A simple modification with the Limberg flap for chronic pilonidal disease

Abstract

A widely acceptable view is that most pilonidal sinuses are acquired by a combination of poor hygiene, excessive hairiness, local trauma, and the presence of a deep natal cleft. 1 Karydakis G.E. Easy and successful treatment of pilonidal sinus after explanation of its causative processes. Aust NZ J Surg. 1992; 62: 385-389 Crossref PubMed Scopus (374) Google Scholar The strongest support for the acquired theory is the observation that recurrences sometimes follow even the most radical local excisions of pilonidal disease, indicating that in most cases, recurrences are caused by acquired new disease rather than persistence of parts of the old sinuses. Following the change in this concept, new operative techniques have been proposed to eliminate factors that predispose the formation of another sinus. In recent years, transposition rhomboid or rhombic (Limberg) flap techniques have gained more popularity. Our initial experience with the Limberg flap in 162 patients found recurrence in 3 patients (2%). 2 Tekin A. Pilonidal sinus: experience with the Limberg flap. Colorectal Dis. 1999; 1: 29-33 Crossref PubMed Scopus (15) Google Scholar After this experience we made a simple modification to the Limberg flap to eliminate recurrence and performed it in 148 consecutive cases.