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Background Isolated coronary sinus atrial septal defect (CSASD) is a rare congenital cardiac anomaly, comprising Case summary A 73-year-old man with a history of electrical defibrillation therapy for atrial flutter presented with worsening exertional dyspnoea. Cardiac examination revealed CSASD without persistent left superior vena cava, showing only moderate tricuspid regurgitation. Surgical repair of the defect and regurgitant valve improved symptoms dramatically. Discussion Elderly patients with atrial arrhythmias might show uncommon presentations of congenital heart disease. Cardiologists should pay attention to enlarged right ventricle, pulmonary artery, and, in particular, enlarged coronary sinus. Direct closure with interrupted sutures secured with pledgets is effective in some case of terminal type of CSASD.

Objective This study was performed to compare the modified direct closure method and traditional skin grafting for wounds at the anterolateral thigh (ALT) flap donor site. Methods Among 29 consecutive patients with wounds at the ALT flap donor site, 14 underwent the modified direct closure method (MDC group) and 15 underwent traditional skin grafting (SG group). The operative time, follow-up time, complications, Vancouver Scar Scale (VSS) score, and Scar Cosmesis Assessment and Rating (SCAR) score of the two groups were statistically analyzed. Results The mean follow-up times in the MDC and SG group were 16.1 and 16.7 months, respectively. Two patients showed partial skin necrosis after skin grafting, but the remaining patients’ wounds healed uneventfully. The operative time in the MDC group was an average of about 64 minutes shorter than that in the SG group. The average VSS and SCAR scores in the MDC group were 2.1 and 3.0 points lower, respectively, than those in the SG group. Conclusions Compared with traditional skin grafting, the modified direct closure method is more efficient for repair of wounds at the ALT flap donor site because of its shorter operative time, better postoperative appearance of the donor site, and higher patient satisfaction.

Objective: To compare drainage and healing by secondary intention with drainage, delayed excision and direct closure (DE/DC). Methods: Between January 2003 and January 2010, 130 patients admitted with an acute pilonidal abscess were randomized to undergo either elliptical incision and drainage (I and D) and healing by secondary intention (Group 1, n=66) or I and D and DE/DC (Group 2, n=64). Data regarding patient and sinus characteristics, hospital stay, healing time, postoperative complications, and recurrence were prospectively collected. Patients were followed-up for a mean of 62.4 months. Results: Ninety percent of patients were men and 10% were women, with a mean age of 26.4 years and a mean body mass index of 31.5. There was no difference in hospital stay between both groups. Mean healing time was significantly (p=0.035) longer for patients in group 1 (32.2 days), compared to those in group 2 (10.7 days). Group 1 patients had significantly fewer postoperative complications (4.5% versus 17.2%, respectively) (p=0.020). The 2 groups had a similar recurrence rate of a pilonidal abscess (6.1% versus 6.3%, p=0.984), and a rate of development of a chronic pilonidal sinus (PNS) (25.8% versus 23.4%, p=0.840). Conclusions: Although there is more rapid healing and fewer visits for dressing with I and D and DE/DC of an acute pilonidal abscess, this is accompanied by a significantly higher overall complication rate than with I and D and secondary healing. Recurrence of an acute abscess or development of a chronic pilonidal sinus is similar with both procedures. [Arch Clin Exp Surg 2012; 1(1.000): 8-13]