Modified Limberg Flap Research Articles

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.

Pilonidal sinus hastalığında Rhomboid eksizyon ve Modifiye Limberg flep uygulanan hastalarda tek merkez klinik deneyiminin değerlendirilmesi

Aims: Pilonidal sinus disease (PSD) is a chronic inflammatory disease that is seen especially in young men, is often located in the sacrococcygeal region and negatively affects the quality of life and daily life of the person. In this study, we aimed to share our experience with the literature by examining our clinical approach and results in the patient group who underwent Modified Limberg flap technique electively in PSD.&#x0D; Methods: Patients who underwent elective modified Limberg flap application due to PSD in the general surgery clinic were included in the study. Demographic and clinical parameters of the patients were investigated retrospectively.&#x0D; Results: The mean age of 76 patients included in the study was 27.5±8.5 years (18-51 years). The median duration of hospitalisation was 2 days. The most commonly preferred prophylactic antibiotic at surgery was cefuroxime + metranidazole combination (60.5%) or cefuroxime alone (32.9%). Drain use was present in approximately 40% of the cases. Subcutaneous tissues were closed with a single layer of polyglactin suture in most cases (94.7%). During the median follow-up period of 12 months, postoperative recurrence was observed in only 6 cases (7.9%).&#x0D; Conclusions: Modified Limberg flap technique is a well-defined, safe and feasible surgical method. Since it is an effective off-midline technique, its application by experienced surgeons in complicated and recurrent cases in elective PSD surgery and its transfer to junior and resident surgeons will be effective in terms of moving away from midline techniques.

Simplified and modified Limberg flap plus vacuum-assisted closure for treatment of sacrococcygeal pilonidal sinus disease.

Pilonidal sinus disease (PSD), a chronic inflammatory disease, affects the sacrococcygeal soft tissue, especially in young adults. The ideal treatment for PSD remains divergence. This study evaluated the application of a simplified modified Limberg flap combined with vacuum-assisted closure for treating PSD. This prospective study was conducted from 1 June 2017 to 31 March 2022 in Changhai Hospital, Naval Military Medical University, Shanghai, China. The study included 88 male patients (91.7%) and 8 female patients (8.3%). The 96 patients ranged in age from 15 to 34 years (mean ± SD, 23 ± 4.4). Under general anaesthesia, all patients underwent simplified modified Limberg flap reconstruction with vacuum-assisted closure. The patient's weight, surgical time, extubation time, hospital stay, time to return to normal life or work, wound infection, wound dehiscence and recurrence rate were recorded. The visual analogue scale (VAS) score and the Vancouver scar score were used to score patients' pain and scars in the surgical area. The volume of resected diseased tissue was 13.5-120 (mean ± SD, 34.993 ± 24.406) cm2 . The average surgical time during the treatment period was 97.68 ± 18.72 min, and the average extubation time was (6.36 ± 1.55) days, the mean hospital stay was 19.4 days; no patients were lost to follow-up. None of the patients experienced post-operative recurrence, wound infection, seroma or hematoma. Six patients (6.3%) experienced wound dehiscence at the flap tip around the natal cleft. The mean time to the resumption of daily activities was 26.3 days. The average VAS pain score was (6.00 ± 1.53) points, and the average Vancouver scar score was (5.96 ± 1.51) points, 12 patients (12.5%) were dissatisfied with their aesthetic results, and the average beauty satisfaction score is (6.64 ± 1.28) points. Simplified modified Limberg flap reconstruction with vacuum-assisted closure surgery is an effective and innovative method for the treatment of PSD, with a low recurrence rate and rapid recovery.

Comparative Study on Short-Term Outcome in Patients Undergoing Pilonidal Sinus Surgery in Tertiary Care

ABSTRACT Background: Pilonidal sinus is a disease that affects young men commonly arising from the hair follicles of the sacrococcygeal area. At present, there is no standardized surgical management available for chronic pilonidal sinus. The purpose of this study is to evaluate wound healing and short-term outcomes in pilonidal sinus patients undergoing modified Limberg flap surgery and lay open for secondary healing after excision in a tertiary care hospital. Patients and Methods: This is a nonrandomized comparative observational study performed at Apollo Hospitals, Chennai, during January 2021 to August 2021. Group A included 25 participants who opted off-midline primary closure using modified Limberg rhomboid flap procedure. Group B included 25 participants who underwent excision of pilonidal sinus and laying the wound open for secondary healing. All patients, in both groups, were seen on the 3rd, 5th, 7th, 15th, and 30th post-operative day. They were followed until complete wound healing. Results: The study showed that the modified Limberg flap closure group had a shorter period of complete wound healing in comparison to the excision and lay-open group but at a cost of prolonged duration of hospitalization. This study shows the significant difference in the period to return to daily activity between Group A and Group B. Postoperative wound complications such as infection and recurrence were seen in Group A. Conclusions: Conventional wide excision of pilonidal sinus and laying it open for secondary healing is advisable in pilonidal sinus disease and be performed as a day-case surgery. For the success of modified Limberg flap closure, prone nursing is recommended.

Surgical Outcome of Modified Karydakis Flap and Modified Limberg Flab in the Management of Sacroccygeal Pilonidal Disease: A Comparative Study

Abstract Introduction Sacrococcygeal pilonidal disease (SPD) is a chronic suppurative condition of the sacrococcygeal region causing chronic sinus tract or cyst. It is an acquired complex disease more common in young adult males, causing considerable morbidity and long periods of interruption in work or education. From simple conservative techniques to complex flap reconstruction, many debatable treatment options are offered; however clear dynamics toward the widespread use of minimally invasive methods and off-midline flap reconstruction are suggested in all guidelines, which recommend the Karydakis and Limberg flap modification. The plethora of literature compares procedures for identification of a single best treatment approach, which has proven to be difficult. The surgical outcome of both techniques is compared in the present study. Objective To compare the surgical outcomes of the modified Karydakis flap (MKF) versus the modified Limberg flap (MLF) in SPD. Materials and Methods The present study was conducted at the general surgery department on SPD patients who were ≥18 years old. A total of 67 participants were included after obtaining the informed consent, with group A comprising 33 patients undergoing the MLF procedure and group B comprising 34 patients undergoing the MKF procedure. Results The mean patient age was 28.85 (range, 18–44) years old. For the MKF and MLF methods, the average operating duration was 32.5 (range, 25–40) and 54.5 (range, 45–65) minutes, respectively. The MKF approach was found to significantly improve pain score, mean sitting painless time, return to normal activity, wound healing time, and patient satisfaction. Conclusion Comparative outcomes were seen between both MKF and MLF; however, our findings show that MKF is a more favourable method than MLF with superior outcomes.

Effectiveness of Local Anesthetic Nerve Block compared with Spinal Anesthesia in cases of Rhomboid excision and Limberg flap closure for Pilonidal Disease

Background: Modified Limberg Flap (MLF) is regarded as the mainstay of treatment for Sacrococcygeal Pilonidal disease due to less postoperative complications as compared to other available surgical procedures. This Operative procedure can be performed under Spinal anesthesia as well as Local Anesthesia. Aim: To compare outcome of patients undergoing Modified Limberg Flap for Sacrococcygeal pilonidal sinus under Local anesthesia with adrenaline versus Spinal anesthesia in terms of post-operative pain, Seroma formation &amp; Hospital stay. Methods: This was a randomized controlled clinical trial conducted at Department of Surgery, Sughra Shafi Medical Complex, Narowal. Study was conducted for a period of 06 months and 80 patients were included through non-probability consecutive sampling technique. Patients were randomly divided into 2 equal groups by computer generated method. Patients in group LA underwent MLF under Local anesthesia with adrenaline while patients in group SA underwent MLF under Spinal anesthesia. Informed written consent was obtained from all the participating patients. Results: Mean age of all patients was 24.78±5.12 years. Minimum and maximum age of patients was 16 and 37 years respectively. Gender distribution shows that 96.25% were male while 3.75% were female. Seroma formation in Group-LA was 0% while in Group-SA, it was 7.5%. Hospital stay of patients in Group-LA and in Group-SA was 9.60±9.39 and 29.10±9.37 hours respectively. Mean operation time in Group-LA was 42±5.64 minutes whereas in Group-SA mean operation time was 46±7.53 minutes. Mean pain score in Group-LA was 2±1.04 at 12th hour of surgery and in Group-SA it was 3.83±1.06 at 12th hour of surgery. Conclusion: It is concluded that Modified Limberg Flap can be performed under local anesthesia as a day case procedure to save time, reduce work burden and cost of surgery. Keywords: Modified Limberg Flap, Sacrococcygeal Pilonidal Sinus Disease, Local Anesthesia, Adrenaline, Spinal Anesthesia.

Modified Sinotomy versus Modified Limberg flap in Treatment of Pilonidal Sinus

Modified Sinotomy versus Modified Limberg flap in Treatment of Pilonidal Sinus

Compare outcome of simple excision with primary closure vs rhomboid excision with limberg flap for pilonidal sinus

Background: Sacrococcygeal pilonidal sinus is a common condition usually affecting young-to-middle-aged men. For managing sacrococcygeal pilonidal illness, a variety of lateralizing surgical flap procedures based on this principle have been published, including the Karydakis flap, Limberg flap, modified Limberg flap, Z-plasty, and Y-V advancement flap. Aim: To compare the outcome of simple excision with primary closure versus rhomboid excision with limberg flap for sacrococcygeal pilonidal sinus. Methodology: Randomized control study conducted in Surgery Department, Ghurki Trust Hospital, Lahore. 90 patients fulfilling the inclusion criteria were selected from wards and were randomly divided in two equal groups. In group A, patients underwent rhomboid excision with limberg flap. In group B, patients underwent simple excision with primary closure. The operation was performed under spinal anesthesia. After surgery, patients were evaluated every 24 hours if they are able to move on their own then they were discharged and hospital stay was noted. Then after 10 days, patients will be called in OPD for assessment of wound healing. If wound did heal and patient complained of pain (VAS&gt;4) and cannot sit and have fever (temp&gt;100oF) Results: The average age in group A was 44.37±15.42 years while that in group B was 45.24±14.50 years. In group A there were 23(51.1%) males and 22 (48.9%) females whereas in group B there were 25(55.6%) males and 20(44.4%) females. There was difference significant in the mean stay in hospital in both groups (p-value=0.002). Conclusion: The conclusion of the study, that primary sacrococcygeal pilonidal sinus disease and rhomboid excision with Limberg's flap is an effective treatment. Keywords: Simple Excision with Primary Closure, Rhomboid Excision, Limberg Flap, Sacrococcygeal Pilonidal Sinus

Modified Limberg Flap Cover for Recurrent Sacrococcygeal Pilonidal Sinus: Our Experience at a Medical College In Nepal

Introduction: Pilonidal sinus is an inflammatory disease seen mostly in the intergluteal region of young males. Although any treatment strategy of this condition is generally free of life-threatening complications due to its superficial nature, it is still a feared disease because of recurrence which greatly increases the morbidity.&#x0D; Objective: To investigate the results of wide rhomboid excision and modified Limberg transposition flap reconstruction to treat recurrent pilonidal sinus.&#x0D; Methodology: Well-documented records of all patients with recurrent sacrococcygeal pilonidal sinus who underwent wide excision and a modified Limberg transposition flap at our center during the past 3 years and followed up for longer than 12 months were analyzed. The modification primarily consisted of an asymmetrically rotated rhomboid excision and lateralization of the lower midline. Patient demographics, days of hospitalization, complications, patient satisfaction and recurrence rates were evaluated.&#x0D; Result: Most patients in the study were overweight. No relationship was detected between BMI and number of sinus openings, hospital stay, drain placement or recurrences but an association with infection was noted. The number of pilonidal sinus orifices did not have a correlation with age, number of previous surgeries, duration of hospital stay or drains placement. The mean duration of hospitalization was 7.89 ± 3.41 days and the mean duration of suction drainage was 6.33±2.87 days. Half of our patients developed complications in the postoperative period. The only patient who developed superficial wound infection stayed the most in the hospital. All patients had some complaints regarding the operation site; however, they were satisfied with the result of the operation and had no recurrence at 12 months of follow-up.&#x0D; Conclusion: Rhomboid excision of recurrent sacrococcygeal pilonidal sinus with modified Limberg flap closure is a promising surgical technique with advantages of a good patient satisfaction and no recurrence after a year of surgery.

Different Surgical Approaches for Pilonidal Sinus – Our Experience in a Peripherally Located Tertiary Care Hospital

Introduction: Pilonidal disease in sacrococcygeal or intergluteal region is an acquired chronic inflammatory disorder with superimposed infection. It is commonly seen in young hairy individuals and usually presents as an abscess or a painful sinus tract in the natal deft with sero/purulent discharge. Aims and Objectives : The objectives of the study were to assess and compare different surgical techniques in the management of pilonidal sinus disease. Materials and Methods This retrospective study was conducted in the Department of General Surgery, Adichunchanagiri Institute of Medical Sciences, B. G. Nagara, Mandya (D), from August 2018 to January 2020. Results During the study period, 30 patients were enrolled, 22 patients were male and 8 were female, with a mean age of 24.3 years. The mean operative time for primary closure was 61 min and flap reconstructions were 70 min with mean hospital stay of 8 and 6 days, respectively. The mean time to walk without pain is 30 and 12 days, respectively. Wound dehiscence was noted in a patient with primary closure. No recurrence was noted for a mean follow-up period of 6 months in any patients. Conclusions: Flap reconstructions were superior to primary closure after excision of pilonidal sinus and that modified Limberg flap was superior with regard to wound infection and recurrence for pilonidal disease.

The short-term results of modified limberg flap in treatment of pilonidal sinus disease

Background: Pilonidal sinus disease is a chronic disease of the sacrococcygeal region, which commonly occurs in young adults. The male population is affected more than the female one. Many surgical techniques have been described in the literature for the treatment of this disease. This study aimed to assess the effectiveness and short term results of the modified Limberg flap technique in the treatment of pilonidal sinus disease. Patients and methods: This randomized clinical trial study was carried out in Zagazig university hospital. It included eighteen patients with pilonidal sinus disease who attended GIT Unit, General Surgery Department, during the period from January 2020 to August 2020. The 18 patients underwent the modified limberg flap procedure. All patients were subjected to Demographic data taking, complete clinical examination and Laboratory investigations. Results: The mean operative time was 63.056±6.673 min. The healing time and duration of work-off were 15.833 ± 2.256 and 16.833 ± 2.256 days respectively. Two patients were complicated. Combined hematoma and dehiscense occurred in one patient (5.6%) and seroma occurred in one patient (5.6%). No patients had a recurrence. Conclusion: modified Limberg flap technique showed early healing, short duration of work-off, and a low rate of complications and recurrence.

Surgical procedures in the pilonidal sinus disease: a systematic review and network meta-analysis

The most appropriate surgical treatment for pilonidal sinus disease (PSD) is still in dispute. This study aims to comprehensively compare the outcomes of surgical interventions using network meta-analysis. Randomized controlled trial studies were searched systematically to identify all eligible studies in multiple databases and previous publications and Bayesian network meta-analysis was performed. Our primary outcome was the recurrence rate. Differences in the findings of the studies were explored in meta regressions and sensitivity analyses. The risk of bias of each study was assessed using the Cochrane risk of bias tool. Confidence in evidence was assessed using CINeMA (Confidence in Network Meta-Analysis). A total of 39 studies and 5,061 patients were identified and the most common surgical intervention was the Limberg flap. In network meta-analysis, modified Limberg flap and off-midline closure were associated with the lowest recurrence rate. However, the Karydakis flap was associated with shorter operation time by several minutes compared with other interventions and few significant results were found in other outcomes. Modified Limberg flap and off-midline closure provided relatively low recurrence and complications rates. Therefore, they could be two promising surgical interventions for PSD patients.

Comparison of classical versus modified Limberg flap techniques in pilonidal sinus surgery

Comparison of classical versus modified Limberg flap techniques in pilonidal sinus surgery

Crystallized phenol treatment is less effective in patients with recurrent pilonidal disease after surgery compared to patients with primary pilonidal disease

Aim: Primary pilonidal disease can be treated with crystallized phenol with an overall cure rate of 80%. However, the effect of crystallized phenol in patients who had recurrence after pilonidal disease surgery has not been analyzed in the English medical literature in detail yet. The purpose of this study was to investigate the effect of crystallized phenol in recurrent pilonidal disease. Material and Methods: 28 male and 10 female patients who had recurrence after surgical intervention to treat pilonidal disease were evaluated. Twenty male and 8 female patients underwent excision and primary closure surgery, whereas 8 male patients and 2 female patients underwent modified Limberg flap surgery. All of these 38 patients were treated with one-time application of crystallized phenol.Results: The mean period for recurrence of patients treated with single application of crystallized phenol after primary excision and primary closure surgery was 45.85±11.82 days (range: 35-90 days) and it was 66.5±25.31 days (range: 40-120 days) after modified Limberg flap surgery. The follow-up period was 6 months. The cure rate in recurrent excision and primary closure group was 57.14%, whereas the cure rate in the recurrent modified Limberg flap group was 40%. Overall cure rate was 52.63%.Conclusion: As a result, crystallized phenol treatment was less effective in patients who had recurrence after pilonidal disease surgery in comparison to patients who were only treated with crystallized phenol without prior surgical intervention.

Experience of tear-drop-shaped excision with modified limberg transposition flap among sacrococcygeal pilonidal sinus diseases

Background: Sacrococcygeal pilonidal sinus disease (PSD) is notorious for prolonged morbidity and recurrence. Mild pain, shorter hospitalization, mild risk of complications, early return to routine activities, better cosmesis, and minimal recurrence rate are the suggested criteria of ideal treatment of PSD. In Limberg flap technique, flattening of the intergluteal cleft is flattened, and the scar is placed away from the midline. This eliminates the causative factors of PSD. However, the drawbacks of this procedure are necrosis of flap at its vertex and maceration of skin at the incision site. This study aimed to perform tear-drop-shaped excision and reconstruction with modified Limberg transposition flap technique among patients for PSD at the sacrococcygeal region and discuss the clinical results. Materials and Methods: Eleven patients with primary sacrococcygeal PSD were included in the study between September 2017 and September 2018 at the JNMC, Wardha, Maharastra, India. It was planned for each case to undergo tear-drop-shaped resection and reconstruction with a modified Limberg transposition flap with a suction drain. Drains were removed after 48 h. Results: The mean age of the patient was 28.2 ± 8.4 years. All were male with a mean duration of symptoms of 3.8 ± 1.3 years. The mean operative time was 84 ± 23 min. Primary healing was obtained in all patients. Stitch was removed on the 14th postoperative day. The average hospital stay was 10 days as 2/3rd patients wanted discharge after stitch removal. The mean time to resume work was 22.6 ± 7.2 days. The mean follow-up period was 18 ± 6 months without any documented recurrence except hypoesthesia on the flap among two cases. Conclusions: More cases are required to conclude better methods among the two procedures of tear-drop-shaped modified Limberg flap and classical Limberg flap.

Pilonidal disease specimens of 905 patients revealed no malignancy, however we still insist on histopathological examination

Aim: Pilonidal disease presents with acute abscess, sinuses, pits and scarring in the sacrococcygeal region. Surgical intervention is one of the treatment options of pilonidal disease. However, it has been a matter of debate, whether histological analysis of surgically resected pilonidal disease specimens would be necessary. Material and Methods: Medical records of the patients with pilonidal disease who underwent either primary excision and closure or modified Limberg flap surgery were reviewed retrospectively. The results of the histopathological examination of the pilonidal disease specimens were evaluated.Results: This study included 905 patients (686 male and 219 female) with pilonidal disease who were treated with surgical intervention. The mean age of the patients was 23.96±7.5 years. All surgically excised pilonidal disease specimens of the patients were histopathologically evaluated in order to rule out malignancy. No malignancy was detected.Conclusion: We conducted a Pubmed search with the term “pilonidal” between January 2000 and March 2019. We identified 91 patients with malignant degeneration arising on pilonidal disease in the English medical literature. The most common pilonidal disease associated malignancy was squamous cell carcinoma. Even it is rare, malignancy may accompany pilonidal disease. Therefore, even we have not encountered any malignancy in 905 patients with pilonidal disease, we still insist on histopathological examination of all surgically resected pilonidal disease specimens in order to rule out malignancy.

Modified Limberg flap versus modified Karydakis flap in pilonidal sinus disease: single surgeon experience

Background: The aim of this study was to analyze and compare the results of the modified Limberg flap (MLF) and modified Karydakis flap (MKF) techniques which were performed for the treatment of pilonidal sinus disease (PSD).Methods: The patients who were operated for PSD by the same surgeon between November 2010 and July 2013 in Konya Seydisehir Hospital were retrospectively analyzed. A total of 106 patients were evaluated in this study regarding age, gender, operation time, length of hospital stay, and postoperative complications.Results: There were 14 female and 92 male patients (MLF; 5/52 and MKF; 9/40). MLF was performed in 57 (53.8%) patients and MKF was performed in 49 (46.2%) patients. Length of Hospital stay and drain removal time were less in MKF group but it was not significantly different between two groups (p&gt;0.05). Operation time was shorter in MKF group than MLF group (p&lt;0.05). The complication rates of the MLF and MKF groups were 10.5% and 12.2% respectively. The recurrence was seen in 1 patient in MLF group and 2 in MKF group.Conclusions: MKF has shorter operation time than MLF, however both techniques have a similar complication and recurrence rate. In conclusion MLF and MKF procedures can be safely used as a surgical treatment of PSD.

Standardization of modified Limberg flap technique by using an acetate template for the treatment of pilonidal disease

Standardization of modified Limberg flap technique by using an acetate template for the treatment of pilonidal disease

Could Early Postoperative Complications be Considered as Risk Factor for Recurrence after Pilonidal Sinus Surgery?

Background: There is no widespread consensus in treatment techniques of sacrococcygeal pilonidal disease (PD). Among surgical techniques, especially Karydakis procedure (KP) or modified Limberg flap (MLF), are frequently preferred. Causing prolonged follow-up and return to daily activity, postoperative complications are very annoying. We aimed to determine risk factors for possible complications and especially recurrence in the patients undergoing surgical treatment for PD. Methods: This is a seven-year retrospective study, which was conducted between January 2011 and January 2018. Eight hundred forty-one patients were evaluated in this work. We performed the same technique-the same surgeon approach in our surgical treatment. All cases were divided into two groups as KP (n=417) and MLF (n=424). Results: It was found no significant difference between the KP and MLF groups in terms of age, gender, BMI, smoking, history of acute abscess drainage (HAAD), the timing of suture removal, the follow-up period, seroma, hematoma, dehiscence, wound infection (WI), pain and recurrence. In this study, the follow-up period of patients was 48.6 21.4 months in KP group and 48.2 +- 21.7 months in MLF group (Mean - SD). American Society of Anesthesiologists (ASA) score were found to be higher in the KP group. While mean duration of operation (DO) was shorter in the KP group, the timing of drain removal, hospitalisation period and return to daily activity (RDA) were longer. There was an established enhancing effect of BMI, HAAD, DO, and RDA on the early complications (EC) development in both of the groups, and of ASA scores on the EC development in the KP group. The rate of recurrence ratio was determined to be 6% in the KP and 4.72% in the MLF groups. In both of the groups, dehiscence or WI was found to be risk factors for recurrence. Conclusion: Although its DO is short, KP technique bear some of the disadvantages such as prolonged HP and delayed RDA. A significant positive correlation was found between various factors such as higher BMI, presence of HAAD, prolonged DO, prolonged RDA and the development of EC in both groups. We concluded that dehiscence and WI from EC may be evaluated as independent risk factors for recurrence. We also concluded that recurrence may be prevented if wound care is carried out carefully in the patients who developed dehiscence or wound infection.

Pilonidal Sinus—Plenty of Literature yet Lack of Direction: A Pooled Analysis

A systematic analysis was conducted to compare various surgical treatment modalities and evaluate the short- and long-term outcomes in the management of sacrococcygeal pilonidal disease. Pilonidal sinus is a common and debilitating condition often requiring a surgical approach to treatment, of which many are available. Despite numerous treatment methods, no universal decision has been made as to the most efficient and effective surgical treatment. All randomized control trials published between January 1, 2003 and January 8, 2013 were accessed. Interventions included classic and modified Limberg flap, Karydakis flap, primary closure, and healing by secondary intention. Primary outcome measures included rate of surgical site infection, recurrence, and length of hospital stay. Secondary outcome measures were hematoma or seroma, and return to work. The search identified 22 articles suitable for inclusion in this review totaling 3693 patients. Analysis showed a 50% reduction in the rate of infection and recurrence in patients receiving closure with flaps compared with primary midline closure and healing by secondary intention. The Karydakis flap was shown to be more favorable cosmetically; however, it failed to compete with the classic and modified Limberg flap in treatment of complicated disease. No significant difference was noted between the modified Limberg and Limberg flap. These results show that the Karydakis flap, classic, and modified Limberg flap demonstrate significant benefits over healing by secondary intention and primary closure.