Limberg Flap Technique Research Articles

Modified Limberg flap technique in the treatment of pilonidal sinus disease in teenagers

BackgroundPilonidal sinus disease (PSD) is most common in young adults but can also affect teenagers. Although many techniques have been used to treat pilonidal sinus disease in adults, few studies have compared treatment methods for the condition in teenagers. In this study, we aimed to compare the modified Limberg flap technique with the excision and primary closure technique, both of which are used routinely in adults and teenage patients. Materials and methodsThis study was a retrospective review of 40 teenaged patients who underwent surgery in a single pediatric surgery center over ~2years. The patients' age, gender, body mass index (BMI), number of sinuses, surgery technique and any complications were recorded. The patients underwent excision and primary repair or rhomboid excision and a modified Limberg flap. ResultsOf the 40 patients, 22 (55%) were female, and 18 (45%) were male. The mean age of all the patients was 15.20±1.31 (12–17) years. The average number of sinuses was 3.18±0.90 (1–5). Of the patients, 52.5% (n=21) had a high body mass index. These patients were obese (n=4) and overweight(n=17). Pilonidal sinus excision and primary repair were performed in 8 (20%) of the patients, while the remaining 32 (80%) underwent the modified Limberg flap technique. Complications were observed in 87.5% of the patients undergoing excision and primary repair, and in 15.6% of those who underwent the modified Limberg flap technique. Recurrence was observed with only the primary repair technique (37.5%). DiscussionWhen compared with adults, teenage pilonidal sinus disease occurs more frequently in females. In this study, no correlation existed between the number of sinuses, symptoms, BMI and postoperative complications. Based on the results of this study, the modified Limberg flap technique has a low complication rate when used to treat pilonidal sinus disease in teenagers.

Comparison of surgical Limberg flap technique and crystallized phenol application in the treatment of pilonidal sinus disease: a retrospective study.

This study was designed to compare the efficacy of crystallized phenol method with Limberg flap in pilonidal sinus treatment. Patients with a diagnosis of pilonidal sinus disease treated with surgical excision + Limberg rhomboid flap technique and crystallized phenol method between 2010-2011 in the Şevket Yılmaz Training and Research Hospital, Department of General Surgery were evaluated retrospectively. Patients' age, sex, length of hospital stay, complications and recurrence rates were evaluated. Eighty eight percent of patients were male and mean age was 26.84±6.41 in the Limberg group, and 24.72±5.00 in the crystallized phenol group. Sinus orifice locations and nature, and duration of symptoms before surgery were similar in the two groups. Length of hospital stay in the Limberg group was 1.46±0.61 days; whereas all patients in the crystallized phenol group were discharged on the same day. Infection, hematoma, wound dehiscence, and cosmetic problems were significantly higher in the Limberg group. There was no difference between the two groups in terms of recurrence and seroma formation. The less invasive method of crystallized phenol application may be an alternative approach to rhomboid excision and Limberg flap in patients with non-complicated pilonidal sinus disease, yielding acceptable recurrence rates.

Single Stage Reconstruction of Type IIA Defect of the Ear Lobule: The Limberg flap Technique Revisited.

The ear lobule is an important reference point for symmetry of the face and its loss causes an obvious aesthetic abnormality. Type II A defects are characterized by loss of the ear lobule without presence of a nubbin of tissue attached to the cheek. Such defects are typically seen in individuals having an unattached ear lobule. The goal of surgery should be an aesthetically pleasing reconstruction that maintains symmetry with the opposite ear lobule. The Limberg-flap technique using a doubled-over skin flap allows a one stage reconstruction of the ear lobule. It is technically simple and may be performed under local anesthesia. The aesthetic results are generally well acceptable and there is a good color match between the neolobule and the surrounding skin.

Comparison of the Three Surgical Flap Techniques in Pilonidal Sinus Surgery

We aimed to study the efficacy of three surgical flap techniques in pilonidal surgery. Pilonidal disease is characterized by chronic inflammation and infection in the sacrococcygeal region. Complications and recurrence are common after treatment and optimal treatment for the disease has not been established yet. We enrolled a total of 401 patients in this study. Patients have been treated with Karydakis (n = 113), modified Limberg (n = 179), or Limberg (n = 109) flap techniques. Mean off-work period, time to walk without pain, time to sit on the toilet, time to take the drainage catheter off, maceration rates, recurrence, and hypoesthesia rates were significantly better in the modified Limberg group. In conclusion, we showed the modified Limberg technique is superior than both Limberg and Karydakis techniques.

Comparison of the Limberg flap and bilateral gluteus maximus advancing flap following oblique excision for the treatment of pilonidal sinus disease

This study was performed to compare the use of a bilateral gluteus maximus advancing flap (BGMAF) following oblique incision, which was recently described for the surgical treatment of sacrococcygeal pilonidal sinus (SPS) disease, with the widely used Limberg flap (LF) technique following a rhomboid incision. A total of 105 patients treated for SPS were evaluated retrospectively. The patients were evaluated in terms of their age, body mass index, symptoms, length of the operation, complications, postoperative hospital stay, time to return to work, postoperative cosmetic satisfaction and recurrence rate. Fifty-six of the patients were treated with BGMAF, while 49 were treated with LF. The mean follow-up was 20.5 ± 5.4 months. The mean length of the operation, hospital stay and time to return to work were shorter, while the cosmetic satisfaction score was higher in the BGMAF group compared to the LF group. There was no statistically significant difference between the groups for the other criteria. The BGMAF appears to be superior to the LF in terms of the length of the operation, time to return to work and degree of cosmetic satisfaction. It is preferable for sinuses not to require wide excision, while the LF is more appropriate for sinuses with a large post-excision defect.

Treatment of adolescent pilonidal disease with a new modification to the Limberg flap: Symmetrically rotated rhomboid excision and lateralization of the Limberg flap technique

Background/PurposePilonidal disease is a common and frustrating problem among adolescents due to its high recurrence rate. The rhomboid excision and Limberg flap techniques promise successful results, but the lower part of the incision left on the intergluteal sulcus is prone to recurrences. Consequently, we have developed a new modification to this technique and have designed a descriptive prospective study to evaluate its efficiency. MethodsWe conducted this prospective study between March 2011 and March 2012. All of the patients who were operated on for sacrococcygeal pilonidal disease were included in this study. The surgical procedure primarily consisted of symmetrically rotated (clockwise) rhomboid excision and lateralization of the Limberg flap in order to keep the inferior corner of the suture line apart from the intergluteal sulcus. ResultsA total of 15 adolescents (8 boys and 7 girls) were included in the study group. Of the patients, 47% were normal, 13% were overweight, and 40% were obese. Five patients were operated on under general anesthesia, and 10 were operated on under spinal anesthesia. The length of the flap margins ranged from 2.5 to 7cm (median=4cm). The median duration of hospitalization was 5days, and the median duration of suction drainage was 4days. The median postoperative follow-up period was 4months (ranging from 1 to 12months), and we did not encounter any wound infection or recurrent disease during this period. Only one patient had wound hematoma as a result of drain breakdown and was treated with wound care without any additional complications. ConclusionAlthough the number of patients in this study was small and the follow-up period was short, we obtained satisfactory results without any recurrence by performing a symmetrically rotated rhomboid excision and lateralized Limberg flap procedure.

Comparision of the Limberg flap with the V-Y flap technique in the treatment of pilonidal disease

PurposeIn this study, we investigated whether there is a factor that can aid determi nation of the preferred technique by comparing the early and late results of two different surgical techniques for the treatment of pilonidal sinus.MethodsThe medical records of 176 patients in whom the Limberg flap (LF) or V-Y flap techniques were applied for reconstruction after the excision were evaluated retrospectively.ResultsThe development rates of postoperative hematoma, wound separation, wound infection, and seroma were 2.8%, 5.1%, 5.6%, and 6.3%, respectively, while total flap necrosis was not observed in any patient. Return to daily activities was achieved after a mean of 17.1 days (13 to 21 days) days in the LF group and 32.7 days (18 to 47 days) in the V-Y flap group. During the average follow-up of 65 months (36 to 110 months), nine patients (5.1%) developed recurrent disease. There was no difference between the two groups with respect to early surgical complications (P = 0.286) or disease recurrence (P = 0.094), whereas the resumption of daily activities was longer in patients with a V-Y flap (P < 0.001).ConclusionThe early postoperative and long-term results of the LF and V-Y flap techniques for the treatment of pilonidal sinus were similar. Because the resumption of daily activities at work is achieved later in patients undergoing the V-Y flap compared with the LF technique, patients' employment (or position in working life) must be considered when determining the most appropriate surgical technique.

Comparison of Z-plasty, Limberg flap, and asymmetric modified Limberg flap techniques for the pilonidal sinus treatment: Review of literature

The aim of this study is to analyze and compare the early complications and recurrent results of Z-plasty, Limberg flap, and asymmetric modified Limberg flap both demographically and clinically. Between March 2009 and February 2010, a total of 45 patients with pilonidal sinus were enrolled in this study. 10 of 45 patients (22.2%) required Z-plasty; 24 patients (53.3%) had surgery with Limberg flap closure, and 11 patients (24.4%) had asymmetric modified Limberg flap. A total of 45 patients were included in the study (mean age: 23.36 > +/- 3.4 (range, 20-33) years). When we compared duration of operation and the length of stay in hospital, no statistically significant findings were detected (p = 0.595 and p = 0.23, respectively). The mean follow-up was 22.4 (range, 18-24) months. Recurrence was not seen in any of the patients. Our results were similar: the comparison of the three techniques revealed no significant differences regarding early complications and recurrence.

Modified Limberg transposition flap in the treatment of pilonidal sinus disease

Pilonidal sinus disease (PSD) is a common problem in surgical practice. Different non-surgical and surgical methods have been used for treating PSD. Flap techniques including the Limberg flap have become more popular in recent years. A modified Limberg flap was used to reduce the problems of skin maceration and recurrence associated with the conventional Limberg flap technique. The aim of this retrospective study was to assess the effectiveness of the modified Limberg flap technique for PSD. Medical records of 94 patients with PSD who had been treated with a modified Limberg flap between December 2006 and 2009 were evaluated. The patients' age, sex, duration of preoperative symptoms, operative time, mean hospital stay, postoperative complications, wound infection rate, maceration rate and recurrence rate, time until return to work, time until sitting on the toilet without pain, hypoesthesia in the gluteal region, and satisfaction score were recorded during follow-up or at the last interview. Clinical data were obtained at the end of the 5th postoperative day and at 1, 3, 6, and 12 months following surgery. There were 83 male and 11 female patients. The mean operative time was 38.95 ± 6.77 min (range 30-67 min). All patients were followed up longer than 12 months, and the mean follow-up period was 30.97 ± 12.7 months (range 12-54 months). While wound dehiscence was observed in only one patient, we did not detect any case of flap necrosis. Two cases of seroma were observed. Wound infection was detected in 5 patients (5.3%). Surgical drainage was performed in 2 cases. Another 3 patients were treated with oral antibiotics. Maceration of the surgical incision site was detected in 8 patients (8.5%) who were all successfully treated with conservative measures. There were 4 patients (4.2%) with recurrence in this series. When compared with the available data on use of the conventional Limberg flap for PSD, our results suggest that use of the modified Limberg flap is associated with a lower maceration and recurrence rate, and greater patient satisfaction.

Reconstruction following excision of sacrococcygeal pilonidal sinus with a perforator-based fasciocutaneous Limberg flap

Many procedures have been proposed for the management of sacrococcygeal pilonidal sinus disease. The aim of this work is to evaluate the superiorly based flap (used before for reconstruction of pressure sore) for reconstruction after excision of sacrococcygeal pilonidal sinus. Between January 2004 and February 2007, 25 male patients of ages between 14 and 29 years(median age: 23 years), who had recurrent pilonidal sinus, underwent surgical treatment by the Limberg flap technique. The mean duration of symptoms was 5.2 + or - 4.5 years (range 3-6 years). Rhombic-shaped excision of the sinus-bearing skin and subcutaneous tissue up to the presacral fascia guided by electrocautery was performed, followed by reconstruction of the defect by perforator-based Limberg flap (based on the superior gluteal and sacral perforators). Primary healing occurred in 22 patients. Two patients (8%) had seroma with negative bacterial cultures, which healed completely with bedside drainage and conservative treatment. Another patient (4%) had superficial wound infection that were treated by appropriate antimicrobial therapy. Complete healing of all cases occurred without recurrence during the follow-up period. The mean operative time was 40min (ranging between 30 and 45min according to the size of the lesion). There was no ischaemia or necrosis of the flaps, and all flaps remained viable. The mean length of hospital stay was 2 days, ranging between 1 and 6 days. The use of superiorly based Limberg flap in reconstruction after excision of sacrococcygeal pilonidal sinus is reliable, easily performed, associated with complete cure and low postoperative complications.

Impact of fibrin sealant on Limberg flap technique: results of a randomized controlled trial

Pilonidal disease is a common chronic disorder mainly seen in the sacrococcygeal region, especially in young males. Different surgical methods have been described for the treatment. Limberg flap has low morbidity and recurrence rates. Fibrin sealant, a two-component tissue adhesive composed of fibrinogen and thrombin, has been used in a number of surgical procedures to achieve hemostasis and to seal tissues. The purpose of this study was to investigate the impact of fibrin sealant on the Limberg flap procedure. Between January 2003 and January 2004, 32 male patients with pilonidal disease were randomly assigned to receive the standard Limberg flap technique (n=16) alone or with fibrin sealant application (n=16) before drain insertion. The two groups were similar for age and body mass index. The total drainage volume was 64.4+/-28.0 ml in the control group and 16.2+/-13.6 ml in the fibrin sealant group (p<0.001). Moreover, hospitalization time was 3.9+/-0.6 days in the control group and 2.0+/-0 days in the fibrin sealant group (p<0.001). Use of fibrin sealant for Limberg flap technique shortens hospitalization time, reduces drainage volume and is therefore recommended.

Comparison of Different Surgical Options in the Treatment of Pilonidal Disease: Retrospective Analysis of 175 Patients

Pilonidal sinus disease is a benign disorder with an unidentified etiology and is observed mainly in young adults. It is an important health problem because it causes work loss. Although various nonsurgical treatment options have been tried up to date, there is a consensus on surgical intervention to treat the disease today. The optimal surgical method should be simple, associated with short hospital stay and low recurrence rates. In this study, patients who have undergone different surgical treatment methods due to pilonidal disease were retrospectively analyzed. The medical records of 175 patients who were operated on between 2002 and 2005 at the General Surgery Departments of Gaziosmanpasa University Medical School and Bartin State Hospital for pilonidal disease were reviewed for treatment option, postoperative complications, hospitalization time, work-off periods, and recurrence rates. The patients consisted of 150 (85.3%) males with a mean age of 26.47 +/- 7.78 years. Marsupialization was applied to 82 (46.9%), unroofing to 20 (14.7%), primary closure to 29 (16.6%), and Limberg flap to 44 (25.1%) patients. The longest hospitalization period of 3.61 +/- 1.08 days was observed in the Limberg flap group. The longest return to work period (20.12 +/- 5.1 days) was observed in the marsupialization group. Both differences were significant. The highest complication rate was observed among the primary closure group (31%) followed by the patients treated by Limberg flap technique (15.8%). In the primary closure group, infection was detected in five (17.2%) and wound dehiscence in four (13.8%) individuals. The highest complication rates (31.03%) and recurrences (13.8%) were observed in the primary closure group. Various operative methods utilized in the treatment of pilonidal disease are associated with a number of advantages and disadvantages. Postoperative complication rates of unroofing and marsupialization are low, but require long wound care. In our study, we did not observe any recurrence among the patients treated by unroofing, but experienced a high recurrence ratio among subjects treated by marsupialization. In addition, there were high complication rates in the primary closure and Limberg flap groups. So, the best option is to explain the advantages and disadvantages of the available surgical methods and respect the patient's decision.

Does technique alter quality of life after pilonidal sinus surgery?

Background Pilonidal sinus is a common disease in young adults that carries high postoperative morbidity and patient discomfort. Controversy still exists about the best surgical technique for the treatment of the disease in terms of recurrence rate and patient discomfort. Methods From January 2000 to November 2003, 100 consecutive age- and sex-matched patients with chronic pilonidal sinus disease were randomized to receive surgical treatment in the forms of either excision and primary closure or rhomboid excision and Limberg flap. Time to return to work and to complete healing were recorded. To evaluate quality of life and patient comfort, all patients were asked to complete a questionnaire including short form 36, Visual Analogue Scale, time to sitting on toilet without pain, and time to walking without pain 3 months after surgery. Results Each group was composed of 50 patients. Mean follow-up was 19 months. There was a significant difference between the groups in terms of length of hospital stay ( P = .005), time to complete healing ( P < .001), time off work ( P < .001), and wound infection rate ( P = .03). Statistically significant differences were noted between the groups in items of general health perception (71.1 ± 11.7 vs 78.2 ± 14.1; P = .008), social functioning (87.3 ± 32.8 vs 110.4 ± 33.8; P = .001), and pain (54.5 ± 14.0 vs 67.5 ± 18.4; P < .001). Times to sitting on toilet and walking without pain showed significant differences between the groups ( P = .006 and P < .001, respectively). The mean postoperative Visual Analogue Scale scores were 6.5 ± 1.7 and 7.4 ± 1.4, respectively ( P < .001). Conclusions Shorter hospital stay, earlier healing, shorter time off work, lower ratio of complications, lower pain perception, and improved general health perception are the main advantages of te Limberg flap technique in pilonidal sinus surgery. All together, these parameters add to patient comfort and satisfaction after surgical treatment.

Local anesthesia and midazolam versus spinal anesthesia in ambulatory pilonidal surgery

Study objective To evaluate two anesthetic techniques, namely, local anesthesia with sedation, and spinal anesthesia, with respect to recovery times, postoperative side effects, pain scores, patient satisfaction, and hospital costs for ambulatory pilonidal disease surgery. Design Prospective, randomized study. Setting University Hospital of Pamukkale. Patients 60 consenting patients scheduled for pilonidal disease operation with Limberg flap technique. Intervention Patients were randomly allocated into two groups: Group 1 (n = 30) received spinal anesthesia with hyperbaric bupivacaine 1.5 mL 0.5%, and Group 2 (n = 30) received local infiltration with a 50-mL mixture containing 10 mL bupivacaine 0.5%, 10 mL prilocaine HCl 2%, and 30 mL isotonic solution with 1:200 000 epinephrine in combination with intravenous (IV) midazolam sedation. Measurements Perioperative and postoperative side effects, patient satisfaction, preoperative visual analog scale (VAS) pain scores, and VAS scores from the fourth hour postoperatively until the seventh day were assessed. Anesthesia, operation, surgery, and total hospital time, and costs (drug, resources, and labor) were recorded. Main results No difference was found between groups in the frequency of side effects. Urinary retention was diagnosed in two patients in the spinal anesthesia group. There was no statistical significant difference seen in satisfaction scores between groups. No statistical significance in VAS pain scores between groups was noted except for the fourth postoperative hour values. The average time spent in the operating room (OR) was greater in the spinal anesthesia group. All Group 2 patients achieved fast-tracking criteria in the OR and were able to bypass the postanesthesia care unit (PACU). Total hospital time and total cost were significantly higher in the spinal anesthesia group than local anesthesia-sedation group (p < 0.05). Conclusion The use of local anesthesia-sedation for ambulatory anorectal surgery resulted in a shorter hospital time, lower hospital costs, and no side effects compared with spinal anesthesia.