scholarly journals Limberg flap as a Primary Treatment for Pilonidal Sinus at Nepal Mediciti Hospital: A Single Unit Experience

2021 ◽  
Vol 2 (2) ◽  
pp. 64-67
Author(s):  
Subodh Ghimire ◽  
Sunil Kumar Sharma Dhakal ◽  
Pranil Rai ◽  
Nirvan Rai
Keyword(s):  
Prone Position ◽  
Pilonidal Sinus ◽  
Single Unit ◽  
Primary Treatment ◽  
Limberg Flap ◽  
Related Complication ◽  
Duration Of Symptoms ◽  
Presenting Symptoms ◽  
Suction Drain ◽  
Minimal Scarring

INTRODUCTION: Pilonidal Sinus is a common condition with estimated incidence of 260 per million population with more male predilection and is often seen in sacrococcygeal area but has also been described in other areas with hair. The Limberg rhomboid flap was designed by Limberg in 1946 for the closure of a sixty degree rhombus shaped defect with a transposition flap. We would like to share our single unit experience of Rhomboid Limberg flap for Pilonidal sinus in our hospital. METHODS: This is an ongoing prospective descriptive study in the Department of General Surgery and Digestive Diseases of Nepal Mediciti Hospital from October 2018. The demographic of the patients, presenting symptoms, duration of symptoms and previous interventions are recorded and the Rhomboid Limberg flap surgery is done under regional or general anesthesia in prone position. The patient is given intravenous antibiotic and is instructed to sleep laterally or in prone position for 24 hours. The dressing is removed and the wound is inspected for flap status in the next morning. The patient is discharged on 1st post-operative day on oral antibiotics for 7 days and is followed on 7th post-operative day for removal of suction drain and alternate sutures in the skin and remaining sutures are removed on 10th post-operative day. RESULTS: We have done 28 cases of Limberg flap for Pilonidal Sinus from October 2018 to December 2020 of which 24 were male patients. None of our patients had flap necrosis. One patient presented with accidental removal of suction drain on 5th postoperative day, however he didn’t develop any wound related complication. One patient had superficial wound dehiscence on 10th post-operative day which healed on its own with dressing. One patient developed seroma from 5th postoperative and was managed with dressing and antibiotics and it healed in 2 weeks. None of our patients have developed recurrence and their wounds have healed satisfactorily with minimal scarring and pain. All the patients were able to resume their regular activities within 21 days. All except 2 patients were satisfied with cosmetic outcome. CONCLUSION: The Limberg flap is ideal treatment for pilonidal sinus with minimal postoperative pain, short hospital stay, few complications, rapid return to normal activities, good cosmesis, and a low recurrence rate with short learning curve for young surgeons. Hence, Limberg flap should be routinely used as primary treatment for pilonidal sinus.  

scholarly journals Limberg Flap is a Safe and Effective Procedure for the Surgical Treatment of Pilonidal Sinus in Sacrococcygeal Region

2021 ◽  
Vol 12 (1) ◽  
pp. 6-8
Author(s):  
Md Rashidul Islam ◽  
Abul Bashar Md Abdul Matin ◽  
Sami Ahmad ◽  
Md Armanul Islam ◽  
Shoaeb Imtiaz Alam
Keyword(s):  
Postoperative Pain ◽  
Pilonidal Sinus ◽  
Young Male ◽  
Main Concern ◽  
Limberg Flap ◽  
Suction Drain ◽  
Sacrococcygeal Region ◽  
Flap Procedure ◽  
Secondary Closure

Pilonidal sinus in the sacrococcygeal region is an acquired condition and usually seen in young male adults. Diagnosis is indicated by to see the site and appearance of chronic discharging opening, and identification of midline pit in the natal cleft. The management of the sacrococcygeal pilonidal sinus varies from clipping of hairs with good hygiene of the area, wide excision of the area with primary or secondary closure and newer flap procedures, but none is widely accepted. The main concern for the treatment to the patient is the recurrence. This prospective study has been performed to determine the effectiveness and safety of the Limberg flap procedure for sacrococcygeal pilonidal sinus for new and recurrent cases. Primary end point was rate of recurrence and secondary end points were its complianceand complications such as wound infection, postoperative pain and return to work. A total of 17 patients were operated from March 2012 to June 2016.Both primary and recurrent diseases were included. All patients successfully underwent surgery. Patients complained very minimal postoperative pain. LO were average 2 days. All patients were discharged with negative suction drain in situ. Drains were removed on 7th POD and stitches were removed on 9th to 12th postoperative day. All patients returned to work after 2nd weeks. In our study no recurrence or major complications were found. Limberg flap for sacrococcygeal pilonidal sinus was found very useful and effective in terms of recurrence rate and patients morbidity. J Shaheed Suhrawardy Med Coll, December 2020, Vol.12(1); 6-8

scholarly journals Management of pilonidal sinus disease with Limberg flap: our experience

2020 ◽  
Vol 7 (5) ◽  
pp. 1575
Author(s):  
Mahavir Singh ◽  
Saish Dalal ◽  
Baleshwar . ◽  
Sethu Raman
Keyword(s):  
Pilonidal Sinus ◽  
Pilonidal Disease ◽  
Tertiary Care ◽  
Pilonidal Sinus Disease ◽  
Common Disease ◽  
Main Concern ◽  
Limberg Flap ◽  
Sinus Disease ◽  
Minimal Scarring ◽  
Early Return

Background: Pilonidal sinus disease is a common disease of young adults. The management of the sacrococcygeal pilonidal sinus varies from conservative measures to various surgical procedures. The main concern for the treatment to the patient is the recurrence. Although several methods have been described all have been associated with high recurrence rates. This study was carried out to evaluate the advantages, results of rhomboid excision and limberg flap reconstruction in the management of pilonidal sinus disease.Methods: This prospective study was conducted in General Surgery department of a tertiary care centre of Haryana. It includes 29 patients who were treated for pilonidal sinus disease by Limberg flap surgery from January 2015 to January 2019.  Results: All patients were successfully treated with minimal postoperative discomfort. Only two patients developed seroma which was managed conservatively and in two patients there was slight flap tip necrosis which was also managed conservatively. Rest all other patients wound healed nicely with minimal scarring, with very less postoperative pain, with no recurrence so far.Conclusions:Limberg flap is very effective treatment for pilonidal disease. It has many advantages as it is easy to perform and design, and it flattens the natal cleft with large vascularized pedicle, sutured without tension. This in turn maintains good hygiene, reducing the friction, preventing maceration, and avoiding scar in the midline. The technique is easy to perform in quick time, useful in both primary and recurrent diseases, with very low complication and recurrence rate. Other advantages are quick healing time, short hospital stay, and early return to daily life.  

scholarly journals Limberg flap for pilonidal sinus: an institutional study

2017 ◽  
Vol 4 (2) ◽  
pp. 496
Author(s):  
Sameer Ahmed Mulla ◽  
Srinivas Pai ◽  
Prakash Mahalingashetty
Keyword(s):  
Pilonidal Sinus ◽  
Pilonidal Disease ◽  
Pilonidal Sinus Disease ◽  
Limberg Flap ◽  
Recurrence Rates ◽  
Duration Of Symptoms ◽  
Surgical Data ◽  
The Mean ◽  
Surgical Modality ◽  
A Prospective Study

Background: Pilonidal sinus disease is a common disorder affecting the gluteal cleft and it is notoriously recurrent. Limberg flap is a well-known surgical modality for the treatment of pilonidal sinus. This study aims at studying the surgery in a single institution.Methods: This is a prospective study of 17 limberg flaps done from 2013 to 2016. The various demographic, clinical and surgical data are studied and compared to other studies.Results: In this study, 17 patients of sacrococcygeal pilonidal disease underwent rhomboid excision and limberg flap reconstruction. The mean duration of symptoms was 6.52 months (2-13 months), and the mean operative time was 67.05 min with a range from 60 to 90 min. The mean post-operative stay was 6.05 days (3 to 10 days).Conclusions: Recurrence is known and hence surgery with flap coverage not only decreases the recurrence rates, but it also makes the stay short by eliminating daily dressing. Limberg flap is an easy and efficient way with less and manageable complication.

scholarly journals A prospective study on limberg flap procedure for pilonidal sinus

2021 ◽  
Vol 11 (2) ◽  
pp. 241-244
Author(s):  
Samarendra Satpathy ◽  
Ashok Kumar Nayak ◽  
Sanjay Kumar Mahapatra ◽  
Akhil Unnikrishnan
Keyword(s):  
Prospective Study ◽  
Pilonidal Sinus ◽  
Disease Process ◽  
Hair Follicles ◽  
Limberg Flap ◽  
Flap Reconstruction ◽  
Recurrence Rates ◽  
Duration Of Symptoms ◽  
Reconstruction Surgery ◽  
A Prospective Study

Pilonidal sinus is a blind ending track containing hair follicles within it and is primarily a disease involving sacrococcygeal region. The exact etiology of this disease process is unknown and is still controversial. There are various treatment methods for pilonidal sinus and the preferred method is Limberg flap reconstruction surgery due to its less complications and less recurrence. Our study was a prospective study including 28 patients who were admitted for pilonidal sinus and operated by Limberg flap reconstruction surgery at Veer Surendra Sai Institute of Medical Sciences And Research from January 2018 to June 2020. Our study included 28 patients, and the female to male ratio is 1:13. Duration of symptoms had a range from 1-4 months and the mean age of the study population was 28.5 year. Patients underwent Limberg flap reconstruction surgery and 89.28% followed a normal course after surgery , 7.14% developed seroma and 3.57% developed surgical site infection in their post-operative period. Limberg flap reconstruction surgery is the most preferred method of treatment for pilonidal sinus because of its low infection and recurrence rates, better aesthetic results after surgery and short duration of hospital stay.

Treatment of Pilonidal Sinus by Limberg Flap-Only Hope of Cure (Study of 50 Cases)

2020 ◽  
Vol 22 (2) ◽  
pp. 89-94
Author(s):  
Nasir Uddin Mahmud ◽  
ABM Khurshid Alam ◽  
Mohammad Altaf Hossain Chawdhury ◽  
Mohammad Abul Khair
Keyword(s):  
Pilonidal Sinus ◽  
Skin Barrier ◽  
Limberg Flap ◽  
College Hospital ◽  
Medical College ◽  
Flap Technique ◽  
Unpleasant Smell ◽  
Lower Morbidity ◽  
Computer Operator

Background : Pilonidal sinus was first described by Dr. A.W. Anderson in 1847 and is often seen in the intergluteal region. It is a disease of mainly younger male and rarely affects after 40. Main causes for the formation of this sinus are hirsutism, sweating in the area, repeated maceration due to trauma, leading to breakage of the skin barrier, attracting hair inside which initiates a foreign body reaction leading to infection with abscess or sinus formation. Most common embarrassing situation is discharging sinus. The diagnosis is mainly on clinical ground. Though there are a lot of modalities of treatment but recurrence is still a challenge. We have adopted Limberg flap technique since 2012 with a least recurrent chance. Objectives : To prove that this procedure will be end up with lower morbidity & least chance of recurrence Methods : This prospective study was done jointly by the Department of Surgery of Central Medical College and Comilla Medical College Hospital. In this series 50 patients were selected from July 2012 to June 2017. Results : Out of 50 patients operated by Limberg flap technique 42(84%) were males and 8(16%) were females. Mean age was 27.3 years (range 18–37years). Of them,12(24%) were driver, 6(12%) police, 6(12%) teacher, 6(12%) student, 5(10%) worker, 4(8%) millitary army, 4(8%) housewife, 4 (8%)service holder, 2(4%) computer operator, 1(2%) doctor and 1(2%) were barber. In our study most common mode of presentation were chronic discharging sinuses 15(30%), beside this 12(24%) had multiple sinuses, 10(20%) had multiple pits,7(14%) had acute abscess and 6(12%) had unpleasant smell. Associated hirsutism were present in 30(60%) and absent in 20(40%) patients. One (2%) male patient had wound gap & discharge and six(12%) patients had flap edema. We have found no recurrence in follow up period. Conclusion : Pilonidal sinus is a notoriously recurrent disease, so treatment by this flap technique is the only hope of cure with lower morbidity. Journal of Surgical Sciences (2018) Vol. 22 (2) : 89-94

Pilonidal sinus disease: Karydakis flap procedure in our patients

2020 ◽  
Vol 99 (8) ◽  
Keyword(s):  
Wound Healing ◽  
Pilonidal Sinus ◽  
Healing Process ◽  
Pilonidal Sinus Disease ◽  
Wound Complications ◽  
Limberg Flap ◽  
New Disease ◽  
Sinus Disease ◽  
Flap Procedure

Introduction: Despite the available guidelines, opinions of many surgeons are quite ambiguous when it comes to the therapy of pilonidal sinus disease. The treatment can be a frustrating problem both for the surgeon and the patient because it is associated with wound complications and high recurrence rate. The objective of this study was to analyze the results of patients with pilonidal sinus disease undergoing the Karydakis flap procedure. Methods: A total of 27 patients treated for primary and recurrent pilonidal disease using the Karydakis flap procedure at our department between October 23, 2018 and November 22, 2019 were analyzed prospectively. We evaluated postoperative wound healing, complications and recurrence of the disease in a short-term follow-up period. Disease recurrence was defined as prolonged healing or as a new disease requiring repeated surgery. Results: In December 2019 all 27 patients came for a follow-up visit. The result was a fully lateralized wound without any signs of a new disease in all patients. In May 2020 a follow-up visit by phone was performed. The median follow-up was 12 months. The healing process was free of any serious complications in 25 patients. Seroma formation cases were managed by puncture in the outpatient setting. Conclusion: According to the available evidence and guidelines, off-midline procedures – the Karydakis flap, Bascom cleft lift, and Limberg flap procedures – are associated with lower recurrence rates and better wound healing. An important goal is to achieve complete wound lateralization and to change the configuration of the gluteal cleft by reshaping it, which results in a nicely flattened gluteal crease.

scholarly journals Pilonidal Sinus Disease: Risk Factors for Postoperative Complications and Recurrence

2012 ◽  
Vol 97 (3) ◽  
pp. 224-229 ◽  
Author(s):  
Akin Onder ◽  
Sadullah Girgin ◽  
Murat Kapan ◽  
Mehmet Toker ◽  
Zulfu Arikanoglu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Pilonidal Sinus ◽  
Primary Closure ◽  
Disease Risk ◽  
Pilonidal Sinus Disease ◽  
Limberg Flap ◽  
Sinus Disease ◽  
Faculty Department ◽  
Closure Method

Abstract The aim of this study is to analyze the risk factors for complications and recurrence in pilonidal sinus disease. The prospective study consisted of 144 patients with pilonidal sinus disease who were operated on at Dicle University Medical Faculty, Department of General Surgery, between February 2008 and December 2010. Patients receiving the Limberg flap totaled 106 (73.6%), while 38 (26.4%) had primary closure. Postoperative complications developed in 42 subjects (29.2%), and recurrence occurred in 19 (13.2%). The Limberg flap method was statistically considered as a risk factor for postoperative complications (P  =  0.039). Regarding recurrence, family tendency (P  =  0.011), sinus number (P  =  0.005), cavity diameter (P  =  0.002), and primary closure (P  =  0.001) were found to be risk factors. Postoperative complication rate is higher in the Limberg flap method than primary closure method. The risk of recurrence is related to family tendency, sinus number, cavity diameter and anesthesia type and is also higher in primary closure.

STEREOTACTIC RADIOSURGERY FOR CAVERNOUS SINUS OR ORBITAL HEMANGIOMAS

Neurosurgery ◽  
2009 ◽  
Vol 65 (5) ◽  
pp. 914-918 ◽  
Author(s):  
Aftab A. Khan ◽  
Ajay Niranjan ◽  
Hideyuki Kano ◽  
Douglas Kondziolka ◽  
John C. Flickinger ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Cavernous Sinus ◽  
Tumor Regression ◽  
Target Volume ◽  
Symptomatic Improvement ◽  
Primary Treatment ◽  
Vascular Tumors ◽  
Presenting Symptoms ◽  
Primary Treatment Modality

Abstract OBJECTIVE Hemangiomas are rare but highly vascular tumors that may develop in the cavernous sinus or orbit. These tumors pose diagnostic as well as therapeutic challenges to neurosurgeons during attempted removal. We analyzed our increasing experience using stereotactic radiosurgery (SRS). METHODS Eight symptomatic patients with hemangiomas underwent SRS between 1988 and 2007. The presenting symptoms included headache, orbital pain, diplopia, ptosis, proptosis and impaired visual acuity. The hemangiomas were located in either the cavernous sinus (7 patients) or the orbit (1 patient). Four patients underwent SRS as primary treatment modality based on clinical and imaging criteria. Four patients had previous microsurgical partial excision or biopsy. The median target volume was 6.8 mL (range, 2.5–18 mL). The median prescription dose delivered to the margin was 14.5 Gy (range, 12.5–19 Gy). The dose to the optic nerve in all patients was less than 9 Gy (range, 4.5–9 Gy). RESULTS The median follow-up period after SRS was 80 months (range, 40–127 months). Six patients had symptomatic improvement; 2 patients reported persistent diplopia. Follow-up imaging revealed tumor regression in 7 patients and no change in tumor volume in 1 patient. All the patients improved after SRS. CONCLUSION Our extended experience confirms that SRS is an effective management strategy for symptomatic intracavernous and intraorbital hemangiomas. Our study is the first long-term report on the safety and efficacy of SRS.

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

2021 ◽  
pp. 2920-2922
Author(s):  
M. Kaleem ◽  
F. Mubarik ◽  
M. U. Afzal ◽  
A. Zahid ◽  
W. I. Andrabi ◽  
...  
Keyword(s):  
Pilonidal Sinus ◽  
Primary Closure ◽  
Advancement Flap ◽  
Pilonidal Sinus Disease ◽  
P Value ◽  
Limberg Flap ◽  
Simple Excision ◽  
Group A ◽  
Group B ◽  
Rhomboid Excision

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>4) and cannot sit and have fever (temp>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

Day-Case Limberg Flap for Recurrent Pilonidal Sinus: Does Obesity Complicate the Issue?

2010 ◽  
Vol 76 (9) ◽  
pp. 995-999 ◽  
Author(s):  
Khaled M. Madbouly
Keyword(s):  
Hospital Stay ◽  
Pilonidal Sinus ◽  
Operative Time ◽  
Day Surgery ◽  
Complete Healing ◽  
Limberg Flap ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Rhomboid Excision

The purpose of this study was to analyze the long-term outcome of rhomboid excision with Limberg flap reconstruction (LF) as one-day surgery in treatment of recurrent pilonidal sinus (RPS). The effect of obesity on outcome will be addressed. Forty-nine patients with RPS were treated by rhomboid excision and LF as one-day surgery. Data collected included demographics, body mass index, operative time, flap ischemia, wound infection, length of hospital stay, time of complete healing, and recurrence. Patients’ mean age was 33.4 years and mean number of previous operations was 3.4. Operative time ranged from 40 to 70 minutes. Two patients developed sterile seroma (4.1%) and two patients (4.1%) had wound infections. No wound dehiscence or flap ischemia was reported. All patients returned to normal activity within 7 days. No recurrences were reported after a mean follow-up of 32.1 months. Obesity significantly increased the operative time, however, it affected neither the postoperative outcome nor the long-term recurrence. Rhomboid excision and LF as one-day surgery is a safe and reliable method for treatment of RPS. It guarantees low morbidity, short hospital stay, short time off work, and carries low risk of recurrence, even in obese patients.

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