Prospective study of limberg flap for treatment of recurrent pilonidal sinus under local anaesthesia

Abstract

Introduction

Pilonidal sinus is a common chronic disease of the sacrococcygeal region. Treatment varies according to the clinical presentation of the disease. Although many surgical methods have been suggested, an ideal method is still lacking because of high recurrence rates. Recurrent disease causes significant morbidity and consequent time off work. The aim of this study was to assess the role of the rhomboid flap in promoting primary healing in recurrent pilonidal disease and to evaluate morbidity and recurrence.

Methods

This prospective study was conducted at the department of general surgery at Dr.Ram Manohar Lohiya Hospital, New Delhi, India, from May 2015 to November 2015. It involved 20 patients with recurrent pilonidal disease, all of whom were male and aged between 21 and 42 years. Their treatment included a rhomboid flap closure for recurrent sacrococcygeal pilonidal sinus.

Results

The mean hospital stay was four days. The follow-up period ranged from two to six months. They all received injected antibiotics and none of the patients displayed any superficial wound infection. Negative suction drainage was removed on the second to third postoperative day. The mean time to return to work after discharge from the hospital was two weeks. No recurrences were reported. None of the patients had complete flap necrosis. Two patients experienced numbness over the flap and six were not pleased with the cosmetic appearance of the scars.

Conclusions

Our study favours the rhomboid flap for recurrent sacrococcygeal pilonidal sinus, especially for complex sinuses, and found it suitable for cases where simpler operations have failed. It allows early return to full activity and has very low recurrence and complication rates which may outweigh the disadvantage of an unfavourable cosmetic appearance.