Outcomes in the repair of pilonidal sinus disease excision wounds using a parasacral perforator flap
The ideal treatment for pilonidal sinus disease has yet to be defined. There are many approaches described in the literature.
Thirty-five consecutive patients who underwent wide excision of pilonidal sinus disease had the wound repaired using a parasacral perforator flap. Outcomes were assessed by case notes analysis and follow-up telephone and postal questionnaires.
There were ten minor complications including six minor wound edge dehiscences. There were two ischaemic complications, with one flap loss. There were 3 recurrences of pilonidal disease at a mean follow-up of 33 months, giving a 5-year recurrence free rate of 86%. Of the patients questioned, all would recommend the procedure to someone else despite 69% being dissatisfied with the cosmetic outcome.
This series indicates that the parasacral perforator flap technique is able to repair pilonidal sinus excision wounds successfully with minimal morbidity and a low recurrence rate at a mean of follow-up of 33 months. The study suggests that it may be a technique best reserved for recurrent cases of pilonidal sinus disease. Patients feel the procedure is successful despite reservations regarding the cosmetic outcome.
Available from: John Tallach Murchison
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ABSTRACT: Medical smartphone applications are increasingly popular amongst doctors. However, the quality of their content is variable. We assessed contemporary radiology-related smartphone applications, focussing on the level of advertised medical involvement in application development.
Six major application stores were searched between 18-30 June 2012 using the terms radiology, radiation, x-ray(s), computed tomography/CT, magnetic resonance imaging/MRI, ultrasound, nuclear medicine, fluoroscopy and mammography/mammogram. Application ratings, cost and medical input in development were recorded.
321 applications were identified. One hundred fifty-eight were "teaching" and 96 "reference". Three of the 29 DICOM viewing applications had FDA approval for primary diagnosis, while 62 % stated they should not be used for primary diagnosis; 24 % of applications stated named medical professional involvement, 12 % had unnamed medical involvement and 4 % acknowledged guidelines or papers; 42 % did not disclose authorship.
A large variety of radiology-related smartphone applications are available with many potential benefits. Advertised medical involvement in application design is variable, making assessment of their accuracy difficult prior to purchase. Additional measures are required to ensure the accuracy of such applications. The limitations of image interpretation using smartphones are a major drawback of DICOM viewing applications. Further research into the accuracy of primary diagnosis using such applications is needed.
• A large variety of radiology smartphone applications are available with many potential benefits • Variable medical involvement in application design limits assessment of accuracy before purchase • Limitations of image interpretation using smartphones are a drawback of DICOM viewing applications • Further work on the accuracy of primary diagnosis using these DICOM viewing applications is needed.
Insights into Imaging 08/2013; 4(5). DOI:10.1007/s13244-013-0274-4
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ABSTRACT: The clinical environment is becoming increasingly dominated by information technology, most recently the smartphone with its applications (apps) of a multitude of uses. There are already tens of thousands of medical apps available for download, to educate both patients and trainees, and many more are being designed to facilitate delivery of care. The rapid development of this technology has outgrown its quality evaluation and regulation, both urgently required to maintain patient safety, protect sensitive data, and ensure dissemination of accurate information. We review medical apps themed towards cardiothoracic surgery in terms of medical professional involvement in their content and design.
iTunes and Play Store were searched for cardiothoracic surgery-themed medical apps, using the terms cardiothoracic, thoracic, cardiac, heart, lung, surgery, and variations thereof and including the term medical.
A focused search yielded 379 apps, of which 6% were associated with a named medical professional, 15% with a publisher or professional society, and 63% with a user rating.
The findings suggest inadequate input from the medical profession. The article discusses the pressing issues regarding quality evaluation, regulation, and information security, required for smartphones and handheld devices to become an integral and safe part of delivery of care.
The Journal of thoracic and cardiovascular surgery 10/2013; 146(6). DOI:10.1016/j.jtcvs.2013.08.033 · 4.17 Impact Factor
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ABSTRACT: The Italian Society of Colorectal Surgery (SICCR.) has prepared clinical practice guidelines to help its members to optimize the treatment of pilonidal disease, a very common condition, especially among young people, and therefore of great importance on a socioeconomic level. The SICCR committee of experts on pilonidal disease analyzed the international literature and evaluated current evidence. Nonoperative management includes gluteal cleft shaving, laser epilation as well as fibrin glue and phenol injection: reported healing rates and recurrence incidence are satisfactory but the majority of studies are small series with low-quality evidence. Surgical therapy which can be divided into two categories: excision of diseased tissue with primary closure using different techniques or excision with healing by secondary intention. On the whole, no clear benefit is demonstrated for one technique over the other.
Techniques in Coloproctology 09/2015; 19(10). DOI:10.1007/s10151-015-1369-3 · 2.04 Impact Factor
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