealing with such common problem. The aim of this study was to reduce the costs incurred in surgical drainage of acute skin and soft tissue abscess. Method This was a prospective, cost-effective study of the expenses incurred in surgical drainage of acute cutaneous and subcutaneous abscesses treated under the general surgeons' care over one year. Results A consequential saving of £13,962 was achieved during the study period. Between October 2019 and October 2020, 322 patients with soft tissue abscesses were treated by incision and drainage in general surgery. We calculated a total cost of £55.26 per patient for this routine operation. These expenses were based on basic surgical drapes pack, standard surgical gowns, sterile gloves and obtaining and processing the microbiology specimens. We have designed and implemented a new theatre protocol specifically for this procedure, resulting in a substantial reduction of the costs to £11.90 per patient. The total savings of £13,962 do not include savings caused by abscess drainage under local anaesthesia and does not calculate the savings that occurred due to shorter inpatient stay. These extra savings will be calculated and added later. Conclusions Considering the increasing financial burden on the NHS, we could make significant savings of nearly 80% of the operative costs of surgical drainage of a cutaneous abscess. We could achieve that by implementing simple modifications in the current surgical pathways without compromising patients' safety.

TUBERCULOUS GUMMA AN UNUSUAL EXTRAPULMONARY TB IN A 17-YEAR-OLD MALE: A CASE REPORT

TOPIC: Chest Infections TYPE: Fellow Case Reports INTRODUCTION: Extrapulmonary TB (EPTB) is estimated at 15% of the global burden and 1.5% of these cases are cutaneous TB. Tuberculous gummas, are unusual forms of cutaneous TB, with an incidence of 1%–2% of all cutaneous TB cases. Local data shows a total 139 tuberculosis of skin and subcutaneous among pediatric population as reported by the accredited hospitals of the Philippine Pediatric Society. CASE PRESENTATION: This is a case of a 17-year-old male, Filipino, from Metro Manila with a history of chest pain, aggravated by exertion, relieved by rest and a lumbar mass a year prior to consult. He was seen at outpatient clinic with a lumbar mass measuring 16cm x 17cm, on the right and 9cm x 7cm on the left, both were soft and non-tender. (Figure 1) His chest CT scan showed opacities in the mediastinum, reticulonodular opacities in the left upper lobe and pericardial thickening with a large, well-circumscribed, non-enhancing hypodense mass in the right posterior chest wall underneath the right trapezius muscle. Ultrasound of his lumbar mass revealed subcutaneous anechoic masses and greenish purulent fluid was evacuated. The collected specimen was positive for reverse transcriptase PCR for M. tuberculosis DNA. DISCUSSION: Tuberculosis (TB) is primarily transmitted via airborne. Cutaneous TB a rare form is acquired via 4 routes: (1) direct inoculation from an exogenous source such as in tuberculous chancre and verrucosa cutis; (2) direct extension from a primary focus such as in scrofuloderma; (3) hematogenous spread such as in miliary tuberculosis and tuberculous gumma and (4) lymphatic spread such as in lupus vulgaris. Metastatic tuberculous abscess known as tuberculous gumma presents as non-tender and fluctuant subcutaneous abscess, solitary or multiple on the trunk, extremities and often invade the skin. Similarly, our patient had a lumbar mass which was soft and non-tender. The National Tuberculosis Control Program recommends treatment of newly diagnosed tuberculosis involving the skin with 2 months intensive therapy with Isoniazid (10 mkd), Rifampicin (15 mkd), Pyrazinamide (30 mkd) and Ethambutol (20 mkd), followed by 4 months maintenance therapy of isoniazid and rifampicin whether bacteriologically confirmed or clinically diagnosed. In this patient, there was a significant decrease in the mass after 1-month intensive therapy with resolution of chest pain. CONCLUSIONS: Tuberculosis mimics various disease condition. This report presents a case of a patient with a rare form of extrapulmonary TB. Extrapulmonary TB should be a part of the differential diagnosis among individuals with baffling presentation, in our case a mass skin lesion. Adherence to government mandated preventive measures must be strictly implemented to further decrease the transmission of TB. It is likewise important to upskill health care personnel to identify possible cases of extrapulmonary TB and prevent its' dreaded outcomes. REFERENCE #1: Global Tuberculosis Report, Executive Summary 2020, Available, https://www.who.int/tb/publications/global_report/TB20_Exec_Sum_20201014.pdf REFERENCE #2: Machan A, Hanafi T, Hjira N, Boui M. Tuberculous gummas: Epidemiological, clinical, bacteriological, immunological, and therapeutic features. Int J Mycobacteriol 2018;7:203-11 REFERENCE #3: Philippine Pediatric Society ICD10 Registry. Philippine Pediatric Society. [cited 2021 April 24]. Available from https://pps.org.ph/icd-10-registry DISCLOSURES: No relevant relationships by Edmund Anthony Sumayod, source=Web Response

ИНФИЦИРОВАННАЯ КИСТА УРАХУСА У ВЗРОСЛОГО

Urachus is a tubular formation originating from the top of the urinary bladder and directed to the umbilicus between the peritoneum and the transverse fascia of the abdomen. In an embryo, it serves to divert primary urine to the amniotic fluid. In case, if obliteration of the duct does not occur until the birth, various pathological processes can develop in it. The most common abnomalies of urachus reported in adults are an infected urachal cyst and urachal carcinoma. These diagnoses are not always easy to make due to atypical symptoms of their manifestation and the rarity of these diseases - just two cases per 100,000 hospitalizations of adults. A 22-year-old man with a subcutaneous abscess and anexternal fistula located in theumbilical region with redness of the surrounding skin. 16 hours after dissection and drainaging of the abscess, the patient’s condition worsened, pain in the lower parts of the abdomen began, muscle tension of the anterior abdominal wall and inflammatory changes in blood tests were revealed. The patient was operated on for peritonitis. A two-chambered urachus cyst of the «hourglass» type, with the formation of a dense consistency calculus in one of the cavities, which perforated into the abdominal cavity This clinical case is of the great interest from the point of view of the atypical course and the treatment of a rather rare anomaly in adults. The publication will remind emergency medicine physicians about the possibility of infected urachus in patients with symptoms of acute abdomen.

Photodynamic and photothermal co-driven CO-enhanced multi-mode synergistic antibacterial nanoplatform to effectively fight against biofilm infections

Photothermal therapy (PTT) and photodynamic therapy (PDT) have garnered much attention for effectively treating biofilm infections. However, even highly efficient PTT reagents and photosensitizers still require high concentration and irradiation doses to ablate biofilms due to their limited permeability in biofilms, while these attempts tend to cause severe tissue damage and inflammation. Herein, a CO-enhanced multi-mode synergistic antibacterial nanoplatform (ICG&CO@G3KBPY) with controllable CO generation behavior, notably enhanced biofilm penetration, antibacterial, biofilm ablation, and anti-inflammatory activity was effectively developed to combat biofilm infections. ICG&CO@G3KBPY is constructed by physically encapsulating indocyanine green (ICG) and manganese pentacarbonyl bromide (MnBr(CO)5) into a 2,2′-bipyridine-4-carboxylic (BPY)-modified peptide dendrimer-based nanogel (G3KBPY). ICG&CO@G3KBPY can rapidly generate massive quantities of CO under the co-driven effects of PTT and PDT. Notably, the generated CO not only promotes the biofilm penetration of ICG and enhances the antibacterial and biofilm eradication performance of PTT and PDT, but also significantly alleviates the inflammatory response caused by bacterial infection, PTT and PDT. The combination of CO, PTT, and PDT offers excellent biofilm ablation effects in treating urinary catheter infection and subcutaneous abscesses, accompanied by good biocompatibility. This study provides an efficient and safe multi-mode synergistic antibacterial strategy for combatting biofilm infections.

Antimicrobial, Antibiofilm, and Anti-persister Activities of Penfluridol Against Staphylococcus aureus.

Staphylococcus aureus has increasingly attracted global attention as a major opportunistic human pathogen owing to the emergence of biofilms (BFs) and persisters that are known to increase its antibiotic resistance. However, there are still no effective antimicrobial agents in clinical settings. This study investigated the antimicrobial activity of penfluridol (PF), a long-acting antipsychotic drug, against S. aureus and its clinical isolates via drug repurposing. PF exhibited strong bactericidal activity against S. aureus, with a minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of 4–8 and 16–32 μg/ml, respectively. PF could significantly inhibit biofilm formation and eradicate 24 h preformed biofilms of S. aureus in a dose-dependent manner. Furthermore, PF could effectively kill methicillin-resistant S. aureus (MRSA) persister cells and demonstrated considerable efficacy in a mouse model of subcutaneous abscess, skin wound infection, and acute peritonitis caused by MRSA. Notably, PF exerted almost no hemolysis activity on human erythrocytes, with limited cytotoxicity and low tendency to cause resistance. Additionally, PF induced bacterial membrane permeability and ATP release and further caused membrane disruption, which may be the underlying antibacterial mechanism of PF. In summary, our findings suggest that PF has the potential to serve as a novel antimicrobial agent against S. aureus biofilm- or persister-related infections.

Evaluation of Different Methods of Treatment of Pilonidal Sinus; a Randomized Controlled Trial

Background: Sacrococcygeal Pilonidal disease is an infection of the skin and subcutaneous tissue at or near the upper part of the natal cleft of the buttocks. This results from chronic infection of hair follicles and subsequent formation of a subcutaneous abscess. Hair then enters the abscess cavity and provokes a foreign body tissue reaction with chronic suppuration and discharge. The aim of this study was the selection of best method of treatment of pilonidal sinus. Patients and methods: This randomized controlled trials was conducted on 56 patients with the diagnosis of pilonidal sinus disease were admitted to the Department of General Surgery, Zagazig University Hospitals from March 2020 to September 2020. The patients were allocated randomly into four groups, each included 14 patients; Group (1): was Conservative method with medical treatment and drainage if needed. Group (2): were operated by Open technique. Group (3): were operated by Limberg flap technique. Group (4): were operated by Karydakis technique. All patients were subjected to history taking, complete clinical examination, preoperative Laboratory investigations. Results: Recurrence was significantly associated with open and conservative groups while there was only one case in Limberg Group and no case in Karydakis Group. Conclusion: The Karydakis flap procedure should be chosen instead of the Limberg flap for treating uncomplicated Sacrococcygeal pilonidal disease because of its shorter operative time, earlier return to work, faster healing time and significantly higher patient satisfaction.

L-Arg-Rich Amphiphilic Dendritic Peptide as a Versatile NO Donor for NO/Photodynamic Synergistic Treatment of Bacterial Infections and Promoting Wound Healing.

The development of alternative strategies for the efficient treatment of subcutaneous abscesses that do not require the massive use of antibiotics and surgical intervention is urgently needed. Herein, a novel synergistic antibacterial strategy based on photodynamic (PDT) and NO gas therapy is reported, in which, a PDT-driven NO controllable generation system (Ce6@Arg-ADP) is developed with l-Arg-rich amphiphilic dendritic peptide (Arg-ADP) as a carrier. This carrier not only displays superior bacterial association and biofilm penetration performance, but also acts as a versatile NO donor. Following efficient penetration into the interior of the biofilms, Ce6@Arg-ADP can rapidly produce massive NO via utilizing the H2 O2 generated during PDT to oxidize Arg-ADP to NO and l-citrulline, without affecting singlet oxygen (1 O2 ) production. The combination of 1 O2 and the reactive by-products of NO offers notable synergistic antibacterial and biofilm eradication effects. Importantly, following efficient elimination of all bacteria from the abscess site, Arg-ADP can further generate trace quantities of NO to facilitate the angiogenesis and epithelialization of the wound tissues, thereby notably promotes wound healing. Together, this study clearly suggests that Arg-ADP is a versatile NO donor, and the combination of PDT and NO represents a promising strategy for the efficient treatment of subcutaneous abscesses.