Limberg Flap Research Articles

Comparing Limberg Flap Technique and Phenol Treatment Methods in Treatment of Pilonidal Disease

DOI: 10.4328/JCAM.3311 Received: 12.02.2015 Accepted: 14.02.2015 Printed: 01.04.2015 Corresponding Author: Burhan Hakan Kanat, Genel Cerrahi Klinigi, Elazig Egitim ve Arastirma Hastanesi, Elazig, Turkiye. T.: +90 4242381000/1408 E-Mail: ku318@mynet.com Editor icin: Urganci ve ark. tarafindan yazilmis olan “Pilonidal Hastalik Tedavisinde Limberg Flep Teknigi ve Fenol Tedavisi Yontemlerinin Karsilastirilmasi” baslikli makaleyi ve sonrasinda bu yazi icin Turk ve arkadaslari tarafindan yazilmis olan Editore mektup yazilarini merakla ve buyuk bir ilgi ile okudum [1,2]. Her iki yazar grubuna; benim de ilgi alanimda olan sakrokoksigeal pilonidal sinus ile ilgili yazilari bizlere sunmus olduklari icin tesekkur ediyorum. Modern cerrahide bircok onemli hastaligin tedavisinde belirli bir gorus birligine varilmis olmasina ragmen, maalesef pilonidal sinus hastaliginin tedavisi, halen tartismali alanlardan biri olmaya devam etmektedir. Gunumuzde hala ideal tedavi yontemi kararlastirilamamistir. Pilonidal sinus hastaligi icin, bircok cerrahi ve cerrahi olmayan tedavi metotlari aciklanmistir. Yazarlar; en cok uygulanan cerrahi yontemlerden biri olan Limberg Flep Teknigi ile Fenol Tedavisi Yontemini karsilastirmis olup; analjezik kullanmadan agrisiz yurume zamani, ise baslama zamani acisindan ve postoperatif komplikasyon acisindan fenol tedavisinin daha ustun oldugunu istatistiksel olarak kanitlayarak bildirmislerdir. Bu konuda literaturdeki yazilar da Urganci ve arkadaslarini desteklemektedir. Urganci ve arkadaslarinin yazisinda fenol tedavisinin kur orani % 86 oraninda bildirilmistir. Bu oran Turk ve arkadaslari tarafindan bizim calismamiz ile kiyaslanmis ve bizim calismamizdaki % 64.5 basari orani ornek olarak verilmistir. Ancak bu oran yazimizin basliginda da yazmakta olan tek kur uygulamanin sagladigi basaridir. Yazimiz dikkatlice okundugunda toplam basari oranimizin 2 veya daha fazla uygulama ile % 95’lere vardigi yazmaktadir [3]. Buraya dikkat cekmek isterim. Fenol tedavisinin, ozellikle secilmis vakalarda uygulandiginda, basari oraninin yuksek oldugu bilinmelidir. Ayrica Urganci ve arkadaslari mikro-sinusektomiye ek olarak sivi fenol tedavisi uygulamislardir. Bizim calismamizda ise orifisler klemp yardimi ile genisletilerek kristalize fenol kullanilmistir. Bu acidan da bu iki makale kiyaslanarak bir yargiya varilmamalidir. Maliyet konusu icin yazida gozlem sonucu bir gorus bildirilmis. Tibbi yazilarda elbette kanita dayali bildirimlerde bulunulmasi vazgecilmez olmalidir. Ancak gerek hastanede yatis, gerek anestezi ihtiyaci, gerekse de kullanilan malzemeler ve ise donusun gecikerek hastanin kazanc kaybina ugramasi gibi parametreler goz onune alindiginda kur orani % 86 oraninda bildirilmis bir konservatif tedavi yonteminin maliyet acisindan cerrahi bir yontemden daha iyi oldugu asikardir. Hasta secimi veya tedavi yonteminin secimi acisindan ise en onemli faktorun cerrahin tecrubesi oldugunu dusunmekteyim. Ozellikle konservatif tedavilerde sinus sayilari ve yerlesimlerinin dikkate alinmasi gerekmektedir. Bu acidan Turk ve Polat ile ayni fikirdeyim. Uygun olan tedavi yontemi veya yontemleri hasta ile paylasilmali, bunun sonucunda karar verilmelidir. Hastaya ve hastaligin durumuna gore tedavi planlandiginda; gerek konservatif yontemlerden biri gerekse de cerrahi yontemlerden biri secilmelidir. Unutulmamalidir ki; hastada tedavi yonteminin iyi secilmesiyle; konservatif yontemle tedavi edilebilecek hastaya gereksiz cerrahi operasyon onlenebilir ve ayni sekilde cerrahi yapilmasi gereken hasta konservatif yontemlerle tedavi edilmeye calisilmayip zaman ve is gucu kaybi onlenmis olur. Turk ve Polat yazilarinda Limberg Flep yonteminin vazgecilemez oldugunu dusunduklerini belirtmislerdir. Ancak literatur irdelendiginde; Limberg Flep Tekniginden baska bircok cerrahi teknigin oldugu, ayni zamanda bircok konservatif tedavi yonteminin tariflendigi gorulmektedir. Bana gore sakrokoksigeal pilonidal sinus tedavisinde; semptomatik safra kesesi tasinin tedavisindeki laparoskopik kolesistektomi gibi altin bir standart yoktur. Tedavi yontemi; hastaya, hastaligin durumuna ve cerrahin tecrubesine gore belirlenmelidir. Bu acidan hicbir tedavi yontemi vazgecilemez degildir. Cerrahi tedavi ile ayni oranda kur sansi ve yine benzer nuks oranlarina sahip olan konservatif yontemler; uygun vakalarda mutlaka dusunulmeli ve hastalara bu sans taninmalidir.

Primary wound closure with a Limberg flap vs. secondary wound healing after excision of a pilonidal sinus: a multicentre randomised controlled study.

Off-midline procedures seem to be the best method of primary wound closure after excision of a pilonidal sinus. Primary wound closure with a Limberg flap was compared to secondary wound healing. From January 2006 to July 2012, 102 patients with given informed consent (mean age 28 years, men 81%) who had excision of a pilonidal sinus in three hospitals in Switzerland were randomised to group L (Limberg flap, n = 51) or to group E (excision only, n = 51). Primary endpoint was duration of incapacity for work. Follow-up was at 3 weeks and at 1 year postoperative (95% follow-up). Both groups were comparable with regard to patient characteristics. The median (range) operation time was 60 (30-80) min in group L vs. 30 (10-75) min in group E (p < 0.001). No significant differences were found in postoperative pain and painkiller intake; pain, percentage of patients at work and overall satisfaction at 3 weeks postoperative; and overall duration of incapacity for work and overall satisfaction at 1-year follow-up. The complication rate was 49% in group L vs. 12% in group E (p < 0.001). Complications in group L were seroma (6%), wound dehiscence (45%), skin necrosis (10%), hematoma (6%), infection (4%) and recurrent disease (13%). Complications in group E were recurrent disease (6%) and wound healing disorder (6%). After excision of a pilonidal sinus, primary wound closure with a Limberg flap has no advantage over secondary wound healing. The main reason for this conclusion is the relatively high complication rate of primary wound closure with a Limberg flap.

English

OBJECTIVE: to study the outcome of Limberg flap reconstruction in pilonidal sinus disease. STUDY DESIGN: Prospective study. MATERIALS AND METHODS: 32 patients with pilonidal sinus disease underwent rhomboid excision with Limberg flap. Duration of operation, postoperative pain, duration of hospital stay and postoperative complications were noted. Follow up of all patients was performed on an out-patient basis. RESULTS: There were 30 males (93.75%) and 2 females (6.25%), with a mean age of 28 years. The mean duration of symptoms was 6 months. Mean operative time was about 45 minutes. Mean pain score (VAS scale), was 3.65. The mean length of hospital stay was 4 days and most patients returned to work within 3 weeks. Three patients presented with post-operative complications of which one patient had recurrence (3%). CONCLUSION: Limberg flap technique is an effective procedure for pilonidal sinus disease associated with fewer complications and an easily mastered technique.

Efficacy of modified Limberg flap in surgical treatment of infected pilonidal abscess: a case–control study

Despite several surgical techniques in the treatment of pilonidal sinus, the ideal management is still under debate. Recently, Limberg flap has revealed promises owing to a lower recurrence rate. Our study aimed to assess mid-term outcomes of Limberg flap in patients with pilonidal abscesses. Through a prospective case–control study, we enrolled 90 consecutive patients with pilonidal disease attending department of surgery in one of the university hospitals in Tehran, Iran, between January 2010 and April 2011. Patients with simple sinus (control group) underwent wide excision of the sinus, while those with infected pilonidal abscess received incision and drainage of the abscess and then excision (case group), and ultimately all the patients were treated with Limberg flap. Patients were followed by regular outpatient visits at 1 week, 2 weeks, 1 month, 6 months, and 1 year. Of 90 patients, 17 were in the case group (18.88 %) and 73 in the control group (81.12 %). All patients were treated with Limberg flap and then followed at regular outpatient visits for a median of 11 months. With regard to the early complications, hematoma occurred in one patient (1.4 %) and infection in three patients (4.1 %) of the control group, while late complications occurred only in two patients of the control group as paresthesia, which did not differ significantly. This study showed that Limberg flap is effective in the surgical treatment of infected pilonidal abscess, with desirable mid-term outcomes.

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 depression, anxiety and long-term quality of health in patients with a history of either primary closure or Limberg flap reconstruction for pilonidal sinus

OBJECTİVE:Pilonidal sinus is characterized by high operative morbidity mainly due to wound problems. We aimed to compare the quality of health, comfort and psychological status in patients who underwent surgery for pilonidal sinus.METHODS:A total of 205 pilonidal sinus patients operated on with either primary closure or Limberg flap reconstruction were compared in terms of depression, anxiety, and long-term quality of health by using Short Form 36, Beck Depression Inventory, and Beck Anxiety Inventory scales.RESULTS:There were 107 patients in the primary closure group with a mean follow-up of 29.6±7.7 months and 98 patients in the Limberg flap group with a mean follow-up of 34.1±7.3 months. In the SF-36 analysis, the mental health and bodily pain scores (59±6 and 56±11 in the primary closure group and 62±8 and 61±10 in the Limberg flap group) were significantly higher in the Limberg flap group (p = 0.014 and p = 0.002, respectively). The mean Beck Depression Inventory (19±6.13 vs. 16±4.90 p<0.001) and Beck Anxiety Inventory (19±6.27 vs. 16±4.90 p<0.001) scores were lower in the Limberg flap group.CONCLUSION:Limberg flap reconstruction produced better quality of health scores according to the SF 36, especially in terms of mental health and bodily pain. There was a higher tendency towards anxiety and depression in the primary closure group.

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.

Retrospective Review of Pilonidal Sinus Patients With Early Discharge After Limberg Flap Procedure

The aim of this study was to evaluate the results of cases with pilonidal sinus (PS) disease that underwent Limberg flap (LF) transposition and to compare the short and long-term results of early discharge cases with those in the literature. A total of 345 patients who underwent rhomboid excision and LF transposition for PS were evaluated retrospectively. No major anesthetic or surgical complications occurred. Partial wound dehiscence, localized flap necrosis, hematoma, wound infection, and seroma rates were determined as 4.0, 2.1, 1.5, 3.3, and 3.7% respectively. All patients other than those with a hematoma or localized necrosis were discharged with a drain in place 24 hours after the operation. The recurrence rate was 3.9% after a mean 33.1-month follow-up (range, 6-72 months). As a result, we found that short and long-term results of patients who underwent LF and were discharged 24 hours after the operation were similar to those in the literature. We suggest that patients without postoperative complications, such as hematoma or flap necrosis, can be discharged early.

Direct closure versus local flaps in management of pilonidal sinus

Objectives The aim of this randomized prospective trial was to compare both the results of direct closure and local flaps in management of pilonidal sinus. Background The best surgical technique for sacrococcygeal pilonidal disease is still controversial in terms of minimizing disease recurrence and patient discomfort. The present study analyzes the results of excision with primary closure and excision with flap reconstruction in the surgical treatment of sacrococcygeal pilonidal disease. Materials and methods From February 2012 to February 2013, 30 consecutive patients with chronic pilonidal sinus disease received surgical treatment in the form of either excision and primary closure (group 1, n = 15 patients) or excision and flap reconstruction [group 2, n = 15 patients; classic Limberg flap ( n = 5), modified Limberg flap ( n = 5), and V-Y advancement flap ( n = 5)]. Demographic data, operative time, postoperative pain, hospital stay, duration of incapacity for work, postoperative complications (infection, flap edema, wound dehiscence), patient satisfaction, and postoperative recurrence were recorded. Results The mean follow-up was 12 months. A significant difference was observed between the two groups in terms of operative time (min), postoperative complications, and patient satisfaction (P 0.05) for all comparisons. In the modified Limberg flap, no wound infection or recurrence of the disease occurred. Conclusion Flap reconstructions were superior to primary closure after excision of pilonidal sinus, and modified Limberg flap was superior with respect to wound infection and recurrence.

The Limberg flap procedure in the treatment of pilonidal cyst disease of the sacrum - initial report.

Pilonidal cyst disease mainly concerns young people, aged between 16 and 25 years. The disease causes significant pain, considerable discomfort and impairs daily functioning, often resulting in an inability to work and study. Many techniques have been introduced in the treatment of pilonidal cysts, but till today no gold standard has been established. The aim of the study was to present initial results considering the treatment of pilonidal cyst disease with the use of a skin flap by means of Limberg's method. During the period between January, 2012 and March, 2013, 10 patients were operated due to pilonidal cysts using the Limberg flap procedure. All patients presented with the chronic form of the disease and were after previous surgical incisions. Pain considering patients was evaluated using the visual pain scale (VAS), one and 10 days after the operation. Patients reported for control 10 days, one month, and 6 months after the surgical procedure. The planned procedure was safely performed in all cases. There were no complications during the procedure, nor late postoperative complications. We observed no wound infection or dehiscence in all operated patients. The mean follow-up time of the presented group was 13.32 months (ranging between 7.53‑21.57). During the follow-up period there was no episode of recurrence. The use of the skin flap by means of Limberg's method after excision of the pilonidal cyst in the sacrum area is a good method, which provides a very low percentage of recurrences and complications. Fast return to daily activities, no significant pain in patients, and an acceptable cosmetic result are strong reasons in favor of the above-mentioned method. Preliminary observations and experience enable to recommend this method for the treatment of pilonidal cysts in the vicinity of the sacrum.

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.

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Limberg Flap Versus Bascom Cleft Lift Techniques for Sacrococcygeal Pilonidal Sinus: Prospective, Randomized Trial

Although various methods have been described for surgical treatment of pilonidal sinus disease, which is best is under debate. Tension-free techniques seem to be most ideal. We aimed to evaluate the effects of two tension-free methods in terms of patient satisfaction, postoperative complications, and early recurrence. A group of 122 patients were prospectively included in the study. Patients were divided into two groups based on the operative method used: Limberg flap or Bascom cleft lift. Quality of life scores, pain scores, length of time for healing, hospital stay, surgical area-related complications, excised tissue weight, and early recurrence information were evaluated. Follow-up of patients in each group was completed. Patients in the Bascom cleft lift group had shorter operation duration, less excised tissue weight, better bodily pain score, and less role limitation due to physical problems score on postoperative day 10. There was no statistically significant difference between groups for the other criteria. Although both techniques provided good results during the early period, the Bascom cleft lift procedure is a reliable technique that provides shorter operation duration and better quality of life during the early postoperative period.

Comparison of Short-term Results Between the Modified Karydakis Flap and the Modified Limberg Flap in the Management of Pilonidal Sinus Disease

The modified Karydakis flap and the modified Limberg flap are commonly used in the surgical management of sacrococcygeal pilonidal sinus disease. The study aimed to compare short- term results of these techniques. The modified Karydakis flap and the modified Limberg flap were compared in a randomized controlled trial. The study was conducted in the day-case surgery department of a large academic teaching hospital in Alexandria, Egypt, from February 2009 through September 2011. Patients undergoing surgery for chronic sacrococcygeal pilonidal sinus disease were eligible for the study. Patients with sepsis were eligible only after aggressive treatment to eliminate sepsis. Patients were randomly allocated to undergo surgery with either the modified Karydakis flap or the modified Limberg flap. The primary end point was operative time. Secondary endpoints included proportion of patients with postoperative complications, proportion of patients who were satisfied with the cosmetic results, and the rate of recurrence. Follow-up times were not sufficient to evaluate long-term recurrence rates. Of 154 patients screened, 125 were enrolled, and 120 patients completed the study. The median operative time was significantly shorter in patients with the modified Karydakis flap than in those with the modified Limberg flap: 33 (range, 28-40) min vs 52 (range, 48-62) min; p < 0.001). No significant differences were found between study groups regarding overall complication rate (23% vs 40%, p = 0.08), wound infection (3% vs 5%, p > 0.99), subcutaneous fluid collection (5% vs 0%, p = 0.24), or hypoesthesia (10% vs 23%, p = 0.09). Full-thickness wound disruption was encountered in 9 patients (15%) in the modified Limberg group vs no patient in the modified Karydakis group (p = 0.003). The median follow-up duration was 20.5 months in each study group. One patient (2%) in the modified Karydakis group developed recurrent disease vs 2 patients (3%) in the modified Limberg group (p > 0.99). In the modified Karydakis group, 58 patients (97%) were satisfied with the cosmetic outcome and were willing to recommend the operation to others vs 43 patients (72%) in the modified Limberg group (p < 0.001). Both techniques provide effective treatment for pilonidal sinus disease and can be performed safely as day-case surgery. The modified Karydakis flap is associated with significantly shorter operative time, a lower full-thickness wound disruption rate, and a higher patient satisfaction rate.

Which flap method should be preferred for the treatment of pilonidal sinus? A prospective randomized study

Although many methods, either surgical or non-surgical, are being used for the treatment of pilonidal sinus disease (PSD), there is still no consensus as to what constitutes the most appropriate method of treatment. The aim of this study was to compare the outcomes of the Limberg flap (LF), modified Limberg flap (MLF), and Karydakis flap (KF) procedures. A prospective, randomized study was conducted on 295 patients scheduled for surgical treatment for PSD at the General Surgery Clinic of the Konya Training and Research Hospital in January 2009-May 2010. Patients with recurrent disease, an ASA score higher than III, obesity (BMI > 35 kg/m(2)), insulin-dependent diabetes, or a drug or alcohol addiction were excluded. The procedures performed were as follows: LF (n = 96), MLF (n = 108), and KF (n = 91). The patients were followed up for a median of 33 months (range 24-41 months). There were more female patients in the LF group. The rate of seroma formation was higher in the KF group (19.8 %) compared to the LF and MLF groups (5.2 and 7.4 %, respectively; p = 0.027). The rate of wound dehiscence was higher in the KF group (15.4 %) compared to the LF and MLF groups (2.1 and 3.7 %, respectively; p < 0.001) as was the incidence of flap maceration (11 % in the KF vs. 1 % in the LF and 3.7 % in the MLF; p = 0.004). The incidence of PSD recurrence was also higher in the KF group (11 %) compared to the LF and MLF groups (6.3 and 1.9 % respectively; p = 0.027). In a multivariate analysis, the presence of seroma, hematoma, and wound infection were independent predictors of recurrence. In our study, LF and MLF procedures were associated with a lower recurrence and complication rate compared to KF. However, more randomized studies comparing different reconstruction methods after PSD excision are needed.

Comparison of Limberg flap and excision and primary closure of pilonidal sinus disease, in terms of quality of life and complications

PurposeThe aim of this study was to compare two different treatment methods for pilonidal sinus with respect to complications, recurrence, and patient quality of life.MethodsFive hundred forty-nine patients who underwent surgery for pilonidal sinus between January 2007 and August 2012 were included in this study. The patients were classified into group I (excision and primary closure) and group II (Limberg flap).ResultsThere was no significant difference in the mean age and gender of the patients between groups I and II (P = 0.512 and P = 0.472). The duration of surgical operation was lower in group I (P < 0.001). There was no significant difference in hospitalization time after surgery, minor complications, and recurrence between the groups (P = 0.674, P = 1.000, and P = 1.000, respectively). The time required for pain-free walking, urinating, and returning to work was significantly lower in group II (P < 0.001, P < 0.001, and P < 0.001, respectively). The patients in group I stated that they were more satisfied in terms of aesthetics (P < 0.001).ConclusionAccording to the results of this study, Limberg flap method has better outcomes compared with excision and primary closure. Therefore, we recommend Limberg flap for treatment of pilonidal sinus disease.

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.