Pilonidal disease is a common surgical problem primarily affecting young men between puberty and early thirties and is estimated to affect 26 per 100 000 individuals. surgery is still the primary method of treatment of the disease. Surgical management is usually simple, inexpensive, and is associated with a short hospital stay and rapid wound recovery. The aim of this study was to describe the effect of 5 layers repair technique in the management of pilonidal sinus as regard postoperative efficacy and results regarding pain,wound healing and recurrence. the study included 20 patients with a history of discharge from sacrococcygeal region that is clinically diagnosed as pilonidal sinus. Patients were treated by excision of the whole track till the pre sacral fascia and periosteum (Five Layers Repair) There mean age of patients was 31 years and 18 patients were males, 3 patients presented with discharge only , 6 of them with pain and 11 patient presented with both pain and discharge. Mean time to wound healing was 12 (±2), while Mean time to removal of stitches was 14( ±1) and 21 days was to return to work (±1), 19 patient came with complete healing and only 1 patient showed wound beakdown. Reccurence didn't happened to any patient after 6 month of surgery. Our findings indicated that 5 layers repair technique was superior to other techniques in terms of less operative time, less post-operative VAS of pain, no rate of recurrence presented with patients in our study.

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Background: A latissimus dorsi flap technique is selected when additional tissue is needed to rebuild mastectomy defects and the TRAM flap is not available or other reasons prevent its use. The latissimus dorsi flap is also useful to supplement the skin at the mastectomy site and to provide additional muscle cover for an implant or expander when the reconstructed breast needs to be fuller and more ptotic or when the other breast is to be matched at the time of an immediate breast reconstruction. A latissimus dorsi flap provides implant cover so that the reconstructed breast has a more natural appearance. The aim of this work was to evaluate the efficacy of latissimus dorsi muscle and musculocutaneous flap in reconstruction of breast after treatment of breast cancer as regard cosmetic outcome, complications, patient satisfaction after reconstruction. Methods: This case-control study was carried out at the General Surgery Department in Benha University Hospital, was conducted on 20 female patients with breast cancer which had surgical treatment and need reconstruction. Any female patient presented with breast cancer in our study was taken regarding complete history, complete clinical examination and investigations (mammogram, breast and axillary u/s, biopsy (FNAB) and MRI of breast when indicated). This study was done from April 2019 to March 2022. Results: Regarding operative data, operative time ranged from 175 to 300 minutes with mean 233.75 minutes. Blood loss ranged from 150 to 220 ml with 188 ml. Regarding scar formation, three patients (15%) had unsatisfactory scar formation. Regarding complications, four patients had seroma (20%) and cellulitis occurred in 5%. None of the patients suffered infection, recurrence or keloid formation at the surgical site. We attribute the low number of seroma cases to quick elevation of myocutaneous flap and quick closure of the donor site, as well as tensionless closure of the donor site. All our studied patients had preserved axillary bulge. Conclusion: Latissimus dorsi myocutaneous flap plus musculocutaneous flaps is an extremely safe and reliable option for breast reconstruction. It is a simple technique with fewer complications than other reconstructive techniques, particularly for patients who fear postoperative complications and who wish to return to normal life.