The study aims to test the effect of transdermal application of azithromycin in the prevention of skin flap infection in experimental rats. The accumulative penetration quantities of azithromycin through excised rat skin and the azithromycin quantities in flap tissues from rats given 1%, 2%, and 3% azithromycin gels were assayed by UV spectrophotometer. Staphylococcus aureus and pathogenic Escherichia coli were inoculated to the underneath of the random ischemic rat flaps to induce bacterial infection. The azithromycin gels were applied on the flaps daily for 7 days. The survival areas of flaps were measured by planimetry. The accumulative penetration quantities of azithromycin and the azithromycin quantities in flap tissues increased in a time-dependent manner (P < 0.05). Azithromycin gels decreased the inflammatory reaction and enhanced the survival area of flaps (P < 0.05). We concluded that 1% azithromycin gel could penetrate into the flap tissues and significantly increase survival area of infected flaps.

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Transdermal application of a compound gel with AZM, AB, and LMWH combined is a promising method to prevent and treat flap infection, improve blood circulation, and increase the survival of infected ischaemic flaps.

Rationale: Pilonidal sinus disease (PSD) involving the breast is extremely rare and has not been described in man. Patient concerns: This current case report presents a case of a pilonidal cyst in a 46-year-old man which was surgically treated. He had intermittent pain in his left breast for 2 months and came for local rupture and discharge for 1 week. Diagnosis: The initial diagnosis is male mastitis, on the basis of the histological features of H&E-stained specimens and immunohistochemistry of the resected lump, this case was diagnosed as PSD. Interventions: The patient underwent “enlarged resection of the left breast lesion” under local anesthesia. Outcomes: The patient's surgical area healed well, without any signs of recurrence. Conclusion: PSD involving the breast is extremely rare in man, with no typically clinical manifestations, and could be easily ignored. This disease requires great attentions from clinicians.

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