菱形皮瓣转移治疗骶尾部藏毛窦的护理

总结11例骶尾部藏毛窦患者经菱形皮瓣转移治疗的护理。护理重点为术前做好心理护理、肠道准备及急性感染期护理;术后加强病室管理、体位护理、创口护理、皮瓣移植区的护理,加强出院指导。11例患者切口均一期愈合,愈合时间11~17d,平均13d,随访3~15个月,均无复发。     

两种转移皮瓣成形术治疗骶尾部藏毛窦

目的 评价及比较2种转移皮瓣成形术治疗骶尾部藏毛窦的疗效。方法 96例骶尾部藏毛窦患者分别接受改良Limberg皮瓣成形术(Limberg组,28例)和改良Karydakis皮瓣成形术(Karydakis组,68例)治疗。记录和观察患者的手术时间、术后皮瓣坏死情况、伤口愈合情况、住院时间,术后随访至少3个月,观察复发情况。对2组数据进行比较。结果 Limberg组手术时间较Karydakis组长[中位数(四分位数间距)为110(3.75)min vs.90(40)min],皮瓣水泡、表皮坏死发生率较Karydakis组高(25%vs.0),伤口一期愈合率低于Karydakis组(46%vs.71%),住院时间长于Karydakis组[中位数(四分位数间距)为20(4.75)d vs.17(9)d](P均<0.05)。随访3~49(23.5)个月,2组复发率比较差异无统计学意义(P>0.05)。结论 改良Limberg皮瓣成形术及改良Karydakis皮瓣成形术均是治疗骶尾部藏毛窦的有效方法,改良Karydakis皮瓣成形术的疗效更好。     

骶尾部藏毛窦手术23例分析

目的 探讨骶尾部藏毛窦手术方法的临床效果.方法 使用窦道切除直接缝合术与窦道切除皮瓣转移相结合的手术方式,对23例骶尾部藏毛窦患者进行手术治疗.结果 23例患者中20例Ⅰ期愈合且恢复良好,2例术后复发,1例失败.结论 藏毛窦的手术方式因根据窦道切除后皮肤张力大小而定,若较小并且尚无感染,宜采用窦道直接切除,若张力大时采用皮瓣转移多能收到满意疗效.     

应用湿性愈合理念处理骶尾部藏毛窦的效果观察

目的探讨应用湿性愈合理念处理骶尾部藏毛窦脓肿切开后伤口的治疗效果。方法对8例骶尾部藏毛窦脓肿切开引流伤口给予彻底清创,每次伤口处理时观察伤口渗出液性质、量和气味,评估伤口基底情况,测量伤口大小、深度和潜行。根据伤口愈合的不同时期应用不同敷料进行伤口处理。结果经过3—7d伤口处理,8例伤口脓性分泌物消失,渗出液逐渐减少,肉芽组织开始生长,14～30d愈合,随访半年未见复发。结论对骶尾部藏毛窦脓肿切开后的伤口给予彻底清创和引流,采用现代新型敷料控制感染、管理渗液、调理伤口环境．能有效地促进伤口愈合。     

37例尾部藏毛窦病人手术前后的护理

尾部藏毛窦是一种少见的骶尾部皮肤上含有窦道的疾病。报告了37例尾部藏毛窦病人手术前后的护理。术前护理重点为:对于急性感染期的病人先行局部切开引流,用生理盐水反复冲洗窦道;术前1d做好局部皮肤和肠道准备。术后护理重点为:2~3d内尽量采用仰卧位,配合医生做好换药护理(排便后必须及时换药),观察窦道内是否含有毛发,并注意预防尿潴留。本组均行病灶切除术,创口愈合时间7~65d,随访均未复发。     

骶尾部藏毛窦术后伤口护理进展

藏毛窦是发生于骶尾部臀间裂软组织内的一种慢性窦道,内藏毛发是其特征。本研究主要总结了骶尾部藏毛窦的治疗方法和护理措施,骶尾部藏毛窦主要以根治性切除手术治疗为主,相关护理措施主要包括心理护理、饮食指导、尿潴留干预以及术后伤口护理等。湿性愈合理论及中医外治理念均对骶尾部藏毛窦术后伤口护理有指导意义。     

骶尾部藏毛窦15例诊治分析

目的：探讨骶尾部藏毛窦诊治方法。方法：回顾分析2004/2009年收治的骶尾部藏毛窦15例的临床资料,15例患者均接受手术治疗,其中9例行藏毛窦切除＋直接缝合术,3例行藏毛窦切除＋袋形缝合术,2例行藏毛窦菱形切除＋Limberg皮瓣转移术,1例行藏毛窦切除＋＂Z＂形皮瓣转移术。结果：15例患者中,14例经一次手术治愈,1例术后复发,经二次手术治愈。结论：术前仔细检查,明确手术范围,选择适当的手术方法,手术切除是主要治疗手段。     

骶尾部藏毛窦56例围手术期护理

目的 探讨尾部藏毛窦病人围手术期的护理。方法护理骶尾部藏毛窦病人56例,术前护理重点为：对于急性感染期的病人先行局部切开引流,用生理盐水反复冲洗窦道。术后护理重点为：术后6h内尽量采用仰卧位,配合医生做好换药护理,观察窦道内是否含有毛发,并注意预防尿潴留。结果本组均行病灶切除术,创口愈合时间30～65d,随访有3例复发。结论做好尾部藏毛窦病人手术前后的护理,可以有效地减轻患者痛苦,减少术后并发症,缩短住院时间,预防疾病复发,提高手术成功率。     

超声观察新生儿脊髓圆锥末端正常位置

目的 探讨超声确定正常新生儿脊髓圆锥末端位置的方法。 方法 选择足月产正常新生儿150名,用超声诊断仪测量内终丝的长度和骶圆距离,并以此表示新生儿脊髓圆锥末端的正常位置。 结果 新生儿内终丝的长度为3.62~5.54 cm;骶圆距离为5.92 ~9.72 cm;内终丝长度、骶圆距离与新生儿身高、体质量及内终丝长度与骶圆距离间均有一定相关性。 结论 内终丝的长度和骶圆距离能用以表示脊髓圆锥末端的位置。     

螺旋CT多平面重建技术在骶尾部病变诊断中的应用

目的 分析螺旋CT扫描及多平面重建(MPR)技术在骶尾部病变诊断中的应用价值。方法 对50例骶尾部疼痛患者摄骶尾骨正侧位DR片,后行螺旋CT骶尾部扫描,并进行多平面重建。结果 骶尾骨正侧位DR片均不能发现明显的病变;螺旋CT扫描及多平面重建后,5例发现明确的骨折征象,1例确诊为发育异常,1例确诊为尾部囊肿。结论 螺旋CT扫描及多平面重建技术能够多方位、全面、立体地显示骶尾骨及周围软组织的形态和结构,对骶尾部疾病的诊断和制定治疗方案有重要的临床意义。     

Is Hair Removal Necessary after Crystallized Phenol Treatment in Pilonidal Disease?

ObjectiveThe most important cause of posttreatment recurrence of pilonidal sinus disease (PSD) is the reentry of hair into the skin. The study aimed to investigate the effect of hair removal and its duration on the prevention of recurrence after crystallized phenol treatment.Subject and MethodsPatients with PSD who were treated with crystallized phenol treatment were evaluated. Hair in the sacrococcygeal area was removed with depilatory cream before every crystallized phenol procedure, during the treatment, and after treatment once a month for 6 years. Of 1,016 patients, 735 were contacted by telephone or e-mail regarding the frequency of sacrococcygeal hair removal and recurrence. Demographic and sinus features and crystallized phenol application data of patients treated with crystallized phenol for PSD, as well as recurrences were retrospectively assessed.ResultsThe mean follow-up time was 46.23 ± 33 (range, 11–240) months, with 139 (18.9%) patients experiencing recurrence. Patients who underwent hair removal experienced significantly less recurrence than those who did not (p = 0.003, odds ratio [OR]: 0.54 [95% CI: 0.36–0.82]). The OR of recurrence decreased by 0.8% every month as the hair removal time increased (OR: 0.992, 95% CI: 0.985–1.000, p = 0.049). The cutoff value for sensitivity was 0.636, specificity 0.466, and area under the curve 0.562 in hair removal procedures that lasted for over 30 months.ConclusionRegular hair removal during, and at least 30 months after, crystallized phenol treatment reduced recurrences in patients with PSD.     

The value of superficial parts and endoanal ultrasonography in evaluating pilonidal disease and exclusion of perianal sepsis

Introduction

Pilonidal disease is a benign anorectal inflammatory disease that involves the subcutaneous adipose tissue overlying the sacrococcygeal region.

The aim of the work

The current study aimed to assess the value of preoperative evaluation of pilonidal disease and the exclusion of perianal sepsis using superficial parts ultrasonography and endoanal ultrasound.

Methodology

Referred 30 patients were clinically diagnosed as pilonidal disease, all were examined with superficial parts ultrasonography and if the disease was extending to the perianal region further endoanal US was performed to exclude perianal sepsis.

Results

7 patients showed subcutaneous abscesses and 23 patients showed pilonidal sinus tracts. Among patients with pilonidal sinus tracts, six tracts (26 %) seen as superficially situated, short narrow tracts with straight course, no side branches and with a blind end situated away from the anal canal wall. 2 (9 %) tracts showed vertical orientation and three tracts (13 %) were wide and deeply situated reaching the presacral fascia. 7 cases (30 %) showed branching pilonidal sinus tracts, two cases of them showed more than one external opening. 5 patients (22 %) showed abnormally long tracts seen reaching the perianal region.

Conclusion

Ultrasonography is an available, inexpensive, safe imaging modality that yields a high degree of accuracy in evaluating pilonidal disease and in exclusion of perianal sepsis.     

Application of damage control surgery in patients with sacrococcygeal deep decubitus ulcers complicated by sepsis

ObjectiveTo evaluate the clinical application of damage control surgery (DCS) in patients with sacrococcygeal deep decubitus ulcers complicated by sepsis.MethodsWe conducted a 3-year retrospective clinical study of 32 patients with deep sacrococcygeal bedsores and sepsis admitted from January 2018 to January 2021. According to the concept of DCS, the wound was temporarily closed with vacuum sealing drainage after primary debridement, and a local rhomboid flap was designed to repair the wound in the second stage. Finally, the clinical therapeutic effect was observed.ResultsTwenty-nine patients were treated with skin flap translocation and were cured clinically. Specifically, the skin flap survived in 27 of the 29 patients after the first translocation attempt (success rate of 93.1%). One patient developed incisional dehiscence, and one patient developed a hydrocele under the skin flap.ConclusionsApplication of DCS in patients with sacrococcygeal deep decubitus ulcers complicated by sepsis improves the therapeutic success rate and reduces the risks of the operation and complication rate. It has unique advantages and is worthy of clinical promotion.     

Sacrococcygeal Foreign Body Progressing with Pilonidal Sinus Clinical Picture: Report of a Case

Background

Pilonidal sinus is a benign anorectal disease that is frequently seen in the sacrococcygeal area when a foreign body reaction develops after the invasion of hair follicles.

Objectives

Trauma in this region and clinical abscesses that recur after trauma due to foreign bodies are not frequently observed.

Case Report

This study presents the case of a patient with chronic leakage who had a history of three surgical procedures due to recurrent pilonidal abscesses and the presence of a foreign body in the sacrococcygeal area.

Conclusion

The presence of a foreign body in cases progressing with a single and wide inlet and frequently recurring abscess formation is a condition of which to be aware.     

Pedicle complex tissue flap transfer for reconstruction of duplicated thumbs with unequal size

BACKGROUNDThumb polydactyly is one of the most common congenital hand deformities, and the Bilhaut-Cloquet procedure or a modified one is often used. However, controversy remains over the rare instances in which both thumbs are not of similar length or far apart in distance.AIMTo evaluate the clinical outcomes of pedicle complex tissue flap transfer in the treatment of duplicated thumbs with unequal size.METHODSFrom January 2014 to December 2020, 15 patients underwent duplicated thumb reconstruction by pedicle complex tissue flap transfer at our hand surgery center. The technique was used when it was necessary to combine different tissues from both severed and preserved thumbs that were not of similar length or far apart in distance. Subjective parents’ evaluations and functional outcomes (ALURRA and TATA criteria) were obtained. The alignment deviation, instability, range of motion (percent of opposite thumb) of the interphalangeal and metacarpophalangeal joints, and the aesthetic aspects, including circumference, length, nail size, and nail deformity, were used to assess the clinical outcomes.RESULTSThe average age of patients at the time of surgery was 13 mo, and the mean final follow-up occurred at 42 mo. An appropriate volume with a stable joint and good appearance was obtained in 14 reconstructed thumbs. An unstable interphalangeal joint occurred in one thumb. The flexion-extension arc at the metacarpophalangeal joint was good, while that at the interphalangeal joint was poor. Most of the parents were satisfied with the cosmetic and functional results of the reconstructed thumbs. The mean ALURRA score was 21.8 (range: 20-24), and the Tada score was 6.9 (range: 5-8). Compared with the non-operated side, the length of the operated thumb was approximately 95%, the girth was 89%, and the nail width was 82.9%. The mean ranges of motion were 62.1% of that of the unaffected thumb in the interphalangeal joint and 78.3% in the metacarpophalangeal joint.CONCLUSIONHarvesting a pedicle flap from a severed thumb is a safe and reliable procedure. Defects of the preserved thumb, such as the skin, nail, and bone, can be effectively restored using the complex tissue flap.     

肛管和肛周疾病的MRI诊断

肛管是消化道的重要组成部分,具有复杂的解剖结构。近年来发生于肛管和肛周的疾病呈上升趋势,常见疾病包括肛瘘、肛周脓肿、痔、肛裂等,少见病包括肛管肿瘤、骶尾部藏毛窦及性疾病等,这些疾病严重影响患者的生活质量。MRI具有较高的软组织分辨率,能够全方位、多平面成像,作者着重探讨肛管和肛周疾病的MRI检查技术和表现,旨在提高对肛管和肛周疾病的诊断水平。     

外剥内扎加部分内外括约肌侧切术治疗环状嵌顿痔的临床观察

目的:观察和评价外剥内扎加部分内外括约肌侧切术治疗环状嵌顿痔的临床疗效。方法:将160例环状嵌顿痔患者随机分为治疗组和对照组各80例。治疗组采用外剥内扎加部分内外括约肌侧切术,对照组采用单纯的外剥内扎术。观察两组的疗效、术后创面愈合时间、术后并发症如切口疼痛、肛缘水肿、肛门狭窄、排便困难及术后控便力等。结果:两组在术后创面愈合时间及术后并发症方面均有统计学差异(P0.05)。结论:外剥内扎加部分内外括约肌侧切术治疗环状嵌顿痔具有缩短创面愈合时间、减少术后并发症发生等优点,值得临床推广。     

不溶性藻酸盐泡沫型一次性医用敷料在藏毛窦术开放性切口换药中的疗效观察

目的探讨不溶性藻酸钙泡沫型一次性医用敷料在藏毛窦术开放性切口换药中的临床疗效。方法对23例藏毛窦患者在术后开放性切口换药中,根据创面大小剪取条形状不溶性藻酸钙泡沫型一次性医用敷料放置创口,外加无菌纱布覆盖,1~2次·d-1。术后使用抗生素5~7 d。结果 23例患者术后48~96 h局部皮肤红肿、疼痛等症状消失,换药时患者疼痛减轻,创面渗液明显减少,住院20~25 d,均康复出院。结论在藏毛窦术开放性切口换药中应用不溶性藻酸钙泡沫型一次性医用敷料,可明显缩短创面愈合时间,且无明显的不良反应,是一种疗效好、安全性高的创口敷料。     

成人骶前囊肿再手术10例临床分析

目的探讨成人骶前囊肿再手术的临床特点和原因。方法对成人骶前囊肿再手术10例的临床资料进行回顾性分析。结果本组再手术距首次手术时间1个月～3年。再手术经骶尾部入路9例,经腹及骶尾部联合入路1例,均完整切除囊壁,顺利完成手术,术后伤口愈合时间平均38 d,术后平均随访6.5个月,均无复发。结论导致成人骶前囊肿再手术的主要原因为对此病认识不足,其次为术中囊壁切除不彻底、形成窦道经久不愈。加强对此病的认识,完善术前影像学检查,选用恰当手术方式,完整切除囊壁,是避免骶前囊肿再手术的关键。     

鼻内镜下中鼻道联合改良黏骨膜翻瓣精准下鼻道开窗治疗上颌窦囊肿的临床研究

目的探讨鼻内镜下中鼻道联合改良黏骨膜翻瓣精准下鼻道开窗治疗上颌窦囊肿的临床疗效。方法选择2016年1月-2019年12月该院收治的上颌窦囊肿患者57例,根据手术方式不同分为对照组(n=26)和研究组(n=31)。两组患者均行鼻内镜下上颌窦自然开口入路手术,对照组同时予常规下鼻道开窗术,研究组同时予改良黏骨膜翻瓣精准下鼻道开窗术。比较两组患者的手术相关指标、临床疗效及并发症发生情况。结果两组患者手术时间、术中出血量和住院时间比较,差异均无统计学意义(P 0.05);研究组下鼻道骨窗口及骨窗两侧切除的黏膜面积均小于对照组(P 0.05);两组患者临床疗效比较,差异无统计学意义(P 0.05);研究组上颌窦黏液纤毛传输时间(MTT)较对照组短(P 0.05);研究组术中并发症总发生率较对照组低(P 0.05)。结论鼻内镜下中鼻道联合改良黏骨膜翻瓣精准下鼻道开窗术治疗上颌窦囊肿具有较好的临床疗效,对患者创伤小、上颌窦功能影响小,且术中并发症发生率低,值得临床推广应用。