Closure of excisional defects of pilonidal sinus surgery using a perforator-based island flap

Abstract

Background and Aim of the Work: Pilonidal sinus disease is a common condition in the young adults, which carries significant patient discomfort. There is no consensus regarding the best surgical technique for the treatment of this disease. A controversy is present about the various options for closure of the wound following resection of the affected tissue. In this study, the perforator-based island flap was successfully used for closing the defect left after excising the pilonidal sinus. Methods: Twenty-three patients with a primary complex pilonidal sinus disease were operated upon and followed up in the period from October 2014 to October 2018 at the General Organization of Teaching Hospitals and Institutes hospitals. After wide excision of the pilonidal sinuses, the defects were reconstructed with perforator-based flaps, which were designed with an axis of 45°–90° angle to the vertical axis of the defects. Results: Of the 23 patients included in this study, only three patients developed minor complications (one case of mild seroma and two cases of minor wound infections), and they were treated conservatively. Mean time of hospital stay was <2 days. Mean time to return to normal daily activities was 5 days (range: 3–7). Mean time to complete healing of the wound was 12 days (range: 10–15). Mean time off-work days was14 days (range 12–17). All the patients did not show recurrences during the period of follow-up which continued for at least 9 months postoperatively with a mean time of 10 months (range: 9–15). Conclusions: This study shows that closure of postexcisional defect of pilonidal sinus using a perforator-based island flap is a reliable option for the treatment that fulfill the principles and criteria required to achieve complete cure of the condition in a short period of time.