Rhomboid flap for recurrent pilonidal disease

45 year old man had pilonidal disease since his early 20s. His first operation was 23 years ago and he has had multiple procedures since. His natal cleft was often painful and discharged pus frequently. He had multiple pits and hard indurated tissue in the natal cleft.

To cure the recurrent disease, radical excision of the affected area and coverage of the defect with a rhomboid flap was performed.

First the flap is marked out on the skin

The skin is incised along the lines and the diseased area removed leaving a large defect

The rhomboid flap is mobilized and sutured in place.

The patient was kept in for 2 days nursed on his side or prone.

panproctocolectomy for severe perianal crohns with rectus abdominis flap reconstruction

A man in his 30s presented with a history of 18 years of crohns disease confined to his colon and rectum with a watering can anus. He was unresponsive to medical treatment and continued to smoke

The colon was fully mobilized and extensive excision of peranal skin affected by multiple fistulae performed. The colon, rectum and anus were removed from the perineum.

This left a big defect!

A vertical rectus abdominis flap was raised based on inferior epigastic vessels (forceps pointing to these)

The flap was rotated around and placed in perineum to fill the defect.

The patient went home 9 days after the operation with all healed