Treatment of recurrent pilonidal sinus by flap technique(Limberg flap)

Abstract

Background: pilonidal sinus (PNS) is a chronic disease that mostly affects young adults. describes a hair-filled cavity in the subcutaneous fat of the post sacral intergluteal region, known as the natal cleft , its name arises from the Latin terms “pilus” and “nidus” meaning a nest of hair PNS can be asymptomatic, or may be present as a recurrent abscess or as chronic inflamed cavity and local discharge from sinus or sinuses and local pain and discomfort . Materials and Methods: retrospective study was done from (November 2017 to November 2018) at surgical department in Kirkuk General Hospital in 50 patients with recurrent PNS all will be treated with Limberg flap then follow up for one year this surgery done by excision of PNS till we reach fascia overlying sacrum inferiorly and laterally till we reach gluteal fascia and dissection was performed with electro cautery and reconstruction done by flap (Limberg flap) from gluteal area. Results: in 50 patient with recurrent PNS we have 45 (90%) were male and 5 (10%) were female ,30 patient (60%) patients had a familial history of PNS and 42 patients(84%) with etiology-related risk factors to develop PNS then we divided them according first time surgery done either, by excision and primary closure 30 patient(60%) or excision and healing by granulation tissue and secondary intension 20patient (40%) Discussion: pilonidal sinus not classified as dangerous condition but any patients with PNS live in non-comfortable state and may have complications such as abscess formation or discharging sinus even severe pain therefore Limberg flap is commonly used method to treat recurrent PNS and this good result with healing in short period also satisfactory results in long duration but this method with Sacrococcygeal area disfigure mentation as one long duration complications but less recurrence rates and short stay in hospital and better patient tolerability in this way if we compare it to all other methods even with surgical challenge to create a flap but it less wound infection, hematoma ,edema , wound separation if we compare it to other surgical techniques but fluid accumulation in close space under flap is one of important complications in this method and we decrease it by using a drain and putted in site until fluid drainage in area decreased to be less than 50 ml/day . In this method recurrence rate in our study is 2% but reported recurrence rate for Limberg flap are from 0.8 to 2.7% if we compare to 12% recurrent rate in primary closure therefore we have very good recurrence rate Conclusions: the approach for recurrent PNS should be differ from primary PNS flap reconstruction methods in treatment for recurrent PNS is very good and efficient method even with surgical challenge procedure to create flap, personal hygiene are the keystones for preventing recurrence