Dufourmentel Rhomboid Flap in the Radical Treatment of Primary and Recurrent Sacrococcygeal Pilonidal Disease

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The aim of this study was to assess early and late results of the Dufourmentel procedure in patients with primary and recurrent sacrococcygeal pilonidal disease. Consecutive patients who underwent surgical treatment for pilonidal disease from November 1993 through July 2009 at the Second Department of General Surgery of the Second University of Naples were entered into the study. All patients underwent epidural anesthesia and radical excision followed by reconstruction with a Dufourmentel rhomboid flap. Study variables included preoperative body mass index, hospital stay, time to walking, sitting, and return to work, and pain score (visual analog scale) for evaluation early results and patient comfort. Time to complete wound healing, wound complications, and recurrence rates were recorded to assess late results. A total of 310 patients with pilonidal disease entered the study. Of these, 24 patients were asymptomatic (incidental diagnosis) and 55 had recurrent sinus. Obese patients had a significantly worse clinical presentation than patients with normal weight (P < .001). All operations were uneventful, with a mean operative time of 40 (range, 30-55) minutes after the surgeons' learning period, and no flap necrosis occurred. The median hospital stay was 1 day (range, 1-11 days), median time to return to work was 7 (range 5-30) days, and pain was minimal. Wound complications were experienced by 33 patients (10.6%). All but 2 patients were managed conservatively; in 2 patients (0.6%), the wound was resutured under local anesthesia and healed within 15 days. No patient was lost to follow-up. Recurrence was observed in 7 patients (2.3%). All relapses occurred in 25 months after the operation; no late recurrences were seen (5-, 10-, and 16-year recurrence-free rates were all 97.6%). The recurrence rate was significantly higher in obese than in normal-weight patients (6% vs. 0.5%; P = .0029). Permanent hypoesthesia was negligible (0.9%), and no patient complained about the cosmetic outcome. The Dufourmentel flap is associated with minimal discomfort and excellent results. This technique can be considered in the first- and second-line management of pilonidal disease.