European Journal of Plastic Surgery

, Volume 41, Issue 2, pp 217–222 | Cite as

Flap repair of complex pilonidal sinus: a single institution experience

  • George Kokosis
  • Andrew Barbas
  • Cecilia Ong
  • Howard Levinson
  • Detlev Erdmann
  • Christopher R. Mantyh
Original Paper



Healing of pilonidal cysts after initial excision remains a vexing problem for surgeons. While simple sinus can be managed with success, recurrence of the cyst after primary excision or sizeable sinus often requires a more complex repair; however, the morbidity and ultimate success of these procedures are unknown.


A retrospective review from 2009 to 2014 of all consecutive patients undergoing surgical intervention for pilonidal cyst disease from a single institution was performed. Management of pilonidal disease after excision with flap coverage was examined. Patient demographics, co-morbidities, procedural data, and post-operative outcomes were analyzed.


Twenty-one flap patients were identified. These included 15 V-Y fasciocutaneous repairs, 5 rotational flaps, and 1 Romberg flap closure. Mean BMI was 32, mean defect size was 8 cm, and the patients have had an average of 1.05 attempts prior to the excision and flap repair. The flap group demonstrated 14% recurrence rate, 33% reoperation rate, and 47% dehiscence rate. Mean time to healing was 36.4 days.


Flap repairs for complex pilonidal cysts have high rates of recurrence, reoperation, and wound dehiscence. However, flap patients represent a more challenging repair with long operative times, blood loss, and large sinus size. Absence of the perfect approach to managing a complex sinus necessitates a thorough description of the problem and a discussion between the surgeon and the patient about the merits of each approach before a decision is made.

Level of Evidence: Level IV, therapeutic study.


Pilonidal sinus Cyst Flap 


Compliance with ethical standards



Conflict of interest

George Kokosis, Andrew Barbas, Cecilia Ong, Howard Levinson, Detlev Erdmann, and Christopher R. Mantyh declare that they have no conflict of interest.

Ethical approval

The study is a retrospective study and was conducted after an Institutional Review Board was conducted.

Informed consent

No informed consent was necessary since this was a retrospective study.


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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.Department of Plastic SurgeryJohns Hopkins UniversityBaltimoreUSA
  2. 2.Department of SurgeryDuke University Medical CenterDurhamUSA
  3. 3.Division of Plastic and Reconstructive SurgeryDuke University Medical CenterDurhamUSA

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