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Article
OPEN VERSUS CLOSED METHODS IN TREATMENT OF PILONIDAL SINUS DISEASE

Authors: Ali A Ali علي عزيز علي --- Basher A Abdul-Hassan بشار عباس عبد الحسن --- Anees K. Nile انيس خليل نايل
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2011 Volume: 9 Issue: 2 Pages: 114-119
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background: Pilonidal sinus disease can be managed surgically either by excision & primary closure, or by excision and leaving the wound to heal by secondary intention. This study is designed to show the difference between these two methods.Objective: To assess the difference between excision and primary closure versus excision and healing by secondary intention in treatment of pilonidal sinus disease.Methods: Between January 2005 and January 2009, 60 median aged patients with Pilonidal sinus disease were studied in Al-Kadhimiya Teaching Hospital, Baghdad, Iraq; 30 cases were operated by excision and primary closure (group І); the remaining 30 cases were operated by excision and healing by secondary intention, without closure (group II). The principle outcome measures recorded were duration of hospital stay, operative time, duration of complete healing, wound infection and recurrence rate. Satisfaction and comfort of patient was monitored by using visual analogue scale during first five days post-operatively. Data were statistically analyzed by using SPSS & Chi square.Results: A total of 60 patients were divided into 2 groups, 30 patients operated by using primary closure (group I), and 30 patients operated without closure (group II). Age range of patients was from (16 - 37 yrs). Duration of hospital stay and duration of complete healing was longer in patients of group II than those of group I (p ≤ 0.001). Operative time in group I is more than that in group II (p ≤ 0.001). Pain scores were lower in group I than group II (p = 0.004). The frequency of wound infection and recurrence rate after one year follow up were more in group I than group II, this was statistically of little significance.Conclusions: Excision and primary closure is recommended as a preferred procedure in the management of chronic sacral PNS disease. It has the advantages of short hospital stay, early wound healing, rapid return to work.Key words:pilonidal sinus, primary closure, secondary intention


Article
Excision with Primary Closure and Suction Drainage for Pilonidal Sinus in Adolescent Patients

Author: Ibtesam Khalid Salih Al-Shadydy
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2009 Volume: 8 Issue: 3 Pages: 228-231
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND :Controversy persist regarding the treatment of pilonidal sinus. Sacrococcygeal pilonidal disease is a common chronic disorder of the natal cleft that is often considered a minor problem, but may cause substantial in convenience and local infection. Therefore, adequate treatment of a pilonidal sinus is important in order to improve the quality of life of affected patients.OBJECTIVE:To evaluate the technique of excision with primary suture and suction drainage (PSD) for the treatment of pilonidal sinus in adolescent patients.METHODS:Between 1996 and 2005, forty patients aged 14-19 years (are range 16.4) underwent PS excision with primary closure and suction drainage. Anesthesia was general in 18 (45%) and spinal in 22 (55%). Prophylactic cephalosporine was used is I.V antibiotic. Excision of the sinus done down to the social fascia. Closed continuous suction drain was used.RESULT:No complications due to the anesthesia were observed. Twenty five patients (62.5%) had day case surgery, while the others fifteen patients, (37.5%) were hospitalized for 2-4 days (average 2.3 days). The drain was removed on post operative day 3-6 days (average 3.2 days) primary healing with no postoperative complications occurred in 36 patients (90%). Postoperative infections requiring incision , drainage, and lay-open occurred in 3 cases (7.5%). No recurrence was found at 12-months follow-up. One recurrence (2.5%) was noted 2 years after surgery.CONCLUSION:Excision with primary closure and closed-suction drainage as an ambulatory procedure is thus a simple and effective method of treatment of uncomplicated PS in adolescents


Article
The treatment of non complicated sacrococcygeal pilonidal sinus by minimal excision and primary closure technique

Authors: Nabil I. Naiem نبيل عصام نعيم --- Tharwat I Sulaiman ثروت ادريس سليمان
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2017 Volume: 59 Issue: 1 Pages: 9-13
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: The surgical treatment of pilonidal sinus varies from wide excision and laying the wound open or excision with primary closure or excision with the use of skin graft in some special cases.Objectives: The objectives of this study is to determine the efficacy of treating non complicated pilonidal sinus disease with minimal excision and primary closure technique, complications and recurrence rate.Patients and methods: This is a prospective study conducted in shahid ahmed ismaiel hospital in rania – As sulaimania IRAQ during the period from December 2013 to January 2016 and was carried on one hundred (100) consecutive patients with non complicated non recurrent pilonidal sinus patients who were treated with minimal excision and primary closure technique. The data were analyzed focusing mainly on complications mainly infection, gapping, wound disruption, recurrence rate and patient’s compliance to antibiotics use and local wound care.The results obtained were compared with other similar studies.Result: One hundred patients with non complicated pilonidal sinus were treated with minimal excision and primary closure technique.Fifteen patients developed superficial wound infection, seventeen patients developed simple superficial wound gapping .Three patients developed deep wound infection with disruption. Four patients developed recurrence and they were treated with re-excision and skin graft placement. Minimal follow up was six months, Operations were done under general or spinal anesthesia .operative time ranged between 12 to 22 minutes (mean time 17 minutes).Conclusion: Minimal excision and primary closure technique for the treatment of pilonidal sinus disease is associated with short hospital stay, shorter off work time, less cost, low complications rate and low chance of recurrence.Key words: Pilonidal sinus, minimal excision, primary closure, recurrence rate.


Article
Primary closure of the deltopectoral flap-donor site without skin grafting
الإغلاق الاولي لموقع سديلة deltopectoral المانحة دون تطعيم الجلد

Author: Othman A. Omar
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2014 Volume: 18 Issue: 3 Pages: 781-785
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Abstract

Background and objective: Deltopectoral flap is a two staged flap requiring skin graft of the donor site. This study was conducted to evaluate the possibility of primary closure of the deltopectoral flap-donor site without skin grafting.Methods: The operations were conducted at Rizgari Teaching Hospital in the center of Erbil City, Kurdistan Region of Iraq. From January 2009 to December 2012, 14 deltopectoral flaps for reconstruction of oral/facial cancer ablative defects were done. Data on the age, gender, tumor site, and postoperative complications related to primarily closed deltopectoral flap-donor site (fistula, dehiscence, or hematoma leading to impairment of wound healing) and postoperative hospital stay were recorded.Results: Of the 14 head-and-neck tumours, 10 were squamous cell carcinomas and four were ameloblastomas. Eleven of the patients were males and only three were females. The mean age (±SD) of the patients was 59±13 years. There was no evidence of partial or complete loss of the flap in any of the patients studied. There was no case of breakdown of the primarily closed donor site. The only registered complication was slight localized dehiscence at the most proximal and distal part of the primarily sutured flap donor site in one patient. Conclusion: Primary closure of deltopectoral flap donor site is possible with minimal complication that overcomes the problem of skin grafting. Minimal wound breakdown in younger patients had been noted and left to heal by secondary intention.


Article
Primary Wound Closure Versus Delayed Primary Wound Closure in Complicated Appendicitis in Tikrit Teaching Hospital
دراسة مقارنة بين الاغلاق الابتدائي للجرح و الاغلاق المتأخر للجرح في حالات إستئصال الزائدة الدودية المعقدة في مستشفى تكريت التعليمي

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Abstract

Background: Two methods are used routinely for wound management following an appendectomy: delayed primary closure, which involves packing an open wound for 4-5 days followed by wound closure, and primary closure, which means closing the wound at the time of surgery. Primary closure has the potential benefit of rapid wound healing associated with the elimination of painful and time-consuming dressing, as well as a reduction in overall hospital costs. Objective: To compare the incidence of wound infection after primary wound closure and delayed primary closure in patients with complicated appendicitis.Patients and Methods: A total of 78 patients with complicated appendicitis (gangrenous, perforated, and abscess) admitted to surgical wards in Tikrit Teaching Hospital for a period of 12 months (January 2013 to January 2014). Males were 45 and females were 33, their ages ranged from 17-55 years were included in the study. The patients were adult males and non-pregnant adult females whom underwent appendectomy for complicated appendicitis. Results: Age and gender were not significant factors affecting wound closure type (p=0.772 and p=0.942 respectively). The mean period of symptoms duration in patients with delayed primary closure was significantly (p=0.037) longer (5.9±3.11 days), than that with primary closure (2.81±2.07 days). Duration of surgery was significantly (p=0.021) longer (37.98±6.7 minutes) for delayed primary closure, than for primary closure (22.71±8.11 minutes). The mean duration of stay per hospital was significantly (p=0.030) shorter (6.84±1.71 days) for delayed primary closure than for primary closure (8.7±0.94 days). Conclusion: A better overall results related to the strategy of delayed primary closure despite the relative longer time of surgery and greater efforts done by the surgeon. This will give benefits to both the patient and surgeon.

خلفية الدراسة: هناك طريقتان متبعتان لإغلاق جرح عملية إستئصال الزائدة الدودية، إما عن طريق غلق الجرح الأولي، أو غلق الجرح المتأخر، والذي يشمل حشر الضماد داخل الجرح لمدة 4-5 أيام، ومن ثم يغلق الجرح. ينال الاغلاق الاولي فائدة سرعة التئام الجرح وتفادي الالم المصاحب لتغيير الضماد المكلف في حالة اغلاق الجرح المتأخر.الهدف من الدراسة: : للمقارنة بين حدوث التهاب الجرح بعد اغلاقه عن طريق الاغلاق الاولي والمتأخر بعد عمليات استئصال الزائدة الدودية المعقدة.المرضى وطرائق العمل: تضمنت الدراسة الحالية 78 مصاباً بالتهاب الزائدة الدوية المعقد (أكال، منفجرة، والخراج) مابين كانون ثاني 2013 وكانون ثاني 2014 من الراقدين في ردهة الجراحة لمستشفى تكريت التعليمي. كان عدد الذكور 45 اما عدد الإناث فكان 33. تمتد اعمارهم من 17 الى 55 سنة. اذ كان المشمولين بهذه الدراسة من الذكور البالغين والإناث البالغات غير الحوامل، الذين اجريت لهم عملية إستئصال الزائدة الدودية المعقدة. النتائج: لم تظهر الدراسة فروقا ذات دلالة احصائية لعاملي العمر والجنس على نوع اغلاق الجرح (p=0.0772 و p=0.942 بالتتابع). اذا كان معدل فترة ظهور الاعراض للمرضى الذين اجري لهم اغلاق الجرح المتأخر أطول (5.9±3.11 يوماً) ذو دلالة احصائية (p=0.037) مقارنة بمجموعة اغلاق الجرح الاولي (2.81±2.07 يوماً). وكانت فترة العملية الجراحية لمجموعة الإغلاق المتأخر أطول (37.98±6.7 دقيقة) ذات دلالة احصائية (p=0.021) من مجموعة الإغلاق الأولي (22.71±8.11 دقيقة). وكان معدل فترة رقود المرضى في المستشفى أقصر (6.84±1.71 يوماً) ذو دلالة احصائية (p=0.030) لمجموعة إغلاق الجرح المتأخر من مجموعة إغلاق الجرح الأولي (8.7±0.94 يوماً).الاستنتاج: كانت النتائج العامة ايجابية فيما يخص اغلاق الجرح المتأخر على الرغم من طول وقت اجراء العملية نسبياً مع الجهد الإضافي المبذول من قبل الجراح. وهذا ما يعطي فوائداً لكل من الجراح والمريض.


Article
The Value of Delayed Primary Wound Closure in Perforated Appendicitis
اهمية غلق الجلد المتاخر اثر انفجار الزائدة الدوديه

Author: Majeed H. H Al-Amiri مجيد العامري
Journal: IRAQI JOURNALOF COMMUNITY MEDICINE المجلة العراقية لطب المجتمع ISSN: 16845382 Year: 2017 Volume: 30 Issue: 1 Pages: 44-46
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background: the wound infection is the most common complication following operation for perforated appendix. Drainage and systemic antibiotic agents have not altered the incidence of wound sepsis in cases of perforated appendicitis with primary wound closure.Aims of study: to study the delayed primary wound closure in preventing wound infection in cases of perforated appendicitis.Patients and methods: This is a prospective study conducted on 216 patients with appendicitis who underwent operation at surgical wards of Al – Yarmouk Teaching Hospital, from January 2005- august 2008. The range of age from 11-56year, mean age was 33.5 years. For comparison purposes, the patients were divided into three groups:Group I:- uncomplicated (non perforated) appendicitis.Group II:- perforated appendicitis were treated with appendicectomy and primary wound closure. Group III: perforated appendicitis who were treated with appendicectomy and delayed primary wound closure. All the three groups patients were treated in the following manner:-Grid-iron incision done. Aspiration or swabs of peritoneal fluid or pus and appendix stump and wound edges were taken &send to the laboratory &cultured for aerobic and anaerobic bacteria, appendicectomy done after ligation of the mesoappendix and tube drains used.Results: There were no deaths encountered in the series of 216 patients. Wound infection was defined as any purulent discharge from the wound requiring drainage or repeated dressing, or any collection of purulent exudates in the wound requiring repeated dressing or drainage.Group I:-wound infection occurred in5.26%.Group II:- wound infection was noted in29.03%. Group III. wound infection occurred in 3.03%.

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