weekly_question 15/11/2020

[Admin]

please write the answer and your justification, correct answer will be submitted after 48 hrs

A 17 year old male has had periodic pilonidal sinus infections. He has been treated with warm soaks, epilation and drainage of abscesses. He is planning to start college in 3 months and anxious to pursue surgical treatment.

Most appropriate initial surgical management of his symptomatic pilonidal sinus disease is:

A Sinusectomy

B Wide local excision & primary closure

C Wide local excision & open wound management

D Excision with Romberg advancement flap

E Excision with modified Limberg rotational flap

[Admin]

Correct Answer: A Sinusectomy

Systematic review of pilonidal sinus disease by the APSA Outcomes & Evidence-Based Practice Committee was published in 2019. The trend towards less invasive procedures was underscored with equivalent or better outcomes. Initial conservative measures such as local hygiene with warm soaks, debridement of inspissated hair shafts, epilation and drainage of abscesses are certainly appropriate. Phenol instillation within the tracts may also be of benefit. Asymptomatic patients may require no therapy.

However, if difficulties persist surgical intervention is warranted. Minimal excision (sinusectomy) with open healing is recommended over wide local excision due to faster recovery and similar recurrence rates. This technique of sinusectomy or "pit-picking" was first described by Lord-Milar in 1965, but more recently popularized by Gips in 2008 describing his results in 1358 cases with a recurrence rate of 6.5 % at 1 year.

In those patients who develop recurrent or persistent disease, failing more conservative measures, wide en-bloc excision may be required either leaving the wound open or closing the defect utilizing Bascom cleft lift, Karydakis advancement flap or modified Limberg rotational rhomboid flap. Midline closure is no longer recommended. Although off-midline flap closures are technically more complicated, associated with potential wound compllcations and longer recovery, recurrence rates are minimized.

[Magdilolah]

A.

[Azzouni]

C

[Dr Ammar]

E

[ashrarur]

https://www.youtube.com/watch?v=WLWHt7R-m6U

[ashrarur]

Gip's Procedure
https://www.sciencedirect.com/scienc...metic%20result.

[Abusnaina mohammed]

A

[Admin]

Correct Answer: A Sinusectomy

Systematic review of pilonidal sinus disease by the APSA Outcomes & Evidence-Based Practice Committee was published in 2019. The trend towards less invasive procedures was underscored with equivalent or better outcomes. Initial conservative measures such as local hygiene with warm soaks, debridement of inspissated hair shafts, epilation and drainage of abscesses are certainly appropriate. Phenol instillation within the tracts may also be of benefit. Asymptomatic patients may require no therapy.

However, if difficulties persist surgical intervention is warranted. Minimal excision (sinusectomy) with open healing is recommended over wide local excision due to faster recovery and similar recurrence rates. This technique of sinusectomy or "pit-picking" was first described by Lord-Milar in 1965, but more recently popularized by Gips in 2008 describing his results in 1358 cases with a recurrence rate of 6.5 % at 1 year.

In those patients who develop recurrent or persistent disease, failing more conservative measures, wide en-bloc excision may be required either leaving the wound open or closing the defect utilizing Bascom cleft lift, Karydakis advancement flap or modified Limberg rotational rhomboid flap. Midline closure is no longer recommended. Although off-midline flap closures are technically more complicated, associated with potential wound compllcations and longer recovery, recurrence rates are minimized.

[Admin]

Gip's Procedure
https://www.sciencedirect.com/scienc...metic%20result.

Thank you prof Ashrarur for video and paper

[ashrarur]

Always a pleasure dear. I enjoy learning all the time.

[Admin]

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