Objective: There are various options for wound treatment after the excision of a pilonidal sinus. The aim of our study was to compare secondary healing to Limberg flap wound closure, with a focus on scar quality and patient complaints, rate of recurrence, period of absence from work as well as functional and aesthetic results one year after surgery. Method: 33 out of 55 patients who underwent pilonidal sinus excision in our department (KlinikumStadtSoest, Soest, Germany) between 2011 and 2012 were enrolled in the study. 16 of these 33 patients had chosen secondary wound healing and 17 were treated with a Limberg flap for defect coverage. First and foremost, we aimed to objectify scar quality and elasticity by measuring the parameters of skin distensibility and mobility. To this end, we used a self-developed method to ascertain the sacral lumbar skin distension quotient (SL quotient) as well as sacral skin mobility. 100 healthy volunteers served as a control group. Also we collected information about pain, time of absence from work and frequency of recurrence and asked patients about their satisfaction with the functional and aesthetic results. Results:The results for the sacral lumbar skin distension quotient were significantly better after Limberg flap wound closure compared with secondary wound healing. As regards distensibility, there was a marked trend to more favourable values in the Limberg group. No differences in distensibility and mobility were observed between the Limberg group and the control group, whereas skin distensibility was significantly reduced (p = 0.001) in secondary healing compared with the control group. Time off work was significantly longer in secondary healing (mean 63 days) than after Limberg flap (mean 29 days). No differences were identified regarding patient satisfaction, pain scores and frequency of recurrence.Dieses Dokument wurde zum persönlichen Gebrauch heruntergeladen. Vervielfältigung nur mit Zustimmung des Verlages.

Zusammenfassung Ziel Prospektive Untersuchung der mittelfristigen Ergebnisse nach autologer Fetttransplantation in arthrotische Sattelgelenke. Patienten und Methoden 23 von 27 Patienten (22 Frauen und 5 Männer) mit einem Durchschnittsalter von 59,8 (49–83) Jahren, bei denen bei einer Rhizarthrose eine autologe Fetttransplantation in das Sattelgelenk erfolgte, konnten durchschnittlich nach 45,3 (39,3–50,9) Monaten nachuntersucht werden. 4 Patienten wurden bei zwischenzeitlich erfolgter Trapezektomie von der Nachuntersuchung ausgeschlossen. Erfasst wurden das Schmerzniveau (VAS), die Grob- und die Pinchkraft und der DASH-Score. Ergebnisse Die durchschnittliche Pinchkraft verbesserte sich von präoperativ 3,7 kg auf 5,1 kg (p = 0,052). Die durchschnittliche Grobkraft von 22,2 kg auf 22,8 kg (p = 0,506). Der DASH-Score verbesserte sich hochsignifikant von präoperativ 50,8 Punkte auf 29,6 Punkte postoperativ (p = 0,000). Das durchschnittliche Schmerzniveau sank hochsignifikant von präoperativ 5,9 auf 1,9 (p = 0,000). Patienten mit einer fortgeschrittenen Sattelgelenksarthrose erzielten ähnlich gute Ergebnisse wie Patienten mit einer Arthrose im Anfangsstadium. Schlussfolgerung Die autologe Fetttransplantation in arthrotische Sattelgelenke zeigt auch im mittelfristigen Verlauf gute bis sehr gute Ergebnisse, Pinchkraft, Schmerzniveau und DASH-Score betreffend und ist eine sichere, minimalinvasive vielversprechende Therapiealternative zu den herkömmlichen Operationsverfahren.

By comparing lumbar and sacral skin distension in the same study participant, we are able to obtain intraindividually valid findings about possible changes in skin and scar quality. Owing to the lack of known published data about sacral skin elasticity, the proposed measurement method, while restricted to a number of special cases, seems to be practicable and independent of the patient's general condition. Compared with devices that have been used for the measurement of elasticity in other skin areas, our procedure is generally available and cost-neutral.

Background: Cryolipolysis—a popular noninvasive technique for body contouring—has fewer side effects compared with liposuction; however, its effectiveness in terms of reducing local adipose tissue is also lower. This study is, to the authors’ knowledge, the first prospective, controlled, investigator-blinded split-body trial to evaluate whether postcryolipolytic heating can increase the efficacy. Methods: Twenty-five subjects were treated with one session of cryolipolysis on the lower abdomen and a subsequent heating with a mud pack of a randomized side of the treated region (left or right). Epidemiologic, temperature, edema, erythema, hypesthesia, and pain level data were obtained. Photographs, fat layer thickness (on ultrasound, caliper, and abdominal girth), satisfaction, and side effects were documented over a follow-up period of 12 weeks. Results: The side effects—edema, erythema, and hypesthesia—faded almost completely with heating, whereas they remained on the nonheated site. However, the mean sonographic reduction of local adipose tissue after 12 weeks was significantly lower on the heated sites than on the control sites (9.6% versus 14.1%; P = 0.0003). The overall satisfaction was high (9.2 of 10 points), even though only 44% of participants had a subjective recognition of fat loss without difference between the sites. Conclusions: Active heating following cryolipolysis increases bodily well-being by reducing common side effects, but it reduces the effectiveness of cryolipolysis significantly and should therefore be avoided. Further improvements are necessary to enhance the efficacy of cryolipolysis. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.

Plastic reconstruction with Limberg transposition flap (group 2) provides a chance to reduce the period of incapacity for work due to a shorter treatment period. With that said, patients should nonetheless be offered both techniques as the current literature does not reveal a clear benefit for either procedure.