Limberg Flap Reconstruction in Treating Sacrococcygeal Pilonidal Sinus

Background: Pilonidal sinus is the relatively common condition affecting men almost twice as often as the women we experienced. The estimated incidence is 0.26 per thousand populations in general. The management of pilonidal sinus disease remains controversial, and gold standard treatment modality has yet to be established. Limberg procedure is a safe and reliable technique in the treatment of the sacrococcygeal pilonidal sinus disease, with a low complication and recurrence rates if performed according to the appropriate surgical principles. Methods: This is a Prospective study on 24 patients between the period from July 2014 to Dec 2018 in the Department of Surgery in Bangabandhu Sheikh Mujib Medical University (BSMMU) as well as other different hospitals in Dhaka, Bangladesh. The patients having primary or recurrent pilonidal sinus disease underwent the foresaid surgical treatment. Results: Twenty four patients underwent this operation. Among them, the picture was that 20(83.3%) were males and 4(16.7%) were female. The mean age was 31, (Range: 17-45 years). 6(25%) patients were presented with recurrent sinus and 5 of them had one or more occasion previous surgery. Twenty one patients (87.5%) had full primary healing without any complication. But 1(4.2%) patient had minimal sarcoma, 1(4.2%) patient had superficial infection and the remaining other 1(4.2%) had partial flap necrosis. However, all three healed completely with conservative treatment. The mean length of hospital stay was 2.45 (Range: 1-5) days and the most patients returned to their work within 3 weeks. Conclusion: Limberg flap is very effective for sacrococcygeal pilonidal sinus disease with low complication rates, shorter hospital stay, low recurrence rates, earlier healing and reduced off-work period. The surgery can be easily mastered. We recommend Limberg flap as preferred surgery in the cases of Sacrococcygeal Pilonidal sinus. Bangladesh Journal of Medical Science Vol.19(1) 2020 p.105-109

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Modified Limberg flap versus modified Karydakis flap in pilonidal sinus disease: single surgeon experience

International Surgery Journal ◽

10.18203/2349-2902.isj20194035 ◽

2019 ◽

Vol 6 (9) ◽

pp. 3069

Author(s):

Umit Turan

Keyword(s):

Hospital Stay ◽

Pilonidal Sinus ◽

Length Of Hospital Stay ◽

Operation Time ◽

Pilonidal Sinus Disease ◽

Limberg Flap ◽

Complication Rates ◽

Sinus Disease ◽

Surgeon Experience ◽

Modified Limberg Flap

Background: The aim of this study was to analyze and compare the results of the modified Limberg flap (MLF) and modified Karydakis flap (MKF) techniques which were performed for the treatment of pilonidal sinus disease (PSD).Methods: The patients who were operated for PSD by the same surgeon between November 2010 and July 2013 in Konya Seydisehir Hospital were retrospectively analyzed. A total of 106 patients were evaluated in this study regarding age, gender, operation time, length of hospital stay, and postoperative complications.Results: There were 14 female and 92 male patients (MLF; 5/52 and MKF; 9/40). MLF was performed in 57 (53.8%) patients and MKF was performed in 49 (46.2%) patients. Length of Hospital stay and drain removal time were less in MKF group but it was not significantly different between two groups (p>0.05). Operation time was shorter in MKF group than MLF group (p<0.05). The complication rates of the MLF and MKF groups were 10.5% and 12.2% respectively. The recurrence was seen in 1 patient in MLF group and 2 in MKF group.Conclusions: MKF has shorter operation time than MLF, however both techniques have a similar complication and recurrence rate. In conclusion MLF and MKF procedures can be safely used as a surgical treatment of PSD.

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Anatomic effect of classical Limberg plastic surgery procedure in the sacro-coccygeal region for pilonidal sinus disease - A pilot study

International Surgery ◽

10.9738/intsurg-d-16-00151.1 ◽

2016 ◽

Author(s):

Michael Ardelt ◽

Gregor Hallof ◽

Rene Fahrner ◽

Felix Dondorf ◽

Stefan Ludewig ◽

...

Keyword(s):

Pilonidal Sinus ◽

Statistical Significance ◽

Pilonidal Sinus Disease ◽

Limberg Flap ◽

Recurrence Rates ◽

Natal Cleft ◽

Sinus Disease ◽

Rima Ani ◽

Background Data ◽

Male Patients

Abstract Objective Sacro-coccygeal pilonidal sinus disease is a frequent surgical problem. Some authors assign the low recurrence rates of the Limberg flap to the flattening or elevation of the natal cleft. Summery of the background data: Numerous authors describe a flattening or elevation of the natal cleft as a result of a Limberg flap that originated from the gluteal region. However, thus far these were not quantified. Methods The aim of our study was to quantify the flattening or elevation, respectively, of the natal cleft. In the context of our study on the Limberg flap plasty with a homogenous group of 12 male patients, we measured the depth of the rima ani after the excision and we also measured the thickness of the Limberg flap. Results The median thickness of the rima ani at excision was 3.35 cm [IQR: 2.70; 4.18]. The median thickness of the Limberg flap was 4.85 cm [IQR: 3.90; 5.18]. The thickness of the rima ani after excision was statistically significantly less as compared to the thickness of the Limberg flap (p = 0.002). Conclusion In our study, we have shown the elevation of the crena ani with statistical significance by performing the Limberg flap for the treatment of sacro-coccygeal pilonidal sinus disease, leading to a flattening of the sacro-coccygeal region. As a deep crena ani is a factor in the pathogenesis of pilonidal sinus, the flattening of the sacro-coccygeal region with a Limberg flap plasty, as reported in countless publications, may explain the low recurrence rates.

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Modified Limberg Flap Cover for Recurrent Sacrococcygeal Pilonidal Sinus: Our Experience at a Medical College In Nepal

Birat Journal of Health Sciences ◽

10.3126/bjhs.v6i1.37555 ◽

2021 ◽

Vol 6 (1) ◽

pp. 1274-1279

Author(s):

Budhi Nath Adhikari ◽

Abhishek Bhattarai ◽

Pragya Devkota ◽

Sushma Khatiwada

Keyword(s):

Patient Satisfaction ◽

Hospital Stay ◽

Pilonidal Sinus ◽

Limberg Flap ◽

Recurrence Rates ◽

Transposition Flap ◽

Young Males ◽

Modified Limberg Flap ◽

The Mean ◽

Rhomboid Excision

Introduction: Pilonidal sinus is an inflammatory disease seen mostly in the intergluteal region of young males. Although any treatment strategy of this condition is generally free of life-threatening complications due to its superficial nature, it is still a feared disease because of recurrence which greatly increases the morbidity. Objective: To investigate the results of wide rhomboid excision and modified Limberg transposition flap reconstruction to treat recurrent pilonidal sinus. Methodology: Well-documented records of all patients with recurrent sacrococcygeal pilonidal sinus who underwent wide excision and a modified Limberg transposition flap at our center during the past 3 years and followed up for longer than 12 months were analyzed. The modification primarily consisted of an asymmetrically rotated rhomboid excision and lateralization of the lower midline. Patient demographics, days of hospitalization, complications, patient satisfaction and recurrence rates were evaluated. Result: Most patients in the study were overweight. No relationship was detected between BMI and number of sinus openings, hospital stay, drain placement or recurrences but an association with infection was noted. The number of pilonidal sinus orifices did not have a correlation with age, number of previous surgeries, duration of hospital stay or drains placement. The mean duration of hospitalization was 7.89 ± 3.41 days and the mean duration of suction drainage was 6.33±2.87 days. Half of our patients developed complications in the postoperative period. The only patient who developed superficial wound infection stayed the most in the hospital. All patients had some complaints regarding the operation site; however, they were satisfied with the result of the operation and had no recurrence at 12 months of follow-up. Conclusion: Rhomboid excision of recurrent sacrococcygeal pilonidal sinus with modified Limberg flap closure is a promising surgical technique with advantages of a good patient satisfaction and no recurrence after a year of surgery.

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Limberg flap for pilonidal sinus: an institutional study

International Surgery Journal ◽

10.18203/2349-2902.isj20164700 ◽

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.

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Karydakis procedure for sacrococcygeal pilonidal sinus disease: Our experience

Indian Journal of Plastic Surgery ◽

10.4103/0970-0358.146615 ◽

2014 ◽

Vol 47 (03) ◽

pp. 402-406 ◽

Cited By ~ 3

Author(s):

N. Arun Kumar ◽

Prasenjit Sutradhar

Keyword(s):

Hospital Stay ◽

Pilonidal Sinus ◽

Operative Time ◽

Simple Procedure ◽

Pilonidal Sinus Disease ◽

Recurrence Rates ◽

Sinus Disease ◽

Stay Suture ◽

Flap Procedure ◽

Flap Repair

ABSTRACT Aim: The purpose of this study was to evaluate patients with sacrococcygeal pilonidal sinus disease (SPSD) who underwent Karydakis procedure at our centre with reference to the perioperative findings, early and late postoperative results and recurrence. Materials and Methods: A total of 103 patients presenting with SPSD at our centre underwent Karydakis flap repair from January 2001 to December 2010. These patients were then followed-up and evaluated with respect to operative time, drain use, hospital stay, suture removal, complications, and recurrence. Results: The mean operative time was 74.9 min with a median hospital stay of 5 days. Drains were removed at a median of 7 days and sutures at a median of 15 days. Twenty-one patients presented with serous collection in the wound. Six patients had wound infection. Patients were followed-up for a median of 29 months. No recurrences were noted in any of the cases. Conclusion: Karydakis flap procedure is a relatively simple procedure for SPSD with reproducible low recurrence rates.

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Comparison of Crystallized Phenol Treatment and Simple Primary Closure Methods for Pilonidal Sinus Disease

International Surgery ◽

10.9738/intsurg-d-15-00066.1 ◽

2019 ◽

Vol 103 (9-10) ◽

pp. 424-428

Author(s):

Ahmet Turkoglu ◽

Zubeyir Bozdag ◽

Metehan Gumus ◽

Abdullah Oguz ◽

Mesut Gul ◽

...

Keyword(s):

Hospital Stay ◽

Pilonidal Sinus ◽

Primary Closure ◽

Healing Time ◽

Pilonidal Sinus Disease ◽

Complication Rates ◽

Female Ratio ◽

Sinus Disease ◽

Phenol Treatment ◽

Crystallized Phenol

The objective of the study was to compare the results of the patients treated with crystallized phenol treatment (CPT) or simple primary closure (SPC) for pilonidal sinus disease (PSD). For PSD treatment, both SPC and CPT have the advantages of rapid recovery, minimal pain, and short hospital stay. Even though these two techniques can be used interchangeably in uncomplicated cases, there is not enough evidence about which method is superior. A total of 102 patients who underwent CPT (n = 57) and SPC (n = 45) for uncomplicated PSD were included in the study. In all of the cases, data were recorded and compared between CPT and SPC groups, including age, gender, duration of the symptoms, hospital stay, complications, healing time, and recurrence. The mean age was 25.6 years and the male-to-female ratio was 93:9. The SPC and CPT groups were similar in terms of age, gender, duration of symptoms, complications, and healing time. The CPT group did not require hospitalization or anesthetic procedure in addition to local anesthesia, but the SPC group required a median of 1 day (range, 1–3 days) of hospitalization, and 3 patients (6.7%) needed spinal anesthesia. During a median of 27.5 months' follow-up, the recurrence rate in the CPT group (6 patients; 10.5%) was lower than in the SPC group (13 patients; 28.9%). Both hospital stay and recurrence rates were better in the CPT group. Healing time and complication rates were similar in both methods. Based on these results, we suggest that CPT should be preferred to SPC in uncomplicated cases.

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A Prospective Study of the Clinical Profile of Pilonidal Sinus Disease at a Tertiary Care Centre in North India - Comparison of Limberg Flap Closure and Z-Plasty in Treatment

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/468 ◽

2021 ◽

Vol 8 (28) ◽

pp. 2532-2537

Author(s):

Gulab Dhar Yadav ◽

Ashish Varshney ◽

Adiveeth Deb

Keyword(s):

Wound Healing ◽

Pilonidal Sinus ◽

Tertiary Care ◽

Wound Dehiscence ◽

Pilonidal Sinus Disease ◽

Limberg Flap ◽

Sinus Disease ◽

The Mean ◽

A Prospective Study ◽

Flap Closure

BACKGROUND Sacrococcygeal pilonidal sinus disease is defined as a hair-filled cavity in the subcutaneous fat of the natal cleft (postsacral intergluteal region). This study was done to investigate the prevalence, clinical presentation, body mass index (BMI) as a risk factor; and complications of Limberg flap and Z-plasty, for the reconstruction of defects after excision of sacrococcygeal pilonidal sinus in terms of the incidence of seroma, wound infection, wound dehiscence, flap necrosis, recurrence, duration of hospital stay and time taken for complete wound healing after the procedure. METHODS This was a prospective study done on 50 patients from January 2018 to October 2020 at a tertiary care hospital in 15 to 50 years of age group presenting with pilonidal sinus disease. Statistical analysis was done using SPSS (Statistical Package for Social Sciences) version 15.0 statistical analysis software. Significance was assessed at 5 %. RESULTS The mean age of presentation was 25 years with chief complains of swelling, discharge and pain, the mean BMI was 24.39 kg/m2 . Anaerobic infection is more common in the sinus (40 %), and among aerobic organisms, Staphylococcus was the most common organism (19 %). In Limberg flap closure, only one 1 developed wound infection and this same patient had partial wound dehiscence, while in Zplasty group, 3 developed seroma, 2 wound infections and 2 partial flap ischemia. CONCLUSIONS The goals of management of pilonidal sinus diseases include conservative management along with definitive surgical treatment of the disease. Pilonidal abscess is managed by incision and drainage and is followed by definitive treatment, later on. Flap procedures are effective ways to treat the disease, of which Limberg flap is the most reliable flap with minimum complications, lesser hospital stay and faster wound healing. KEYWORDS Pilonidal Sinus, Limberg Flap, Z-Plasty

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THE OUTCOME OF LIMBERG FLAP RECONSTRUCTION PROCEDURE FOR PRIMARY NATAL CLEFT PILONIDAL SINUS DISEASE: FOUR YEARS’ EXPERIENCE AT A TEACHING HOSPITAL IN PAKISTAN

Pakistan Postgraduate Medical Journal ◽

10.51642/ppmj.v31i03.331 ◽

2021 ◽

Vol 31 (03) ◽

pp. 123-127

Author(s):

Wasif Majeed Chaudhry ◽

Afza Saleem ◽

Maryam Jamil ◽

Muhammad Saddique Zishan ◽

Adnan Sadiq Butt ◽

...

Keyword(s):

Pilonidal Sinus ◽

Pilonidal Sinus Disease ◽

Limberg Flap ◽

Flap Reconstruction ◽

Reconstruction Procedure ◽

Natal Cleft ◽

Sinus Disease ◽

Duration Of Hospital Stay ◽

The Mean ◽

Primary Healing

Background: Natal cleft pilonidal sinus disease is known for its high recurrence rate after surgery. Different surgical procedures are being used for its treatment and these vary from wide excision followed by healing with secondary intention to excision followed by reconstruction with a flap. Limberg flap reconstruction procedure has been used by many surgeons as their primary choice owing to its low recurrence rate and less postoperative complications. Objective: The objective of this study was to assess the outcome of Limberg flap reconstruction procedure in patients with primary natal cleft pilonidal sinus disease. Methods: This descriptive case series was conducted at Ghurki trust teaching hospital, Lahore, Pakistan, between January 2015 to December 2018. 110 consecutive patients with primary natal cleft pilonidal sinus disease were included in this study. Informed consent was taken from these patients and all patients underwent Limberg flap reconstruction procedure. The evaluated outcomes of this procedure included duration of hospital stay, postoperative pain, primary healing, surgical site Infection, seroma formation, flap necrosis and, recurrence. Results: The patients age ranged between 18 years to 60 years. The mean age was 26.6 ±8.6 years. 73 patients (66.36 %) were males and 23 patients (33.63%) were females. The duration of disease ranged between 1 month to 6 months with a mean of 3.7±1.7 months. The mean operating time was 47.50±5.14 minutes. The mean duration of hospital stay was 1.87±0.80 days. The mean postoperative pain score calculated by the visual analogue scale (VAS) twenty-four hours after the surgery was 3.45. 95 patients (86.36%) had complete primary healing without any complication. 9 patients (8.18%) had a surgical site infection and 6 patients (5.45 %) had seroma formation. No patient suffered from flap necrosis. 2 patients (1.81%) who had complete primary healing presented with recurrence of the disease within six months of the procedure with a period of one year of follow-up designated for every patient. Conclusion: Limberg flap reconstruction procedure is a safe and efficacious treatment option for primary natal cleft pilonidal sinus disease because it provides early complete primary healing in most patients, and shortens the duration of hospital stay thus reducing the cost of treatment. The pain scores fall in the moderate post-operative pain score category and the complication rates and the recurrence rates are very low.

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Pilonidal sinus disease: Karydakis flap procedure in our patients

Perspectives in Surgery ◽

10.33699/pis.2020.99.8.350-355 ◽

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.

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Pilonidal sinus disease on the rise: a one-third incidence increase in inpatients in 13 years with substantial regional variation in Germany

International Journal of Colorectal Disease ◽

10.1007/s00384-021-03944-4 ◽

2021 ◽

Author(s):

Christina Oetzmann von Sochaczewski ◽

Jan Gödeke

Keyword(s):

Pilonidal Sinus ◽

Regional Variation ◽

Disease Incidence ◽

Age Groups ◽

Pilonidal Sinus Disease ◽

National Guidelines ◽

Reconstructive Procedures ◽

Sinus Disease ◽

The Mean ◽

Almost All

Abstract Purpose Collective evidence from single-centre studies suggests an increasing incidence of pilonidal sinus disease in the last decades, but population-based data is scarce. Methods We analysed administrative case–based principal diagnoses of pilonidal sinus disease and its surgical therapy between 2005 and 2017 in inpatients. Changes were addressed via linear regression. Results The mean rate of inpatient episodes of pilonidal sinus disease per 100,000 men increased from 43 in 2005 to 56 in 2017. In females, the mean rate of inpatient episodes per 100,000 women rose from 14 in 2005 to 18 in 2017. In the whole population, for every case per 100,000 females, there were 3.1 cases per 100,000 males, but the numbers were highly variable between the age groups. There was considerable regional variation within Germany. Rates of inpatient episodes of pilonidal sinus disease were increasing in almost all age groups and both sexes by almost a third. Surgery was dominated by excision of pilonidal sinus without reconstructive procedures, such as flaps, whose share was around 13% of all procedures, despite recommendations of the national guidelines to prefer flap procedures. Conclusion Rates of inpatient episodes of pilonidal sinus disease in Germany rose across almost all age groups and both sexes with relevant regional variation. The underlying causative factors are unknown. Thus, patient-centred research is necessary to explore them. This should also take cases into account that are solely treated office-based in order to obtain a full-spectrum view of pilonidal sinus disease incidence rates.

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