Understanding the Mechanical Forces on the Sacrum Can Help Optimize Flap-based Pilonidal Sinus Reconstruction.

Autor:	Kaneyuku S; From the Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan., Dohi T; From the Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan., Hammoudeh DS; Division of Plastic, Reconstructive and Aesthetic Surgery, American University of Beirut, Beirut, Lebanon., Eura S; From the Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan., Kurokawa Y; From the Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan., Ogawa R; From the Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan.
Jazyk:	angličtina
Zdroj:	Plastic and reconstructive surgery. Global open [Plast Reconstr Surg Glob Open] 2024 Jun 19; Vol. 12 (6), pp. e5923. Date of Electronic Publication: 2024 Jun 19 (Print Publication: 2024).
DOI:	10.1097/GOX.0000000000005923
Abstrakt:	Background: Pilonidal sinus can be treated with excision and flap reconstruction, but treatment is often complicated by wound dehiscence, infection, and recurrence. Understanding the mechanical forces on the sacrococcygeal area during posture change could help guide optimal flap choice. Methods: Sixteen volunteers underwent measurements of skin-stretching, pressure, and shear stress on the sacrum when sitting relative to standing. Skin-stretching was measured by drawing a 4 × 4 cm square on the sacrum and measuring the vertical, horizontal, and diagonal axes. Pressure and shear stress was measured at six sacral points with a device. The data analysis highlighted the potential of the superior gluteal artery perforator (SGAP) flap for dissipating mechanical forces. Ten pilonidal sinus cases treated with SGAP flaps were retrospectively reviewed for 6-month outcomes. Results: Sitting is associated with high stretching tension in the horizontal direction [estimated marginal mean (95% confidence intervals) = 17.3% (15.4%-22.6%)]. The lower sacrum experienced the highest pressure [106.6 (96.6-116.5) mm Hg] and shear stress [11.6 (9.7-13.5) N] during sitting. The transposed SGAP flap was deemed to be optimal for releasing the horizontal tension and providing sufficient subcutaneous tissue for ameliorating pressure/shear stress during sitting. It also has high blood flow and can therefore be used with large lesions. Moreover, its donor site is above the high-pressure/stress lower sacrum. Retrospective analysis showed that no patients experienced complications. Conclusions: Sitting is associated with high mechanical forces on the sacrococcygeal skin. The transposed SGAP flap may ameliorate these forces and thereby reduce the risk of complications of pilonidal sinus reconstruction for large defects. Competing Interests: The authors have no financial interest to declare in relation to the content of this article. (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)
Databáze:	MEDLINE
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