Cleft closure for the treatment of unhealed perineal sinus

Branagan, Graham; Thompson, Michael R.; Senapati, Asha

doi:10.1111/j.1463-1318.2005.00925.x

Cited by 15 publications

(10 citation statements)

References 19 publications

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“…The conservative methods such as phenol injection, laser epilation, and shaving are used in the early stages of PSD with different success rates [8][9][10]. Surgical methods including primary closure, marsupialization, the Limberg flap, and cleft closure [11][12][13][14][15] have also been performed for treating PSD; however, there is no current agreement as to what the ideal treatment is. The preferred operation for PSD should be simple, cost-effective, and associated with minimal pain and postoperative complications.…”

Section: Discussionmentioning

confidence: 99%

Modified Limberg transposition flap in the treatment of pilonidal sinus disease

et al. 2011

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Section: Discussionmentioning

confidence: 99%

Modified Limberg transposition flap in the treatment of pilonidal sinus disease

et al. 2011

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“…55,56 Recently, a cleft closure, modified from a technique for treatment of pilonidal disease, has been described. [57][58][59] Branagan and colleagues achieved 100% successful healing in 8 patients using this procedure, which was performed as a same-day surgical procedure with local anesthesia. However, only one patient in the series had Crohn's disease.…”

Section: Treatment Of the Unhealed Perineal Woundmentioning

confidence: 99%

Management of Nonhealing Perineal Wounds

Genua

Vivas

2007

Clinics in Colon and Rectal Surgery

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The manifestations of perianal Crohn's disease vary from primary lesions such as skin tags and fissures, to diffuse septic destruction of tissue and sphincter muscle. These manifestations are often persistent and refractory to surgical treatment; however, a more disappointing scenario is when the treatment itself results in a chronic wound. The ideal approach for management involves basic surgical principles, careful patient selection, and realistic expectations. Choice of appropriate procedure, effective elimination of sepsis, thorough evaluation to rule out concomitant systemic disease, and appropriate use of fecal diversion are each an important principle. If proctectomy is necessary, several strategies such as intersphincteric dissection, avoidance of fecal contamination, and appropriate wound closure, are effective in diminishing the postoperative morbidity of an unhealed perineal wound. When an unhealed perineal wound develops in a patient with Crohn's disease, the initial management is conservative. When surgical treatment is necessary, success depends on careful patient selection, optimizing the patient's condition, elimination of sepsis, and choice of an effective technique for healing.

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“…on the basis of theoretical evidence requiring the wound to heal outside the midline, we recently introduced the Branagan's modification of Bascom's natal cleft lift (18,21). This technique requires resection of the pilonidal sinus and (part of the) vulnerable raphe, flattening of the natal cleft and tension-free asymmetrical closure, avoiding a scar in the midline.…”

Section: Introductionmentioning

confidence: 99%

“…In order to avoid median recurrences and flatten the natal cleft, surgeons have developed numerous procedures such as the Karydakis technique (3,16,17), Bascom procedure (18,19,20,21) and other asymmetrical closing techniques (22,23) such as rhomboid excision with Limberg (24,25,26,27) or Dufourmentel flap closure (28), z-plasty (29) or rotation flap (30). In general, results of these asymmetrical closure and flap techniques seem better than results of open technique or primary midline closure techniques, although the surgical trauma is more extensive, and cosmetic results are not always optimal.…”

Section: Introductionmentioning

confidence: 99%

Secondary Healing versus Midline Closure and Modified Bascom Natal Cleft Lift for Pilonidal Sinus Disease

et al. 2011

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Background and Aims: pilonidal sinus disease is a common disease in young employed male adults. ongoing discomfort usually indicates an operative intervention. the main drawback is however the complication of wound healing. numerous techniques for surgical treatment have been proposed, which underlies the lack of a superior technique.Material and Methods: a retrospective study was performed on the medical notes of 62 patients operated for a pilonidal sinus between may 2005 and december 2006. used techniques were: 'modified Bascom procedure', 'excision and primary closure' and 'excision with secondary wound healing'. patients' characteristics, operative parameters and data on outcome were included. the primary endpoint was wound healing.Results: twenty-five patients underwent the modified Bascom procedure, 19 underwent surgical excision with primary midline closure and 18 underwent surgical excision with secondary wound healing. there were no demographical differences between the groups of patients. the modified Bascom technique showed a significantly reduced wound healing time (29 days) compared to primary closure (52 days, p < 0.01) and secondary healing (62 days, p < 0.01). the duration of this modified procedure was significantly longer (49, 33 and 24 minutes respectively, p < 0.01).Conclusions: Wound healing remains an important problem in the surgical treatment of pilonidal disease. Significant faster convalescence can be achieved using the modified Bascom procedure. Wide local excision as primary therapy should not be advocated.

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Cleft closure for the treatment of unhealed perineal sinus

Abstract: Modified cleft closure for persistent perineal sinus is a simple procedure with low morbidity that can be performed under local anaesthetic in the day surgery unit.

Cited by 15 publications

References 19 publications

Modified Limberg transposition flap in the treatment of pilonidal sinus disease

Modified Limberg transposition flap in the treatment of pilonidal sinus disease

Management of Nonhealing Perineal Wounds

Secondary Healing versus Midline Closure and Modified Bascom Natal Cleft Lift for Pilonidal Sinus Disease

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