Advertisement

Techniques in Coloproctology

, Volume 16, Issue 1, pp 55–59 | Cite as

Modified Limberg transposition flap in the treatment of pilonidal sinus disease

  • B. KayaEmail author
  • C. Eris
  • S. Atalay
  • O. Bat
  • N. E. Bulut
  • B. Mantoglu
  • K. Karabulut
Original Article

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Pilonidal sinus Limberg flap 

Notes

Conflict of interest

The authors declare that no conflict of interest exists.

References

  1. 1.
    Søoendenaa K, Andersen E, Nesvik I, Søreide JA (1995) Patient characteristics and symptoms in chronic pilonidal sinus disease. Int J Colorectal Dis 10:39–42CrossRefGoogle Scholar
  2. 2.
    Surrell JA (1994) Pilonidal disease. Surg Clin N Am 74:1309–1315PubMedGoogle Scholar
  3. 3.
    Chintapatla S, Safarani N, Kumar S, Haboubi N (2003) Sacrococcygeal pilonidal sinus: historical review, pathological insight and surgical options. Tech Coloproctol 7:3–8PubMedCrossRefGoogle Scholar
  4. 4.
    Mentes O, Bagci M, Bilgin T, Ozgul O, Ozdemir M (2008) Limberg flap procedure for pilonidal sinus disease: results of 353 patients. Langenbecks Arch Surg 393:185–189PubMedCrossRefGoogle Scholar
  5. 5.
    Shafik A (1996) Electrocauterization in the treatment of pilonidal sinus. Int Surg 81:83–84PubMedGoogle Scholar
  6. 6.
    Schoeller T, Wechselberger G, Otto A, Papp C (1997) Definite surgical treatment of complicated recurrent pilonidal disease with a modified fasciocutaneous V-Y advancement flap. Surgery 121:258–263PubMedCrossRefGoogle Scholar
  7. 7.
    Hodges RM (1880) Pilonidal sinus. Boston Med Surg J 103:485–486CrossRefGoogle Scholar
  8. 8.
    Kaymakcioglu N, Yagci G, Simsek A et al (2005) Treatment of pilonidal sinus by phenol application and factors affecting the recurrence. Tech Coloproctol 9:21–24PubMedCrossRefGoogle Scholar
  9. 9.
    Lukish JR, Kindelan T, Marmon LM, Pennington M, Norwood C (2009) Laser epilation is a safe and effective therapy for teenagers with pilonidal disease. J Pediatr Surg 44:282–285PubMedCrossRefGoogle Scholar
  10. 10.
    Armstrong JH, Barcia PJ (1994) Pilonidal sinus disease. The conservative approach. Arch Surg 129:914–917PubMedCrossRefGoogle Scholar
  11. 11.
    Gilani SN, Furlong H, Reichardt K, Nasr AO, Theophilou G, Walsh TN (2011) Excision and primary closure of pilonidal sinus disease: worthwhile option with an acceptable recurrence rate. Ir J Med Sci 180:173–176PubMedCrossRefGoogle Scholar
  12. 12.
    Abbas MA, Tejerian T (2006) Unroofing and marsupialization should be the first procedure of choice for most pilonidal disease. Dis Colon Rectum 49:1242PubMedCrossRefGoogle Scholar
  13. 13.
    Eryilmaz R, Sahin M, Alimoglu O, Dasiran F (2003) Surgical treatment of sacrococcygeal pilonidal sinus with the Limberg transposition flap. Surgery 134:745–749PubMedCrossRefGoogle Scholar
  14. 14.
    Branagan G, Thompson MR, Senapati A (2006) Cleft closure for the treatment of unhealed perineal sinus. Colorectal Dis 8:314–317PubMedCrossRefGoogle Scholar
  15. 15.
    Webb PM, Wysocki AP (2011) Does pilonidal abscess heal quicker with off-midline incision and drainage? Tech Coloproctol 15:179–183PubMedCrossRefGoogle Scholar
  16. 16.
    Azab AS, Kamal MS, Saad RA, Abou AL, Atta KA, Ali NA (1984) Radical cure of pilonidal sinus by a transposition rhomboid flap. Br J Surg 71:154–155PubMedCrossRefGoogle Scholar
  17. 17.
    Akin M, Leventoglu S, Mentes BB et al (2010) Comparison of the classic Limberg flap and modified Limberg flap in the treatment of pilonidal sinus disease: a retrospective analysis of 416 patients. Surg Today 40:757–762PubMedCrossRefGoogle Scholar
  18. 18.
    Cihan A, Ucan BH, Comert M, Cesur A, Cakmak GK, Tascilar O (2006) Superiority of symmetric modified Limberg flap for surgical treatment of pilonidal disease. Dis Colon Rectum 49:244–249PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • B. Kaya
    • 1
    Email author
  • C. Eris
    • 2
  • S. Atalay
    • 2
  • O. Bat
    • 1
  • N. E. Bulut
    • 1
  • B. Mantoglu
    • 1
  • K. Karabulut
    • 3
  1. 1.Department of General SurgeryFatih Sultan Mehmet Training and Research HospitalIstanbulTurkey
  2. 2.Haydarpasa Numune Training and Research HospitalIstanbulTurkey
  3. 3.Department of General SurgeryFirat University Medical FacultyElazigTurkey

Personalised recommendations