Limberg flap reconstruction following rhomboid excision of the sacrococcygeal pilonidal sinus

Abstract

Background: Pilonidal sinus disease has been treated with various techniques. There is still no consensus about treatment. However, a long list of surgical techniques available reflects the inability to find an ideal procedure for the treatment. The rhomboid flap of limberg is a transposition flap that has been advocated for treatment of this condition. The objective of this study was to evaluate the limberg flap reconstruction for pilonidal sinus in terms of complications, hospitalization time, days to return to work and recurrence in Indian rural setup. Methods: Patients with simple, complex and recurrent pilonidal sinus were included in the study. Patients presenting with acute abscess were excluded. Patients were followed for a period of three year to report the recurrence. Results: Total 26 patients, with pilonidal sinus disease were treated with rhomboid excision and limberg transposition flaps. All sinus tracts were resected en bloc, and the limberg flap was prepared from the gluteal region and transposed to fill the defect. There were 22 males (80%) and 4 females (20%) with a mean age in males 28.6 years and in females 21.6 years. The mean duration of symptoms was 10.4 months. Mean operative time was about 70.57 minutes. Full primary healing was obtained in 20 patients, 6 patients presented with post-operative complications. Minor infection occurred in 4 patients. 3 patients had minimal necrosis of flap edge and partial gaping of flap. 2 patients developed seroma. But all these complications required no additional treatment except secondary suturing in one patient. The average hospital stay was 4 days. Most patients returned to work within 3.23 weeks. Follow up period was 3 year and no recurrence reported. Conclusions: Limberg flap following rhomboid excision of the sinus area is worth to be considered as the surgical treatment of choice for sacrococcygeal pilonidal sinus disease.

Drain or no drain in Rhomboid excision and Limberg rotational flap for pilonidal sinus

“…An additional procedure of secondary suture was required only in one patient (about 3%). 5 In another large series comprising 411 patients with pilonidal sinus who underwent Rhomboid excision and Limberg flap, complications like seroma and wound infection each occurred in about 3%. 6 In both series, the drain was placed in all cases routinely.…”

“…Most of the series showing successful use of this method in treating pilonidal disease has used drain. 2,4,5 However, one of the studies showed no difference in recurrence when the drain was placed. 8 There seems to be no consensus about when to remove the drain and no studies done regarding the duration drain should be kept to reduce the infection.…”