Limberg Flap Research Articles

Comparison of outcome of Simple Excision vs Limberg Flap of pilonidal sinus in terms of post operative pain, operative time, wound infection and hospital stay.

Objective: To compare post operative pain, wound infection, intraoperative time and length of hospital stay in both groups of simple excision and Limberg flap. Study Design: Comparative Prospective study. Setting: CMA Teaching and Research Hospital/Azra Naheed Medical and Dental College, Lahore, Pakistan. Period: 1st September 2021 to 1st September 2023. Methods: After approval from the Institutional review board of Azra Naheed Medical & Dental College/CMA Hospital, the sample was 120 patients was raised using non-convenience probability sampling divided into 2 groups. Group A patients underwent simple excision while Group B patients underwent Limberg flap Inclusion criteria include all the patients with age more than 13 years and diagnosed as case of pilonidal sinus. All the data was entered and processed by using SPSS 26. Comparison of two groups was done by apply independent sample t-test. A p-value of ≤ 0.05 was considered significant. Results: The average age of the patients was 45.88 ± 9.78 years with minimum and maximum ages were 15 & 59 year respectively. Mean post operative pain was 2.6 ± 1.9 in group A while 3.9 ± 2.7 in group B (p value = <0.05). Similarly wound infection, duration of surgery and length of hospital stay were also less in group A patients as compared to group B patients. Conclusion: Simple excision of pilonidal sinus is better from Limberg flap in terms of post operative pain, wound infection, duration of surgery and length of hospital stay.

Innovative Use of Limberg Flap for MRONJ Reconstruction.

Medication-related osteonecrosis of the jaw (MRONJ) is a serious complication associated with bisphosphonate therapy, characterized by necrotic bone exposure in the maxillofacial region. This case report details the surgical management of a 68-year-old female patient with a history of cancer and bisphosphonate-related osteonecrosis. After the initial sequestrectomy, the patient developed a purulent discharge, necessitating soft tissue reconstruction using a Limberg flap. The surgical procedure involved meticulous debridement and flap placement, resulting in successful healing and resolution of symptoms. This case highlights the importance of tailored management strategies for MRONJ and the potential benefits of the Limberg flap in reconstructive surgery, addressing a notable gap in the literature regarding its application in this context.

An Observational Study On Surgical Procedures Of The Pilonidal Sinus Disease: Primary Closure, Healing By Secondary Intention And Limberg Flap Reconstruction

An Observational Study On Surgical Procedures Of The Pilonidal Sinus Disease: Primary Closure, Healing By Secondary Intention And Limberg Flap Reconstruction

Resection of a Ruptured Epidermoid Cyst with Limberg Flap: Case Report

Epidermoid cysts, also known as epidermal cysts, keratin cysts, epithelial cysts, or sebaceous cysts (although this term is no longer widely used), are benign lesions frequently seen in clinical practice. These cysts arise from epidermal cells trapped beneath the skin's surface. The most common complication is cyst rupture, which can lead to significant inflammation and even a granulomatous response. This article presents the clinical case of a male patient with a ruptured epidermoid cyst that triggered a granulomatous reaction, treated with surgical excision and reconstruction using a Limberg flap. Proper surgical management is crucial in such cases to prevent long-term complications and ensure optimal healing.

Long Term Follow Up of Limberg's Flap Repair for Pilonidal Sinus Disease

Long Term Follow Up of Limberg's Flap Repair for Pilonidal Sinus Disease

LIMBERG FLAP FOR SACROCOCCYGEAL PILONIDAL SINUS: A SAFE AND PROMISING SURGERY

Introduction:Sacrococcygeal pilonidal sinus is a common disease of the adult age group, especially male population, causing significant morbidity from both disease and surgery done for the same. It is essentially a cleavage between the buttocks (i.e., natal cleft), and diagnosis is made by identifying the epithelialized follicle opening (i.e., sinus). The name PILONIDAL is taken from Latin meaning nest of hairs. The estimated incidence is 26 per 1,00,000 people1. It generally presents as a cyst, abscess, or sinus tract with or without discharge2. Men affected more often than women1, rare both before puberty and after the age of 40 years3. The etiology of the pilonidal sinus is a matter of controversy. Aims & Objectives:Literature study showed that Limberg flap reconstruction following rhomboid excision of the sinus area was superior to primary closure and other flap procedures and a safe and reliable method in sacrococcygeal pilonidal sinus disease with low complication and recurrence rates. Hence, this study was performed in our setup to evaluate the usefulness of Limberg flap procedure in sacrococcygeal pilonidal sinus, patient compliance, complications and long-term recurrence rates following the procedure. Materials & Methods:The study involves 22 patients, from May 2022 to September 2023. Most of the patients were males of those 4 were females. Average age was 24 years—the oldest was 29 years and the youngest was 15 years. Results:In this study 22 patients were included. Among them 18 were males and 4 were females. Mean age was 24 years (range 15–29 years). Of the 22 patients, 14 had primary disease, 6 had recurrent disease, and 2 came up after having previous incision and drainage for abscess. All patients came with pilonidal sinus, from May 2022, were assessed for its severity and investigated, and then they underwent Limberg flap surgery under spinal anesthesia. Discussion:Sacrococcygeal pilonidal sinus is blind epithelial tract situated in the skin of the natal cleft, close to anal verge, generally containing hair. The etiology is matter of debate initially congenital origin was thought of which is now given up. Main causes for the formation of this sinus are hirsutism, sweating in the area, repeated maceration due to trauma, leading to breakage of the skin barrier, attracting hair inside which initiates a foreign body reaction leading to infection with abscess or sinus formation. Conclusion:Sacrococcygeal pilonidal sinus is headache to both the patient and the treating surgeon because of its repeated infection, persistent pain with discharge, and high recurrence rates with regular procedures.

A Single-Centre Analysis of Surgical Techniques for Myelomeningocele Closure: Methods, Outcomes, and Complications.

(1) Background: Neural tube defects are a prevalent cause of congenital malformations, myelomeningocele (MMC) being the most severe form. This study evaluates the clinical outcome and postoperative-associated complications following MMC surgical closures, focusing on the following three techniques: direct suture (DS); VY advancement flap (VYF); and Limberg flap (LF). (2) Methods: A retrospective observational study was conducted from March 2015 to February 2023, and the inclusion criteria were newborns who underwent lumbosacral MMC within 24 h of birth. (3) Results: Out of 20 cases, 45% underwent DS closure; 25% underwent VY-F closure; 15% underwent LF closure, and 15% (n = 3) underwent combined flap closure. A significant statistical correlation was observed between intracranial hypertension (IH), the need for external ventricular drainage (EVD), and DS closure type. In the DS group, 60% of patients required EVD (p = 0.041), and 90% had IH (p = 0.027). CSF fistula was present in 40% of LF cases and 30% of DS cases, while wound dehiscence was observed in 60% of LF cases and 30% of DS cases. (4) Conclusions: Our study demonstrated that DS was linked to higher rates of complications. The VY-F is the safest method for closing MMC defects.

Limberg Flap for Lateral Midface Reconstruction.

Several local skin flaps and tissue rearrangement techniques have been described in the literature, including the rhomboid flap. The Limberg flap is one of the most versatile local flaps that can be used for reconstruction of a wide range of skin defects in different parts of the body. The purpose of this study is to demonstrate the safety and applicability of the Limberg flap for reconstruction of skin facial defects, particularly after cutaneous tumor resection. The following article presents a retrospective case series of 8 patients in whom the Limberg flap was used to reconstruct skin defects resulting from malignant tumor resections in the lateral part of the face. No restrictions were collected regarding etiology, location, size, age, sex, or any other patient factors. The recruited patients were treated in the Maxillofacial Surgery Unit of Floraspe Renzetti Hospital of Lanciano and the study was conducted in collaboration with Sapienza University of Rome, from April 2023 to April 2024. All the flaps settled with no complications and all the patients were FOD (free of disease) 6 months after surgery. So, in accordance with the literature, the Limberg flap turns out to be a rapid and reliable option that could be easily applied for small (size around 1-2cm) and medium-sized (size around 2-4cm) cutaneous defects of the face even for the oldest and/or emaciated patients.

Overview of Pilonidal Cyst Treatment Methods - Review Paper

Introduction and purpose A pilonidal cyst also known as a pilondial sinus, is an inflammatory condition that occurs in the intergluteal region, which can lead to serious infections. It most commonly affects young men, with risk factors including the presence of hair in this area, excessive sweating, obesity, and poor hygiene. Symptoms include a lump, pain, and purulent discharge from openings in the skin. Diagnosis involves taking a medical history, a physical examination, and often an ultrasound. The aim of this paper is to present and compare the available methods for treating pilonidal cysts. Materials and methods Literature available in PubMed databases were reviewed using the following keywords: ‘’Pilonidal cyst’’, ‘’Hair cyst’’, ‘’Abscess’’, ‘’Treatment of pilonidal cyst’’,’’ Bascom II method’’,’’ Limberg flap’’,’’ Suchorski technique’’, ‘’V-Y or Z skin flap reconstruction’’,’’ the Karadakis’’ Results The available treatment methods can be divided into conservative and invasive approaches. Conservative methods include hair removal and improved hygiene. Among the surgical methods, there are traditional excision techniques and modern methods such as excision using the Bascom II method, Limberg flap, Suchorski technique, or V-Y or Z skin flap reconstruction. The Karadakis method, which involves shifting a skin flap, is particularly effective for obese patients. Conclusion Treatment of pilonidal cysts depends on the stage and symptoms. Abscesses require urgent surgical intervention, while asymptomatic cysts can be treated conservatively or surgically.

Limberg flap for previously recurrent complex sacrococcygeal pilonidal sinus surgeries

Limberg flap for previously recurrent complex sacrococcygeal pilonidal sinus surgeries

LIMBERG FLAP VERSUS BASCOM CLEFT LIFT TECHNIQUES FOR SACROCOCCYGEAL PILONIDAL SINUS

Objective: The study aims to evaluate and compare the outcomes of two surgical techniques, the limberg flap and Bascom cleft lift, used in the treatment of sacrococcygeal pilonidal sinus. Key metrics for comparison include postoperative complications, hospital stay duration, and surgery duration. Methods: This was a prospective study conducted at ESIC Hospital, Jaipur, involving 100 patients diagnosed with sacrococcygeal pilonidal sinus requiring surgical intervention. Patients were divided into two groups: Group I underwent the Bascom cleft lift procedure (n=40), and Group II underwent the limberg flap technique (n=60). Both groups were evaluated over a period of one and a half years with preoperative assessments and postoperative follow-ups for complications, duration of surgery, and length of hospital stay. Results: The study included 40 patients in the Bascom group (42.5% male, 57.5% female) and 60 in the limberg group (55% male, 45% female). The average surgery duration was significantly shorter for the Bascom procedure (36.73±6.52 min) compared to the limberg flap (74.58±10.10 min). Postoperative complications were higher in the limberg flap group. The Bascom cleft lift patients experienced shorter hospital stays and fewer postoperative issues, including lower rates of discharge and infection. Conclusion: The Bascom cleft lift procedure appears to be superior to the limberg flap in terms of shorter operative time, fewer complications, and quicker recovery. These findings suggest that the Bascom cleft lift could be a more efficient and safer option for the surgical treatment of pilonidal sinus, promoting faster patient recovery with fewer postoperative complications.

A Classic and Effective Approach for Managing Totally Implantable Venous-Access Port Site Dehiscence in Patients with Cancer: The Limberg Flap

Background: Totally implantable venous-access ports (TIVAPs) are essential for long-term intravenous treatment in cancer patients, but TIVAP site dehiscence remains a significant issue. This study aims to investigate how Limberg flap transposition compares to primary repair and other local flap techniques in managing TIVAP site dehiscence.Methods: A retrospective study was conducted on patients who underwent repair operations, without TIVAP removal, for right subclavicular area TIVAP site dehiscence between May 2016 and March 2023. Outcomes of primary repair, Limberg flap transposition and other local flap surgeries were analyzed, focusing on incisional integrity and dehiscence recurrence rate.Results: Nine patients and 3,204 catheter days were included in the study, with a total of 15 surgical repair procedures performed for dehiscence, including cases of recurrence. Among them, Limberg flap transposition demonstrated the longest period of incisional integrity, with a mean of 231.4 days, surpassing primary repair (74.25 days) and other local flap techniques (29.5 days). Additionally, the Limberg flap exhibited the lowest recurrence rate, with 0.86 events per 1,000 catheter days, compared to primary repair (10.10 events per 1,000 catheter days) and other local flap approaches (16.95 events per 1,000 catheter days).Conclusion: Limberg flap transposition is considered as an effective solution for TIVAP site dehiscence, showing reduced complications and recurrence rates compared to primary repair and other local flap techniques. This study suggests Limberg flap transposition should be considered the preferred option for managing TIVAP dehiscence in cancer patients, thereby improving patient care and outcomes.

The application of ERAS in pilonidal sinus: comparison of postoperative recovery between primary suture and Limberg flap procedure in a multicenter prospective randomized trial

The application of ERAS in pilonidal sinus: comparison of postoperative recovery between primary suture and Limberg flap procedure in a multicenter prospective randomized trial

Outcomes of Limberg flap repair in recurrent pilonidal sinus disease: a study in a district hospital of Bangladesh

Outcomes of Limberg flap repair in recurrent pilonidal sinus disease: a study in a district hospital of Bangladesh

Limberg Transpositional Fasciocutaneous Flap in Sacrococcygeal Pilonidal Sinus Disease (SPSD): A Case Series.

Introduction Among young male adults, sacrococcygeal pilonidal sinus disease (SPSD) is a prevalent condition. There are several possibilities for treatment, including both conservative and surgical methods. Medical supervision or conservative management is not the cutting-edge and preferred management nowadays. Although not fatal, it negatively impacts young people's quality of life in terms of schooling and means of subsistence and is socially awkward. Method About 10 individuals in this case series have serous drainage from the sinus in the sacral region, which is a common symptom. The patients were entitled to a full recovery from their illness. In all these patients, the Limberg flap procedure was recommended, and just one patient out of 10 had a minimal infection. Every patient was satisfied with how the surgery turned out. Overall, the Limberg flap (rhomboid flap) approach is becoming the norm for care since it has a lower rate of recurrence, fewer postoperative problems, and a shorter learning curve. Result Flap necrosis instances were absent in all the cases. And out of 10 cases, one patient came with a surgical site infection during the follow-up, suggesting a complication rate of 10%. Conclusion For the treatment of primary pilonidal illness, rhomboid excision utilising the Limberg transpositional fasciocutaneous flap technique is seen as a safer option that encompasses numerous sinuses. It requires less time in the hospital and has fewer postoperative problems.

‘’Comparative outcome study between simple closure and flap technique in Pilonidal sinus disease’’

I have read the interesting article ‘’Comparative outcome study between simple closure and flap technique in Pilonidal sinus disease’’ by Dr. Ram Magar and Dr. Rupali Magar published in your journal on 15th March 2022. According to this valuable study; Limberg flap method has has been found to have better outcome with less wound infection, wound disruption, postoperative discharge and recurrence rate compared to simple closure group. And as stated, it is safe and easy procedure. So it is recommended that Limberg flap method should be used in the treatment of pilonidal sinus disease over other modalities.[1]
 In our 767 patients study group results, we had recommended Limberg Flap Repair Technique for surgical treatment of pilonidal sinus disease. This technique had an acceptable “short” ‘Return to Work Outcome’ when compared with open techniques. Also had the smallest postoperative infection rate and low recurrence rate.
 Still in our daily surgical practice, earlier healing, shorter return to work, lower rates of infection and recurrence are the major factors that make us to use Limberg Flap Repair Technique mostly. Moreover, it is easy, fast, and practical to apply.[2]

Outcomes of pediatric pilonidal disease treatment: excision with off-midline flap reconstruction versus endoscopic pilonidal sinus treatment

PurposePilonidal disease (PD) is marked by chronic inflammation and frequent recurrence which can decrease quality of life. However, debate remains regarding the optimal treatment for PD in the pediatric population. This study compares two recommended treatment approaches—excision with off-midline flap reconstruction (OMF: Bascom cleft lift flap, modified Limberg flap) and minimally invasive endoscopic pilonidal sinus treatment (EPSiT).MethodsSingle-center retrospective evaluation of patients 1–21 years of age with PD who underwent either excision with OMF reconstruction or EPSiT between 10/1/2011 and 10/31/2021. Outcomes included were disease recurrence, reoperation, and wound complication rates. Comparisons were performed using Chi-square and Mann–Whitney U tests.Results18 patients underwent excision/OMF reconstruction and 45 patients underwent EPSiT. The excision/OMF reconstruction cohort was predominantly male (44.4% vs 17.8% p = 0.028), with history of prior pilonidal infection (33.3% vs 6.7%; p = 0.006), and longer median operative time (60 min vs 17 min; p < 0.001). The excision/OMF reconstruction cohort had a higher rate of wound complications (22.2% vs 0%; p = 0.001), but lower rates of disease recurrence (5.6% vs 33.3%; p = 0.022) and reoperation (5.6% vs 31.1%; p = 0.031).ConclusionIn pediatric patients with PD, excision with OMF reconstruction may decrease recurrence and reoperation rates with increased operative times and wound complication rates, compared to EPSiT.

Sinus Laser Closure (SiLaC) with pit excision versus Limberg Flap in pilonidal disease: A prospective, randomized study

BackgroundPilonidal disease is a chronic suppurative condition of the natal cleft associated with significant morbidity primarily affecting the working population causing daily discomfort and activity limitation. Although several treatment modalities have been suggested for the management of this condition, the gold standard continues to be undefined. We conducted a randomized prospective study on the treatment of Pilonidal disease by Sinus Laser Closure (SiLaC) compared with Limberg Flap. Materials and methods100 patients with primary Pilonidal disease were randomized to undergo either SiLaC or Limberg Flap. The primary objective of our study was to establish the advantage of SiLaC over Limberg Flap in terms of the operative time, postoperative pain, duration of hospital stay, healing time, cosmesis and recurrence rates over a period of 2 years. The patient satisfaction and return to normal activities were also documented. ResultsWe analysed a total of 50 cases that underwent SiLaC and 50 that underwent Limberg Flap with similar demographic characteristics. Significantly lower operative time was noted in the SiLaC group. SiLaC was associated with decreased postoperative pain and duration of hospital stay with faster healing and better cosmetic outcome. The patient satisfaction and return to normal activites were also reported to be better in the SiLaC group. Recurrence was reported in 4 patients in SiLaC group versus 6 patients in Limberg Flap group. ConclusionOur study reports SiLaC as superior to Limberg Flap with shorter operative time, lower pain scores, length of hospital stay, faster healing time, decreased recurrence rates and good cosmetic satisfaction.

Outcome of dufourmentel flap versus conventional rhomboid (Limberg flap) in the treatment of complex pilonidal sinus: a randomized controlled study

Background Management of pilonidal disease lacks a single optimal treatment strategy, and recurrence is a problem for both the patient and the surgeon. Various flap-based treatment approaches are available for the treatment of such problems. This study aims to compare the outcome of dufourmentel flap versus conventional rhomboid in complex pilonidal diseases. Patients and methods The present randomized controlled study included 64 patients with complex pilonidal sinus, who were randomly divided into two groups: group A (n=32) patients underwent a dufourmentel flap while group B (n=32) patients underwent conventional rhomboid (Limberg flap). Follow-up was planned for early postoperative complications and recurrence as well as the aesthetic outcome. Results The mean age was 25.3±7.4 and 25.8±5.8.years in groups A and B, respectively. There was a statistically significant longer flap in group A when compared with group B (P=0.04). The mean operative time was 39.3±4.8 and 43±4.4 in groups A and B, respectively. Postoperative follow-up revealed a higher rate of complications in group B than in group A with a statistically significant difference in postoperative infection/discharge, hematoma, seroma, and partial flap loss. Conclusion Due to its adaptability, repeatability, clear, and predictable closure of the defect, and low recurrence rate, the authors suggest the dufourmentel flap as a suitable approach in the treatment of difficult and recurrent cases.

Endoscopic Pilonidal Sinus Treatment {Epsit} vs Limberg Flap for Pilonidal Sinus: A Single Center Experience

Background: Pilonidal sinus, a condition characterized by chronic irritation in the gluteal cleft, predominantly affects males and is often associated with a higher body mass index and a sedentary lifestyle. Despite its prevalence, a universally accepted gold standard for treatment is yet to be established. This study aimed to compare outcomes between two treatment modalities: endoscopic pilonidal sinus treatment (EPSiT) and the Limberg flap procedure. Materials and Methods: This observational study involved 40 patients undergoing pilonidal sinus treatment at a single tertiary care hospital from April to October 2023. Patients were categorized into two groups based on the chosen procedure, and postoperative pain was assessed using the Visual Analog Scale (VAS). Data on early complications and recurrence rates were recorded in case report forms. The groups were compared, and statistical analysis was conducted using SPSS version 21. Results: Among the total patients, 47% underwent EPSiT, while 53% underwent the Limberg flap procedure. Both groups had an age range of 25-80 years. Intraoperative time for EPSiT was shorter than that for the Limberg flap (25.2±5.0 vs 45.5±5.1 minutes). VAS scores indicated lower postoperative pain in the EPSiT group. Wound healing rates were faster in patients who underwent EPSiT. Short-term recurrence rates were lower in the EPSiT group, although long-term recurrence rates were comparable in both groups. Conclusion: Endoscopic pilonidal sinus treatment demonstrated advantages over the Limberg flap procedure in this study. EPSiT showed shorter operative times, reduced postoperative pain, earlier return to routine activities, and faster wound healing. Furthermore, patients undergoing EPSiT experienced fewer complications such as serous discharge and swelling. While short-term recurrence rates were lower in the EPSiT group, long-term recurrence rates were similar between the two treatment modalities. This study contributes valuable insights into the comparative effectiveness of EPSiT and the Limberg flap procedure for pilonidal sinus treatment.