• Archives of Plastic Surgery
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• v.46 no.3
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• pp.235-240
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• 2019

Background The efficacy of Limberg flap reconstruction for pilonidal sinus with acute abscess remains unclear. This study aimed to compare outcomes after Limberg flap reconstruction for pilonidal sinus disease with and without acute abscess. A secondary objective was to perform a review of the literature on the topic. Methods A retrospective chart review was conducted of all patients who underwent excision and Limberg flap reconstruction for pilonidal sinus from 2009 to 2018. Patient demographics, wound characteristics, and complication rates were reviewed and analyzed. Results Group 1 comprised 19 patients who underwent Limberg flap reconstruction for pilonidal sinus disease without acute abscess and group 2 comprised four patients who underwent reconstruction for pilonidal sinus disease with acute abscess. The average defect size after excision was larger in group 2 than group 1 ($107.7{\pm}60.3cm^2$ vs. $61.4{\pm}33.8cm^2$, respectively). There were no recurrences, seromas or cases of flap necrosis postoperatively. There was only one revision surgery needed for evacuation of a postoperative hematoma in group 1. There were comparable rates of partial wound dehiscence treated by local wound care, hematoma, need for revision surgery and minor infection between group 1 and group 2. Conclusions Limberg flap reconstruction for pilonidal sinus in the setting of acute abscess is a viable option with outcomes comparable to that for disease without acute abscess. This practice will avoid the pain and cost associated with a prolonged local wound care regimen involved in drainage of the abscess prior to flap reconstruction.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.7 no.2
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• pp.105-112
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• 2014

Purpose: Ultrasound-guided epidural caudal block for low back pain and radiating pain is often performed in the treatment of outpatients. However, this procedure has a failure rate of up to 25% even when it performed by an experienced physician. The authors investigate the effectiveness of Ultrasound-guided epidural caudal block in patients related to disc herniation or spinal stenosis. Materials and Methods: Ultrasound-guided caudal epidural block was performed in 55 outpatients with LBP and radiating pain. Patient was placed in the prone position and sonographic image of sacral hiatus was obtained using linear probe. A 22-gauge needle was advanced into the sacrococcygeal membrane under ultrasound guidance and then medication was injected into the caudal epidural space. There were 31 cases of disc herniation, and 24 cases of spinal stenosis. Patients were evaluated by Visual Analog Scale (VAS) pain score at pre-treatment, post-treatment, 2 weeks and 4 weeks by telephone interviews. Results: 53 of the 55 cases (96.4%) of needle insertion into the sacral canal under ultrasound guidance were successful. Gender was not significantly different between disc herniation group and spinal stenosis group. But there was a significant age difference between disc herniation group ($42.3{\pm}10.8$), and spinal stenosis group ($62.8{\pm}15.1$) [p<0.001]. The VAS score at pre-treatment, post-treatment, 2 weeks, 4 weeks in disc group were 6.84, 3.1, 1.8 & 1.77. The VAS score at pre-treatment, post-treatment, 2 weeks, 4 weeks in spinal stenosis group were 6.88, 3.58, 4.33 & 4.88. The VAS score in both groups was significantly improved after the procedure (p<0.001). Over time, the two groups were statistically significant differences in VAS score after adjusting for age (p<0.001). Conclusion: Ultrasound-guided caudal epidural block seems to provide a high success rate and a significantly better response in disc group than spinal stenosis group.