藏毛窦外科治疗的疗效分析

目的探讨骶尾部藏毛窦外科治疗方法。方法回顾性分析2007年7月至2014年2月南京中医药大学第一附属医院收治的骶尾部藏毛窦33例患者的临床资料,其中18例行藏毛窦切除+袋形缝合术,15例行藏毛窦菱形切除+Limberg皮瓣转移术。结果18例行藏毛窦切除+袋形缝合术经一次手术治愈。15例行藏毛窦菱形切除+Limberg皮瓣转移术均痊愈,其中5例出现切口部分裂开或坏死延迟愈合,均经常规换药引流后愈合。藏毛窦菱形切除+Limberg皮瓣转移术愈合时间较藏毛窦切除+袋形缝合术短[(19±7)d比(37±12)d,t=6.556,P<0.01].袋形缝合术组术后复发1例,复发率5.6%,Limberg皮瓣转移术组术后无1例复发,2组复发率相比差异无统计学意义(P>0.05)。结论藏毛窦菱形切除+Limberg皮瓣转移术与藏毛窦切除+袋形缝合术均可有效治疗藏毛窦,对于复杂性和复发病例尽可能选择皮瓣转移技术。     

菱形切除Limberg皮瓣转移术与切除一期缝合术治疗骶尾部藏毛窦疗效评价

比较菱形切除Limberg皮瓣转移术与切除一期缝合术治疗骶尾部藏毛窦的疗效。回顾性分析中国医科大学附属第四医院肛肠科2007年1月—2013年6月收治的122例接受两种不同术式治疗的骶尾部藏毛窦患者,其中藏毛窦菱形切除Limberg皮瓣转移术58例(皮瓣组),藏毛窦切除一期缝合术64例(缝合组)。随访12~89个月(平均43.6个月),比较两组的术后疼痛评分、手术时间、住院时间、切口愈合时间、复发及并发症的发生率。皮瓣组的术后疼痛评分、切口愈合时间、复发及并发症发生率均少于缝合组(P0.05);皮瓣组手术时间大于缝合组(P0.05);两组住院时间差异无统计学意义(P0.05)。菱形切除Limberg皮瓣转移术除了手术时间相对较长以外,操作并不复杂,术后疼痛轻、切口愈合时间短、并发症少、复发率低,值得临床推广。     

骶尾部藏毛窦21例治疗体会

目的 比较骶尾部藏毛窦切除后袋形缝合和一期缝合的临床疗效.方法 2007年至2012年我院收治藏毛窦患者并分别进行藏毛窦切除后袋形缝合术或一期缝合手术21例,其中12例采用袋形缝合,9例采用一期缝合.结果 藏毛窦切除后袋形缝合平均创面愈合时间（33.50±19.45）d,袋形组未见明显术后并发症,无复发;一期缝合平均创面愈合时间（27.33±17,16）d,2例术后感染,切开引流,二期愈合,1例出现术后感染后创面未愈,再次手术治愈,1例创面轻微裂开,复发1例（11.1％）.结论 藏毛窦切除后袋形缝合,术后并发症发生率低及复发率低,一期缝合的优点是创面愈合快,但是应当考虑到患者感染率较高的问题.     

四种手术方式治疗复发性藏毛窦的疗效观察

回顾性分析124例复发性藏毛窦手术患者的临床资料, 发现对于急性感染期的复发性藏毛窦患者可以选择袋形缝合, 非急性期的复发病例应尽可能选择皮瓣转移技术, 其中范围较大的藏毛窦或臀沟深陷者, 要优先考虑Limberg皮瓣转移术;对于范围较小并且对创面美观度要求高的藏毛窦患者, 应选择Bascom Ⅱ术。     

藏毛窦切除术后切口开放、缝合或皮瓣转移的疗效回顾

目的探讨藏毛窦手术3种不同切口处理方法的临床效果。方法 2005年5月～2009年10月施行藏毛窦手术62例,随访43例,其中单纯切除术12例(切口开放组),切除后缝合18例(切口缝合组),切除后行各种皮瓣转移术13例(皮瓣转移组,包括菱形皮瓣转移6例,椭圆形皮瓣转移5例,三角形皮瓣转移2例)。结果单纯切除组切口愈合时间(70.1±11.6)d,术后第1天疼痛VAS评分(3.7±0.9)分,愈合后切口不适、针刺样疼痛7例,其中2例瘢痕处反复脱皮,无复发。切口缝合组切口愈合时间(34.3±7.6)d,术后第1天疼痛VAS评分(3.7±1.1)分,术后切口渗出10例,裂开5例,皮肤及皮下组织坏死1例,切口不适、针刺样疼痛3例,无复发。皮瓣转移组切口愈合时间(21.2±6.1)d,术后第1天疼痛VAS评分(2.3±0.9)分,切口裂开2例,前8例中2例皮肤表皮层坏死,改善缝合方法后5例无皮肤坏死,切口不适1例,1例复发。结论藏毛窦手术后切口闭合愈合时间较短,不影响手术效果,择期行切口闭合手术应是较好选择。闭合方法的选择根据切口张力的大小而定,张力小时可直接缝合切口,张力大时采用皮瓣转移术。     

两种手术方法治疗骶尾部藏毛窦 43例的临床分析

目的:评价切开引流囊壁搔刮术与切除袋形缝合术治疗骶尾部藏毛窦的疗效。方法:回顾性分析43例骶尾部藏毛窦患者的临床资料,其中行切开引流囊壁搔刮术治疗(切口开放搔刮组)20例,行切除袋形缝合术治疗(切除袋形缝合组)23例。结果:切口开放搔刮组、切除袋形缝合组的手术时间分别为(30.40±5.22)min、(43.49±7.45)min,住院时间分别为(7.70±1.42)d、(8.17±1.47)d,愈合时间分别为(34.45±7.72)d、(24.48±5.96)d,术后疼痛NRS评分分别为(4.15±1.09)、(4.74±0.96)。两组手术时间、切口愈合时间的差异具有统计学意义(P<0.05),住院时间、术后疼痛的差异无统计学意义(P>0.05)。随访1~6年,两组均无复发。结论:彻底切除病变组织是治愈骶尾部藏毛窦的关键,急性感染期选择切开引流囊壁搔刮术、慢性窦道期选择切除袋形缝合术均可治愈骶尾部藏毛窦。     

改良Limberg皮瓣转移结合负压封闭引流治疗骶尾部藏毛窦的临床价值

为探讨改良Limberg皮瓣转移结合负压封闭引流（VAC）治疗骶尾部藏毛窦的临床价值,回顾采用改良Limberg皮瓣转移结合VAc或一期缝合、减张缝合、敞开引流治疗的37例骶尾部藏毛窦患者资料,就换药次数、材料消耗、住院时间及术后恢复工作时间进行对比分析。结果显示,改良Limberg皮瓣转移结合VAC治疗的患者在换药次数、住院时间及术后恢复工作时间方面均明显优于其他3种术式,P〈O．05;在材料消耗方面,与一期缝合者比较无明显差异,P〉0．05,但明显优于减张缝合、敞开引流治疗者,P〈O．05。结果表明,改良Limberg皮瓣转移结合VAC治疗骶尾部藏毛窦优于一期缝合、减张缝合、敞开引流治疗,值得临床推广应用。     

藏毛窦切除＋袋型缝合治愈藏毛窦7例体会

我院自2009年4月-2011年1月共收治藏毛窦患者7例,均采用了藏毛窦切除＋袋型缝合术,现报告如下。     

双改良Limberg转移皮瓣治疗骶尾部藏毛窦的短期临床疗效

目的探讨双改良Limberg转移皮瓣在治疗骶尾部藏毛窦中的效果。方法纳入2010年10月至2015年5月期间中国医科大学附属盛京医院收治的100例骶尾部藏毛窦患者,分为双改良Limberg转移皮瓣组(简称"双改良皮瓣组",n=30)、经典Limberg转移皮瓣组(简称"经典皮瓣组",n=30)及直接间断缝合组(简称"间断缝合组",n=40)3组。对3组患者的手术时间、术中出血量、住院时间、返回工作时间、复发情况及术后切口并发症发生情况进行对比分析。结果 1 3组患者的年龄、性别、体质量指数及术前并发症情况比较差异均无统计学意义(P0.05)。2术中出血量和住院时间在3组患者间比较差异均无统计学意义(P0.05)。手术时间在双改良皮瓣组和经典皮瓣组均明显长于间断缝合组(P0.05),双改良皮瓣组和经典皮瓣组间比较差异无统计学意义(P0.05)。返回工作时间在双改良皮瓣组和经典皮瓣组均明显短于间断缝合组(P0.05),双改良皮瓣组和经典皮瓣组间比较差异无统计学意义(P0.05)。复发率在双改良皮瓣组和经典皮瓣组明显低于间断缝合组(P0.05),双改良皮瓣组和经典皮瓣组间比较差异无统计学意义(P0.05)。3术后切口血清肿和切口部分裂开的发生率在3组患者间比较差异均无统计学意义(P0.05)。术后切口感染发生率在双改良皮瓣组和经典皮瓣组均明显低于间断缝合组(P0.05),双改良皮瓣组和经典皮瓣组间比较差异无统计学意义(P0.05)。术后切口浸渍率在双改良皮瓣组和间断缝合组均明显低于经典皮瓣组(P0.05),双改良皮瓣组和间断缝合组间比较差异无统计学意义(P0.05)。切口完全裂开率在双改良皮瓣组和经典皮瓣组均明显低于间断缝合组(P0.05),双改良皮瓣组和经典皮瓣组术后均无切口完全裂开者。双改良皮瓣组和经典皮瓣组均无皮瓣坏死发生。结论无论采用哪种转移皮瓣治疗骶尾部藏毛窦均有效,其较传统直接间断缝合有更低的切口并发症发生率,更短的返回工作时间,更低的复发率,而经典Limberg皮瓣较双改良Limberg皮瓣有较高的切口浸渍发生率。由于本研究的样本量比较少,双改良Limberg皮瓣技术长期临床疗效尚需要多中心随机对照试验来进一步证实。     

改良Limberg、Dufourmentel菱形转移皮瓣成形术治疗骶尾部藏毛窦

骶尾部藏毛疾病是原发于臀沟并向上蔓延的骶尾部慢性皮下感染,常反复破溃形成窦道即藏毛窦.藏毛窦的主要治疗方法包括:苯酚注射、冷冻、切开引流搔刮、病灶整块切除等[1].北京市肛肠医院近年收治的藏毛窦患者多为外院手术治疗失败或复发者,通常窦道分支复杂,病变范围广泛,如果术后创口开放,二期愈合时间很长;另一方面,也会增加患者伤口疼痛和换药次数.2010年1月至6月我们采用改良Limberg、Dufourmentel菱形转移皮瓣成形术治疗骶尾部藏毛窦16例,取得良好效果.     

Results of the Limberg transposition flap in the treatment of pilonidal sinus

The surgical treatment of pilonidal sinus with the Limberg transposition flap will be demonstrated in 40 patients (22 male; 18 female). First step is draining the infect by incision, followed by radical excision of the pilonidal sinus and covering of the defect by a rhomboid transposition flap. In 39 out of 40 cases primary wound healing occurred. No recurrence has yet been encountered. In one case a seroma was observed which was drained and showed secondary wound healing. The mean hospital stay was 7.9 days and the mean time until return to work was about 15 days. We consider the Limberg transposition flap to be an effective treatment of pilonidal sinus disease due to its technical simplicity and low complication rate.     

The Limberg transposition flap in surgical therapy of chronic pilonidal sinus

The operative treatment of pilonidal sinus is characterized by an increased rate of wound healing complications and late recurrences. The Limberg transposition flap is an easy method for covering the defect after excision of the pilonidal sinus. The flap smooths out the deep skin fold of the rima ani and counteracts in this manner an important pathogenetic factor of pilonidal sinus recurrence. Between 6/96 and 7/99 we treated 42 patients using this method without complications of wound healing or recurrences. Comparison of literature results of different operative treatments (open granulation, primary suture, Z-plasty) shows lessened complication and recurrence rates for the Limberg transposition flap, which is the method of choice for chronic pilonidal sinus nowadays.     

Modified Limberg Transposition Flap for Sacrococcygeal Pilonidal Sinus

Purpose. To investigate the results of wide rhomboid excision with Limberg transposition flap reconstruction to treat pilonidal sinus.Methods. We analyzed the well-documented records of 238 patients with sacrococcygeal pilonidal sinus who underwent wide excision with a Limberg transposition flap and were followed up for longer than 1 year postoperatively. After the first 40 operations, we modified this flap reconstruction by tailoring the rhomboid excision asymmetrically to place the lower pole of the flap 1–2cm lateral to the midline. Wound infection rates, hospitalization, time required for free mobilization, and recurrence rates were recorded.Results. Postoperative infection developed in two patients (0.8%), which was easily managed by wound care, antibiotics, removal of skin staples, prolonged drainage, or a combination of these treatments. The mean hospitalization was 2.10 ± 0.20 days (range 1–3 days), and the mean time required for recovery and return to daily activities was 8.00 ± 2.50 days (range 4–17 days). There were only three recurrences (1.26%) after a mean follow-up of 29.20 ± 3.10 months (range 12–38 months). Since we started performing our modification of the technique by lateralization of the inferior apex, no further recurrences have been seen. The recurrence rate differed significantly between the classical Limberg flap group and the modified Limberg flap group (P = 0.004)Conclusion. These results provide further evidence that wide excision with a Limberg transposition flap reconstruction is an effective surgical method for primary or recurrent pilonidal sinus, associated with a low complication rate, short hospitalization and disability, and a low recurrence rate. A modification of the technique was devised to further enhance wound healing and reduce the risk of recurrence.     

Limberg Flap for Sacrococcygeal Pilonidal Sinus a Safe and Sound Procedure

Sacrococcygeal pilonidal sinus (SC-PSD) is an acquired condition usually seen in young adults especially males. This prospective study has been performed to determine effects of the Limberg flap rotation surgery for sacrococcygeal pilonidal sinus, its feasibility to the patients, their compliance, and outcomes such as wound infection, postoperative pain relief, recurrence rates, and return to work. A total of 30 patients were operated by the same two surgeons from January 2009 to June 2011, including both primary and recurrent diseases, and patients with previous incision and drainage done for the pilonidal abscess. All patients successfully underwent surgery, with very minimal postoperative pain, stayed in hospital for average 5 days, returned to work after 3 weeks, with 3 patients having flap edema, 2 having flap necrosis, and no recurrences so far. Patients with flap edema and flap necrosis took 2–3 weeks to heal with regular dressing and antibiotic usage. Limberg flap for sacrococcygeal pilonidal sinus was found very useful and sound in terms of postoperative pain, infection rates, and early return to work with almost nil recurrences.     

Treatment of pilonidal sinus by primary closure with a transposed rhomboid flap compared with deep suturing: a prospective randomised clinical trial.

OBJECTIVE: To assess two techniques of primary closure after excision of pilonidal sinus. DESIGN: Prospective randomised study. SETTING: University department of surgery, United Arab Emirates. SUBJECTS: 46 patients with chronic pilonidal sinus disease, 24 treated by rhomboid flap transposition, and 22 by deep suturing technique. MAIN OUTCOME: Early mobility and recurrence. RESULTS: All patients in the rhomboid flap transposition group healed their wounds primarily compared with 17 in the primary deep suturing group (77%). (P = 0.02). Five patients wounds broke down as a result of haematoma and infection (23%). The mean hospital stay for the rhomboid flap technique was 6 days compared with 9 days after deep suturing, and the mean follow up for both groups was 18 months, the rhomboid flap group returned to work a mean of nine days earlier than the deep suturing group (23 days). No recurrence has been identified yet in the rhomboid flap group, while 2 recurrences have developed in the deep suturing group (9%). CONCLUSION: Primary closure after excision of pilonidal sinus with a transposed rhomboid flap is successful in the management of pilonidal sinus and is superior to primary closure by deep suturing.     

Pilonidal sinus: experience with the Limberg flap

A personal series of 162 patients with chronic pilonidal disease was treated by rhombic excision and Limberg transposition flap. Each sinus was totally excised and covered primarily by a fasciocutaneous Limberg flap. Full primary healing was obtained in 161 out of 162 patients. One patient had ischaemia which resulted in necrosis of the flap tips that healed later with a scar. Minor infection occurred in 12 patients (7%). The average hospital stay was 4.2 days, and no patient remained in hospital more than 12 days. The mean follow-up period was 18 months, and three recurrences (2%) have occurred. Surgery for pilonidal sinus should not only eradicate the presenting sinus formation but should also aim to eliminate factors that predispose to formation of another sinus. This can be achieved using a Limberg flap which reduces the depth of the cleft and ensures that all parts of the wound and all suture holes are away from the midline.     

Limberg Flap Versus Primary Closure in the Treatment of Primary Sacrococcygeal Pilonidal Disease; A Randomized Clinical Trial

Pilonidal sinus is a chronic intermittent disease, usually involving the sacrococcygeal area. This study was undertaken to compare the results of rhomboid excision followed by Limberg flap with that of excision and primary closure in patients with primary pilonidal sinus. A total of 120 patients with pilonidal disease were randomly divided into group A who underwent excision and primary closure (n = 60) and group B who underwent the rhomboid transposition flap procedure (n = 60). Length of hospital stay and postoperative complications in two groups were compared. Duration of hospital stay (P < 0.001) and time to resumption of work (P < 0.001) was less for group B, and postoperative complications were fewer in group B (P < 0.05). During follow-up of 2 years, no recurrence was detected in patients in group B, whereas five patients developed recurrence in group A (P = 0.02). Limberg flap procedure is better than the simple excision and primary closure for the management of sacrococcygeal pilonidal disease.