Pilonidal Sinus – A Classical Plastic Procedure according to Limberg (Limberg Flap Procedure) or Its Modified Version?


Authors: M. Kička;  T. Toporcer;  J. Radoňak
Authors‘ workplace: I. chirurgická klinika UNLP, Košice, Slovenská republika, prednosta: prof. MUDr. Jozef Radoňak, CSc.
Published in: Rozhl. Chir., 2011, roč. 90, č. 8, s. 482-487.
Category: Monothematic special - Original

Overview

Pilonidal sinus disease (PSD) is defined as a cyst of sacrococcygeal hair follicle. Complete excision of lesion and skin reconstruction is still the only definitive treatment. Opinions on form and size of excision and type of skin reconstruction and flap are ambiguous.

Retrospective analysis of 83 patients underwent surgery in I. Department of Surgery in Kosice because of chronic PSD was performed. 67 patients underwent excision with Limberg flap (LF). 16 patients underwent excision with modified Limberg flap (mLF). 19 and 3 patients were excluded because of absence of control evaluation. The control evaluations of 48 and 13 patients were performed 12 days and 12 mounts after surgery.

No differences between groups in age of patients and men to women rate were recorded. We have recorded shorter hospital time (LF: 4 days; mLF: 3 days) and lower incidence of disease recurrence in one year (LF: 6.25%; mLF: 0%) in modified Limberg flap group.

Using of flaps in PSD treatment decrease suture tension and minimize risk of suture dehiscence, postoperative tenderness and risk of other complications. Using of flaps in treatment of this disease reduce intergluteal groove and minimize risk of disease recurrence. Using of primary closure without flap carries just little benefit in shorter surgery time. Suture outside of midline minimize risk of early postsurgical complication and decrease risk of disease recurrence.

Published literature in correlation with our results show that modified Limberg flap may be useful standard in PSD treatment.

Key words:
pilonidal sinus – Limberg flap – modified Limbergt flap


Sources

1. Lorant, T., Ribbe, I., Mahteme, H., et al. Sinus excision and primary closure versus laying open in pilonidal disease: a prospective randomized trial. Diseases of the colon and rectum, 2011, roč. 54, s. 300–305.

2. Humphries, A. E., Duncan, J. E. Evaluation and management of pilonidal disease. The Surgical Clinics of North America, 2010, roč. 90, s. 113–124.

3. McGuinness, J. G., Winter, D. C., O‘Rnnell, P. R. Vacuum-assisted closure of a complex pilonidal sinus. Diseases of the colon and rectum, 2003, roč. 46, s. 274–276.

4. Can, M. F., Sevinc, M. M., Hancerliogullari, O., et al. Multicenter prospective randomized trial comparing modified Limberg flap transposition and Karydakis flap reconstruction in patients with sacrococcygeal pilonidal disease. American journal of surgery, 2010, roč. 200, s. 318–327.

5. Akinci, O. F., Bozer, M., Uzunkoy, A., et al. Incidence and aetiological factors in pilonidal sinus among Turkish soldiers. The European journal of surgery = Acta chirurgica, 1999, roč. 165, s. 339–342.

6. Topgul, K., Ozdemir, E., Kilic, K., et al. Long-term results of limberg flap procedure for treatment of pilonidal sinus: a report of 200 cases. Diseases of the colon and rectum, 2003, roč. 46, s. 1545–1548.

7. Bradley, L. Pilonidal sinus disease: a review. Part one. Journal of wound care, 2010, roč. 19, s. 504–508.

8. Bannerjee, D. Pilonidal sinus wounds: the clinical approach. J. Community Nurs., 1999, roč. 13, s. 22–26.

9. Nelson, J., Billingham, R. Pilonidal disease and hidradenitis suppurativa. In: Wolff, B. G., Fleshman, J. W., Beck, D. E., et al., eds. The ASCRS textbook of colon and rectal surgery. New York: Springer; 2007: 228–235.

10. Rabie, M. E., Al Refeidi, A. A., Al Haizaee, A., et al. Sacrococcygeal pilonidal disease: sinotomy versus excisional surgery, a retrospective study. ANZ journal of surgery, 2007, roč. 77, s. 177–180.

11. Nordon, I. M., Senapati, A., Cripps, N. P. A prospective randomized controlled trial of simple Bascom_technique versus Bascom_cleft closure for the treatment of chronic pilonidal disease. American journal of surgery, 2009, roč. 197, s. 189–192.

12. Kička, M., Lukáčová, Z., Vrzgula, A., et al. Riešenie pilonidálneho sínusu operáciou podľa Limberga. Slovenská chirurgia, 2006, roč. 3, s. 8–11.

13. Mentes, O., Bagci, M., Bilgin, T., et al. Limberg flap procedure for pilonidal sinus disease: results of 353 patients. Langenbeck_archives of surgery / Deutsche Gesellschaft fur Chirurgie, 2008, roč. 393, s. 185–189.

14. Tezel, E. A new classification according to navicular area concept for sacrococcygeal pilonidal disease. Colorectal Dis., 2007, roč. 9, s. 575–576.

15. Mentes, O., Bagci, M., Bilgin, T., et al. Management of pilonidal sinus disease with oblique excision and primary closure: results of 493 patients. Diseases of the colon and rectum, 2006, roč. 49, s. 104–108.

16. da Silva, J. H. Pilonidal cyst: cause and treatment. Diseases of the colon and rectum, 2000, roč. 43, s. 1146–1156.

17. Eryilmaz, R., Sahin, M., Alimoglu, O., et al. Surgical treatment of sacrococcygeal pilonidal sinus with the Limberg transposition flap. Surgery, 2003, roč. 134, s. 745–749.

18. Doll, D., Krueger, C.M., Schrank, S., et al. Timeline of recurrence after primary and secondary pilonidal sinus surgery. Diseases of the colon and rectum, 2007, roč. 50, s. 1928–1934.

19. Akin, M., Leventoglu, S., Mentes, B. B., et al. Comparison of the classic Limberg flap and modified Limberg flap in the treatment of pilonidal sinus disease: a retrospective analysis of 416 patients. Surgery today, 2010, roč. 40, s. 757–762.

20. Cihan, A., Ucan, B. H., Comert, M., et al. Superiority of asymmetric modified Limberg flap for surgical treatment of pilonidal disease. Diseases of the colon and rectum, 2006, roč. 49, s. 244–249.

21. Ertan, T., Koc, M., Gocmen, E., et al. Does technique alter quality of life after pilonidal sinus surgery? American journal of surgery, 2005, roč. 190, s. 388–392.

22. Cihan, A., Mentes, B. B., Tatlicioglu, E., et al. Modified Limberg flap reconstruction compares favourably with primary repair for pilonidal sinus surgery. ANZ journal of surgery, 2004, roč. 74, s. 238–242.

23. Sakr, M., El-Hammadi, H., Moussa, M., et al. The effect of obesity on the results of Karydakis technique for the management of chronic pilonidal sinus. International journal of colorectal disease, 2003, roč. 18, s. 36–39.

24. Petersen, S., Koch, R., Stelzner, S., et al. Primary closure techniques in chronic pilonidal sinus: a survey of the results of different surgical approaches. Diseases of the colon and rectum, 2002, roč. 45, s. 1458–1467.

25. Cubukcu, A., Gonullu, N. N., Paksoy, M., et al. The role of obesity on the recurrence of pilonidal sinus disease in patients, who were treated by excision and Limberg flap transposition. International journal of colorectal disease, 2000, roč. 15, s. 173–175.

Labels
Surgery Orthopaedics Trauma surgery
Login
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account