Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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Limberg flap reconstruction for sacrococcygeal pilonidal sinus disease with and without acute abscess: Our experience and a review of the literature

  • Sinnott, Catherine J. (Long Island Plastic Surgical Group) ;
  • Glickman, Laurence T. (Long Island Plastic Surgical Group)
  • Received : 2018.11.02
  • Accepted : 2019.03.09
  • Published : 2019.05.15
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Abstract

Background The efficacy of Limberg flap reconstruction for pilonidal sinus with acute abscess remains unclear. This study aimed to compare outcomes after Limberg flap reconstruction for pilonidal sinus disease with and without acute abscess. A secondary objective was to perform a review of the literature on the topic. Methods A retrospective chart review was conducted of all patients who underwent excision and Limberg flap reconstruction for pilonidal sinus from 2009 to 2018. Patient demographics, wound characteristics, and complication rates were reviewed and analyzed. Results Group 1 comprised 19 patients who underwent Limberg flap reconstruction for pilonidal sinus disease without acute abscess and group 2 comprised four patients who underwent reconstruction for pilonidal sinus disease with acute abscess. The average defect size after excision was larger in group 2 than group 1 ($107.7{\pm}60.3cm^2$ vs. $61.4{\pm}33.8cm^2$, respectively). There were no recurrences, seromas or cases of flap necrosis postoperatively. There was only one revision surgery needed for evacuation of a postoperative hematoma in group 1. There were comparable rates of partial wound dehiscence treated by local wound care, hematoma, need for revision surgery and minor infection between group 1 and group 2. Conclusions Limberg flap reconstruction for pilonidal sinus in the setting of acute abscess is a viable option with outcomes comparable to that for disease without acute abscess. This practice will avoid the pain and cost associated with a prolonged local wound care regimen involved in drainage of the abscess prior to flap reconstruction.

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References

  1. Ferri FF. Ferri's clinical advisor 2018. Philadelphia: Elsevier; 2018.
  2. Hodges RM. Pilo-nidal sinus. Boston Med Surg J 1880;103: 485-86. https://doi.org/10.1056/NEJM188011181032101
  3. Karydakis GE. Easy and successful treatment of pilonidal sinus after explanation of its causative process. Aust N Z J Surg 1992;62:385-9. https://doi.org/10.1111/j.1445-2197.1992.tb07208.x
  4. Limberg AA. Mathematical principles of local plastic procedures on the surface of the human body. Leningrad: Medgiz; 1948.
  5. Limberg AA. Design of local flaps. In: Gibson T, editor. Modern trends in plastic surgery. Vol. 2. London: Butterworth; 1966. p. 38-61.
  6. Akca T, Colak T, Ustunsoy B, et al. Randomized clinical trial comparing primary closure with the Limberg flap in the treatment of primary sacrococcygeal pilonidal disease. Br J Surg 2005;92:1081-4. https://doi.org/10.1002/bjs.5074
  7. Abu Galala KH, Salam IM, Abu Samaan KR, et al. Treatment of pilonidal sinus by primary closure with a transposed rhomboid flap compared with deep suturing: a prospective randomised clinical trial. Eur J Surg 1999;165:468-72. https://doi.org/10.1080/110241599750006721
  8. Ertan T, Koc M, Gocmen E, et al. Does technique alter quality of life after pilonidal sinus surgery? Am J Surg 2005;190: 388-92. https://doi.org/10.1016/j.amjsurg.2004.08.068
  9. Dass TA, Zaz M, Rather A, et al. Elliptical excision with midline primary closure versus rhomboid excision with Limberg flap reconstruction in sacrococcygeal pilonidal disease: a prospective, randomized study. Indian J Surg 2012; 74:305-8. https://doi.org/10.1007/s12262-011-0400-9
  10. Tavassoli A, Noorshafiee S, Nazarzadeh R. Comparison of excision with primary repair versus Limberg flap. Int J Surg 2011;9:343-6. https://doi.org/10.1016/j.ijsu.2011.02.009
  11. Arslan K, Said Kokcam S, Koksal H, et al. Which flap method should be preferred for the treatment of pilonidal sinus? A prospective randomized study. Tech Coloproctol 2014; 18:29-37. https://doi.org/10.1007/s10151-013-0982-2
  12. Steele SR, Perry WB, Mills S, et al. Practice parameters for the management of pilonidal disease. Dis Colon Rectum 2013;56:1021-7. https://doi.org/10.1097/DCR.0b013e31829d2616
  13. Gray H, Lewis WH. Anatomy of the human body. 20th ed. Philadelphia: Lea & Febiger; 1918.
  14. Fahrni GT, Vuille-Dit-Bille RN, Leu S, et al. Five-year follow-up and recurrence rates following surgery for acute and chronic pilonidal disease: a survey of 421 cases. Wounds 2016;28:20-6.
  15. Ciftci F, Abdurrahman I, Tosun M, et al. A new approach: oblique excision and primary closure in the management of acute pilonidal disease. Int J Clin Exp Med 2014;7:5706-10.
  16. Kanat BH, Bozan MB, Yazar FM, et al. Comparison of early surgery (unroofing-curettage) and elective surgery (Karydakis flap technique) in pilonidal sinus abscess cases. Ulus Travma Acil Cerrahi Derg 2014;20:366-70. https://doi.org/10.5505/tjtes.2014.62547
  17. Muzi MG, Milito G, Cadeddu F, et al. Randomized comparison of Limberg flap versus modified primary closure for the treatment of pilonidal disease. Am J Surg 2010;200:9-14. https://doi.org/10.1016/j.amjsurg.2009.05.036

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