PURPOSE: We aimed to compare skin closure techniques, standard (intermittent mattress) and continuous subcuticular sutures, following Limberg flap procedure. METHODS: From July 2013 to July 2015, 92 patients with sacrococcygeal pilonidal disease were prospectively randomized into 2 groups consisting of 46 patients for both. Patients underwent sinus excision and closure with Limberg flap; continuous subcuticular suture was used in subcuticular group (SG) and intermittent mattress sutures were used in mattress group (MG) for skin closure. Characteristics of patients, features of pilonidal disease, macerations, infections, wound dehiscence, flap necrosis, operation time, time of drain removal, wound complications, early recurrences, and time till return to work were compared between the 2 groups. RESULTS: There was no statistical difference between groups per sex, age, body mass index, smoking, number of sinuses, depth of intergluteal sulcus, distance of incision to anus, volume of extracted tissue, number of hair follicles per cm2, recurrence, operation, and mean follow-up time. Two patients showed signs of wound complications (4.4%) in SG, whereas 8 cases (17.4%) showed signs in MG (P < 0.05). One patient in SG had surgical site infection and required antibiotics (2.2%), where as there were 6 cases treated in MG (13.0%) (P < 0.05). Removal of drain tube, and time till return to work rates are lower for SG than MG (P < 0.05). CONCLUSION: In conclusion, surgical procedures which include Limberg flap method and subcuticular closure may reduce infection and maceration rates. Future studies are needed to achieve greater detailed evaluation.
Anal Canal ; Anti-Bacterial Agents ; Body Mass Index ; Follow-Up Studies ; Hair Follicle ; Humans ; Methods ; Necrosis ; Pilonidal Sinus ; Prospective Studies ; Recurrence ; Return to Work ; Skin ; Smoke ; Smoking ; Surgical Flaps ; Surgical Wound Infection ; Sutures ; Wound Infection ; Wounds and Injuries

BACKGROUND: To know the difference between single and double-layer wound closure. METHODS: The study was conducted in ten patients undergoing first session of hair restoration surgery by ‘strip method’ under local anaesthesia. Informed consent was obtained from all the patients. The length and width of the strip were marked pre-operatively. Three points were marked, one in the midline ‘O’ and one on either side, ‘A’&‘B’ at 8 cm from ‘O’. After removing the strip, five deep, interrupted, absorbable sutures were applied on left half but not on the right half. Lower edge trichophytic closure was performed with no undermining of the skin edges. A single continuous non-absorbable sutures was used to close the skin. The stitches were removed on the 10th postoperative day. The patients were assessed at 9 months interval postoperatively. RESULTS: The mean age of the patients was 33.8 years. The average width of the strip removed was 15.1 mm. The average width of the scar on single-layer closure was 1.57 mm and 1.58 mm on the double-layer closure. The mobility of the scar was 7.9 mm on single-layer closure and 6.2 mm on double-layer closure. There was no statistical significance in the scar size and mobility of single-layer vs double-layer closure. The time of surgery was more in double-layer closure and the extra cost of the suture material. CONCLUSIONS: There was no difference in scar quality. The extra time and money was saved in single-layer closure. The mobility of the scar was also found to be better in single-layer closure.
Cicatrix ; Hair ; Humans ; Informed Consent ; Scalp* ; Skin ; Suture Techniques ; Sutures ; Tissue Donors* ; Wounds and Injuries*

BACKGROUND: The brow lift plays an essential role in upper face rejuvenation. The authors designed a new brow lift technique, the endoscope-assisted trichophytic anterior hairline brow lift. It combines the advantages of an endoscopic approach and an anterior hairline approach. This technique was applied to 13 patients with aesthetically excellent results. METHODS: A trichophytic incision line was designed within the fine hairs of the entire anterior hairline and the incision was extended to the temporal hair-bearing scalp. After the incision, most of the procedures were conducted in a similar way to the conventional endoscopic brow lift. Without direct visualization, the dissection was extended down onto the root of the nose and the forehead. An endoscope was used from 2 cm above the supraorbital notch to avoid supraorbital nerve injury. Scars were assessed with the Stony Brook Scar Evaluation Scale (SBSES) at the time the sutures were removed. The visual analogue scale (VAS) score was checked at postoperative 1-year follow-up. The surgical outcomes for brow position and subjective satisfaction were rated with the Global Aesthetic Improvement Scale (GAIS) at postoperative 1-month follow-up. The dermatome of the deep branch of the supraorbital nerve, especially around the hairline, was checked with a two-point discrimination test. RESULTS: From October 2012 through August 2015, 13 endoscope-assisted trichophytic anterior hairline brow lifts were performed. The GAIS score was 1.62 on average. The VAS score was 2.09 on average. No permanent nerve damage has been reported except for 2 cases of temporary paresthesia. These fully recovered at 1-month follow-up. CONCLUSIONS: Based on our results, we think our technique could be a safe and effective treatment option for brow ptosis patients with a high hairline.
Cicatrix ; Discrimination (Psychology) ; Endoscopes ; Follow-Up Studies ; Forehead ; Hair ; Humans ; Nose ; Paresthesia ; Rejuvenation ; Rhytidoplasty ; Scalp ; Sutures

This report describes the use of a tubularized random flap for the curative treatment of recurrent anterior urethral stricture. Under the condition of pendulous lithotomy and suprapubic cystostomy, the urethral stricture was removed via a midline ventral penile incision followed by elevation of the flap and insertion of an 18-Fr catheter. Subcutaneous buried interrupted sutures were used to reapproximate the waterproof tubularized neourethra and to coapt with the neourethra and each stump of the urethra, first proximally and then distally. The defect of the penile shaft was covered by advancement of the surrounding scrotal flap. The indwelling catheter was maintained for 21 days. A 9 month postoperative cystoscopy showed no flap necrosis, no mechanical stricture, and no hair growth on the lumen of the neourethra. The patient showed no voiding discomfort 6 months after the operation. The advantages of this procedure are the lack of need for microsurgery, shortening of admission, the use of only spinal anesthesia (no general anesthesia), and a relatively short operative time. The tubularized unilateral penile fasciocutaneous flap should be considered an option for initial flap urethroplasty as a curative technique.
Anesthesia, Spinal ; Catheters ; Catheters, Indwelling ; Constriction, Pathologic ; Cystoscopy ; Cystostomy ; Hair ; Humans ; Male ; Microsurgery ; Necrosis ; Operative Time ; Penis ; Recurrence ; Surgical Flaps ; Sutures ; Urethra ; Urethral Stricture

PURPOSE: The Inaba's procedure, the treatment of osmidrosis axillae, has the advantages of low recurrent rate and easiness in learning, yet it produces early postoperative discomfort and scar formation by tie-over dressing. The authors modified the Inaba's procedure by using delayed suture of the incision wound and omitting tie-over dressing. The comparative study of Inaba's procedure and its modification was performed to confirm the advantages of modified procedure. METHODS: The study contains the retrospective analysis of the medical records of 296 patients with osmidrosis who were treated using the Inaba's procedure from December, 1996 to February, 2007. The study also contains the prospective analysis of 20 patients, from March, 2007 to July, 2008, who were treated by the modified Inaba's procedure with delayed suture of the incision wound and gentle pressure dressing instead of tie-over dressing. The operative results of two groups were compared and verified by Mann-Whitney U test (SPSS 12.0). RESULTS: The incidence of complications was 14.5% in the Inaba's procedure, whereas 6.2% in the modified Inaba's procedure. Both procedures have the same basic surgical procedure in terms of the location of incision site and subdermal shaving of the sweat glands, and therefore similar good results were obtained in the aspect of postoperative axillary odor, recurrent rate and postoperative condition of axillary hair. Certainly, the modified Inaba's procedure had better outcome in each element of PSS (Patient Scar Self-Rating Scale), compared to the Inaba's procedure. In addition, the modified Inaba's procedure showed a statistical significance in dressing-related pain reduction and overall satisfaction. CONCLUSION: The modified Inaba's procedure had advantages of decreasing early postoperative complications such as hematoma, discomfort and pain caused by tie-over dressing, and decreased scar formation. However, the drawback was delayed suture of the incision wound after 48 hours.
Axilla ; Bandages ; Cicatrix ; Hair ; Hematoma ; Humans ; Incidence ; Learning ; Medical Records ; Odors ; Postoperative Complications ; Prospective Studies ; Retrospective Studies ; Sutures ; Sweat Glands

Dermoid cyst is a teratoma that contains developmentally mature skin, with hair follicles, sweat glands and so on. Dermoid cyst is painless oval or round shaped cystic mass that can make the bony depression after complete excision. Dermoid cyst is commonly found on lateral brow, nasofrontal area, subglottic area. But, we report two cases of dermoid cyst on retroauricular area. A 27 year-old male patient wanted to excise the retroauricular mass. Computed tomography showed that the mass looked like a dermoid cyst without connection to cranial cavity. So, we could completely excise the mass. The other 29 year-old male patient show the infected cystic mass on retroauricular area. We could completely excised the mass. After the excision of the mass, pathologist reported these are dermoid cysts. Retroauricular dermoid cysts have been rarely reported. But, we can suspect the retroauricular dermoid cyst originated in squamomastoid suture through the patient's history, physical and radiologic examination.
Adult ; Depression ; Dermoid Cyst* ; Ear ; Hair Follicle ; Humans ; Male ; Skin ; Sutures ; Sweat Glands ; Teratoma

PURPOSE: To evaluate the clinical efficacy of a reverse eyelid splitting technique that we performed in cases of trichiasis or distichiasis combined with entropion. METHODS: The study comprised 43 eyes of 31 patients with trichiasis or distichiasis combined with entropion treated from November 2004 to December 2005. After skin incision, the muscular layer and tarsus were reversely dissected to find abnormal follicles. The abnormal hair follicle was cauterized under the muscular layer, and 2~3 rotating sutures were done with Ethilon 6-0 to fix the tarsus and skin. Success was defined as having the meibomian gland located in front of the junction of skin and mucosa, without an abnormal hair protruding into the eye for at least three months. RESULTS: Fifteen patients were male and sixteen patients were female. The mean age was 62.1+/-15.2 years. The patients were followed up for an average of 12.4+/-2.0 months after surgery. Surgery was successful in 74.4% (32 of the 43 eyelids) of the cases, and the recurrence rate was 25.6% (11 of the 43 eyelids). No severe complications occurred, such as infection, hemorrhage, wound dehiscence, or granuloma. However, foreign body sensation (1 eye) and eyelid notch (l eye) did occur. CONCLUSIONS: This reverse eyelid splitting technique produced satisfactory results in both cosmetic and functional aspects. Moreover, it resulted in a low recurrence rate and low complication rate in patients with trichiasis or distichiasis combined with entropion.
Ankle ; Entropion* ; Eyelids ; Female ; Foreign Bodies ; Granuloma ; Hair ; Hair Follicle ; Hemorrhage ; Humans ; Male ; Meibomian Glands ; Mucous Membrane ; Nylons ; Recurrence ; Sensation ; Skin ; Sutures ; Trichiasis* ; Wounds and Injuries

OBJECTIVE: To review the safety and effectiveness of a new vaginal hysterectomy method, Minilaparatomically Assisted Vaginal Hysterectomy (MAVH), tried on benign diseases with indication of abdominal hysterectomy. MATERIALS AND METHODS: The analysis of the safety and the effectiveness of MAVH is based on randomized consecutive 75 patients who received the operation from Feb. 1, 2002 to Jul. 10, 2002 in the department of Obstetrics and Gynecology at Gacheon Medical University Hospital. OPERATION TECHNIQUE: Access to the pelvic cavity was obtained by the traditional suprapubic minilaparotomical incision that is 2-2.5 cm long and parallel to the pubic hair line. Through this incision site, the adnexa and other pelvic organs around the bladder were brought into sight by manipulating the uterine elevator that was already inserted into the uterine cavity. By this method, the round ligament, uteroovarian ligament, and the fallopian tube were exposed at the incision site, then clamped, cut, sutured and divided. The dissection of the bladder peritoneum was performed and then followed by the traditional transvaginal approach. RESULTS: The MAVH was successful in 73 cases (97.3%) out of 75 attempts. The mean age, parity, weight, and body mass index of the subjects of the 73 cases were 42.6 (+/-7.8) years, 2.0 (+/-0.7), 59.5 (+/-7.5) kg, and 23.6 (+/-2.6). Forty subjects (54.8%) had a previous surgical history. The operational indications were 44 cases (60.3%) of uterine myoma, 19 cases (26.0%) of uterine bleeding, 7 cases (9.6%) of dysmenorrhea, and 3 other cases (4.1%). There were 6 cases (8.2%) of cumulative complication. In terms of pathologic diagnosis, 54 cases (74.0%) were uterine myoma with adenomyosis, 12 cases (16.4%) adenomyosis, 2 cases (2.7%) endometrial polyp, 1 case (1.4%) endometrial hyperplasia, 1 case endometrial cancer, and 3 other cases. The weights of uteri ranged from 75 gm to 1150 gm with an average of 286.8 (+/-217.5) gm. The average operation time for MAVH from skin incision to the completion of suture was 75.8 (+/-21.8) minutes. The average bowel function recovery time was 45.9 (+/-12.9) hours. The external bleeding loss was 337.0 (+/-306.8) ml, 11.0% (8/73) required transfusion with an average amount of 1.5 pint. No subject of this study needed reoperation or expired. CONCLUSION: The technique of MAVH is simple and easy to learn. The MAVH involves a relatively small size of incision and less pain and complication with fast recovery and small wound. The method requires a little bit of practice but not an expensive equipment. The MAVH is considered as a safe and effective operational method which could replace the abdominal hysterectomy in most cases.
Adenomyosis ; Body Mass Index ; Diagnosis ; Dysmenorrhea ; Elevators and Escalators ; Endometrial Hyperplasia ; Endometrial Neoplasms ; Fallopian Tubes ; Female ; Gynecology ; Hair ; Hemorrhage ; Humans ; Hysterectomy ; Hysterectomy, Vaginal* ; Leiomyoma ; Ligaments ; Obstetrics ; Parity ; Peritoneum ; Polyps ; Recovery of Function ; Reoperation ; Round Ligament of Uterus ; Skin ; Sutures ; Urinary Bladder ; Uterine Hemorrhage ; Uterus ; Weights and Measures ; Wounds and Injuries

The bilobed flap is often used when the primary closure of a skin defect is difficult. We applied a simple and rational method to design a bilobed flap for closure of scalp defect that reconstruction was comparatively difficult. In our method, two triangle flaps are designed; the angle of the first flap is three-fourths the angle of a rhombus at the defect site, and the angle of the second flap is also three-fourth that of the first flap. We applied it to five patients with scalp defect and obtained favorable result. The location of the defect was the parietal region in two cases. the occipital region in two cases. the frontal region in one case. We found that the alopecia by scar formation could be minimized with the designed bilobed flap. The suture line, being "Z" shape, was unnoticeable due to hair line stream. There are several advantages of this method for use in reconstruction of scalp defect such as, easy design and elevation of the flap and short operation time.
Alopecia ; Cicatrix ; Hair ; Humans ; Rabeprazole ; Rivers ; Scalp* ; Skin ; Sutures

A variety of treatments has been used to correct long forehead and frontal alopecia. These include forehead reduction (scalp reduction), hair graft and flap transfer. Among these procedures, forehead reduction (scalp reduction) is the most simple and effective method. In this procedure, various fixation techniques of scalp flap to cranial bone are used to prevent retraction of the scalp. We used Sherlock (or Piranha) screw to anchor the scalp flap to cranial bone. Between August 1998 and May 2000, this technique had been performed for 37 patients. Average follow-up period was 15 months. For forehead reduction (scalp reduction), the scalp was elevated back to the occipital region through a pretrichial incision, and relaxation incisions of galea was made at a right angle to the vector of advancement. The Sherlock (or Piranha) screw was fixed to the cranial bone. The entire scalp was then repositioned anteriorly, advancing the hairline caudally and shortening the forehead. Retraction of the scalp was prevented by anchoring the galeal fascia to the cranial bone using Sherlock (or Piranha) screws. This technique allows sufficient advancement of the scalp and a tension-free closure. Postoperatively scar widening was less than that of other methods. There were not any infection, hematoma, hair loss nor permanent paresthesia on scalp. In 2 cases, screws were palpable and we removed a screw for 1 case. Advantages of using Sherlock (or Piranha) screw are that the procedure is easy and simple, and sufficient advancement of the scalp, tension-free closure, and less scar widening can be achieved. Disadvantages of this procedure include cost of screw and palpability of screw. In conclusion, by using Sherlock (or Piranha) screw, the procedure was simple and we could get aesthetically good results.
Alopecia ; Cicatrix ; Fascia ; Follow-Up Studies ; Forehead* ; Hair ; Hematoma ; Humans ; Paresthesia ; Relaxation ; Scalp* ; Sutures* ; Transplants