Surgical outcome of modified Karydakis flap and modified Limberg flab in the management of sacroccygeal pilonidal disease: a comparative study

Introduction: Sacrococcygeal pilonidal disease (SPD) is a chronic suppurative condition of the sacrococcygeal region causing chronic sinus tract or cyst. It is an acquired complex disease more common in young adult males, causing considerable morbidity and long periods of interruption in work or education. From simple conservative techniques to complex flap reconstruction, many debatable treatment options are offered; however clear dynamics toward the widespread use of minimally invasive methods and off-midline flap reconstruction are suggested in all guidelines, which recommend the Karydakis and Limberg flap modification. The plethora of literature compares procedures for identification of a single best treatment approach, which has proven to be difficult. The surgical outcome of both techniques is compared in the present study. Objective: To compare the surgical outcomes of the modified Karydakis flap (MKF) versus the modified Limberg flap (MLF) in SPD. Materials and Methods: The present study was conducted at the general surgery department on SPD patients who were ≥18 years old. A total of 67 participants were included after obtaining the informed consent, with group A comprising 33 patients undergoing the MLF procedure and group B comprising 34 patients undergoing the MKF procedure. Results: The mean patient age was 28.85 (range, 18-44) years old. For the MKF and MLF methods, the average operating duration was 32.5 (range, 25-40) and 54.5 (range, 45-65) minutes, respectively. The MKF approach was found to significantly improve pain score, mean sitting painless time, return to normal activity, wound healing time, and patient satisfaction. Conclusion: Comparative outcomes were seen between both MKF and MLF; however, our findings show that MKF is a more favourable method than MLF with superior outcomes. (AU)

Comparative outcome study between simple closure and flap technique in Pilonidal sinus disease

Introduction:Pilonidal sinus disease (PSD) is a disease of natal cleft in sacrococcygeal region. The main goal of treatment is low recurrence rate, short hospital stays, early return to work and decrease post-operative work. Present study was undertaken to compare and find clinical outcome between simple closure and flap techniques. Methodology:30 patients of Pilonidal sinus disease (PSD) which were fit to undergo surgery were included. 15 patients undergone simple closure and 15 undergone flap technique (Limberg). Result: Wound Infection, Post-operative discharge and Recurrence rate was found higher in group I patients (20 %, 23.33 %, 30 % and 26.66 % respectively) compared to Group II cases. Difference is statistically significant (p Value 0.03, 0.04, 0.008 and 0.02 respectively). Discussion:Recurrence of the sinus probably depend mainly on the ability of the procedure to obliterate the depth of natal cleft. In the present study we found flap procedures superior in combating the disease recurrence than excision with simple closure. Conclusion: It is recommended that Limberg flap method should be used in the treatment of pilonidal sinus disease over other modalities

Management of pilonidal sinus disease with Limberg flap: our experience

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.

Limberg flap for reconstruction after excision of multiple conglomerate epidermoid cysts

Epidermoid cysts are common, subepidermal, keratin containing nodules, found anywhere on the body in 3rd and 4th decade of life. Surgical treatment is by complete excision with wall of cyst intact. Author presents a 40-year-old male with multiple sebaceous cysts in close proximity to one another on his left thigh. Individual cyst excision would have lead to a difficult primary closure, need for multiple incisions, with contracture and poor cosmesis due to the close proximity of the cysts. instead, the cysts were excised in mass and limberg flap was used for reconstruction and primary closure. Patient was followed up for 6 months. The objective of this study was to prove that limberg flap yields superior cosmesis and healing by primary intention in reconstruction after excision of multiple epidermoid cysts.

A prospective randomised trial comparing MUTAF technique with Limberg flap technique in surgical treatment of chronic pilonidal sinus

Introduction: Pilonidal sinus is a common condition usually seen in young adult. Although several methods have been described all have been associated with high recurrence rate. This study is a prospective randomized trial comparing MUTAF technique with Limberg flap reconstruction in the management of chronic pilonidal sinus. Materials and methods: This prospective study was conducted in Department of General Surgery in Al Azhar Medical College, from June 2018 to June 2019 who were treated for chronic pilonidal sinus by comparing MUTAF technique with Limberg flap technique. Results: A total of 60 patients were included in our study. They were randomly divided into two groups. The demographic data: mean age and sex ratio were not statistically different when compared between two groups. Duration of symptoms in both the groups was 18 months. Mean follow up duration was almost 12 to 18 months in both groups. Mean operative time was less in group 1 with 34.5 +/-14.7 and 46.3 +/- 10.3 in group 2. When length of hospital stay compared there was significant difference between the groups (p < 0.001). Mean hospital stay time was more in group 2 (3.8+/- 1.6) than group 1 (2.1+/-1.2). Between the groups there was no significant difference in recurrence rate. In our study we had no recurrence in both groups. Most common complication was seroma (group 1 =02, group 2 =03) and wound infection (group = 01, group 2 = 03). The seroma patient was treated with wound aspiration without wound open. One patient had wound dehiscence in group 2 and was treated with local wound care and improved in a month. Manjunath H R, Reny Jayaprakas, Anjali Nair. A prospective randomized trial comparing MUTAF technique with Limberg flap technique in surgical treatment of chronic pilonidal sinus. IAIM, 2019; 6(8): 41-46. Page 42 Conclusion: MUTAF technique can be a good alternative for the treatment of chronic pilonidal sinus because of excellent surgical outcome. In Mutaf technique due to double flap there is less flap tension reduced postoperative pain and early return to work. In both Flap techniques natal cleft is flattened and displace the incision scar from midline resulting in low recurrence.

Comparison of depression, anxiety and long-term quality of health in patients with a history of either primary closure or Limberg flap reconstruction for pilonidal sinus

OBJECTİVE: Pilonidal sinus is characterized by high operative morbidity mainly due to wound problems. We aimed to compare the quality of health, comfort and psychological status in patients who underwent surgery for pilonidal sinus. METHODS: A total of 205 pilonidal sinus patients operated on with either primary closure or Limberg flap reconstruction were compared in terms of depression, anxiety, and long-term quality of health by using Short Form 36, Beck Depression Inventory, and Beck Anxiety Inventory scales. RESULTS: There were 107 patients in the primary closure group with a mean follow-up of 29.6±7.7 months and 98 patients in the Limberg flap group with a mean follow-up of 34.1±7.3 months. In the SF-36 analysis, the mental health and bodily pain scores (59±6 and 56±11 in the primary closure group and 62±8 and 61±10 in the Limberg flap group) were significantly higher in the Limberg flap group (p = 0.014 and p = 0.002, respectively). The mean Beck Depression Inventory (19±6.13 vs. 16±4.90 p<0.001) and Beck Anxiety Inventory (19±6.27 vs. 16±4.90 p<0.001) scores were lower in the Limberg flap group. CONCLUSION: Limberg flap reconstruction produced better quality of health scores according to the SF 36, especially in terms of mental health and bodily pain. There was a higher tendency towards anxiety and depression in the primary closure group. .

Comparision of the Limberg flap with the V-Y flap technique in the treatment of pilonidal disease / 대한외과학회지

PURPOSE: In this study, we investigated whether there is a factor that can aid determi nation of the preferred technique by comparing the early and late results of two different surgical techniques for the treatment of pilonidal sinus. METHODS: The medical records of 176 patients in whom the Limberg flap (LF) or V-Y flap techniques were applied for reconstruction after the excision were evaluated retrospectively. RESULTS: The development rates of postoperative hematoma, wound separation, wound infection, and seroma were 2.8%, 5.1%, 5.6%, and 6.3%, respectively, while total flap necrosis was not observed in any patient. Return to daily activities was achieved after a mean of 17.1 days (13 to 21 days) days in the LF group and 32.7 days (18 to 47 days) in the V-Y flap group. During the average follow-up of 65 months (36 to 110 months), nine patients (5.1%) developed recurrent disease. There was no difference between the two groups with respect to early surgical complications (P = 0.286) or disease recurrence (P = 0.094), whereas the resumption of daily activities was longer in patients with a V-Y flap (P < 0.001). CONCLUSION: The early postoperative and long-term results of the LF and V-Y flap techniques for the treatment of pilonidal sinus were similar. Because the resumption of daily activities at work is achieved later in patients undergoing the V-Y flap compared with the LF technique, patients' employment (or position in working life) must be considered when determining the most appropriate surgical technique.

Effect of Modified Rhomboid Excision and Limberg Flap for the Treatment of Recurrent Pilonodal Sinus

PURPOSE: Recurrence of a pilonidal sinus after surgery is well known. Many surgical techniques have been developed but there is no efficient method available. This study evaluated the results of a Modified Rhomboid excision and Limberg flap of a pilonidal sinus, and examined the value of this method. METHODS: Five patients, who had been treated with a modified rhomboid excision and Limberg flap procedure for recurrent pilonidal sinus, were evaluated. The patient's age, gender, duration of symptoms, length of hospital stay, complications, time required for the return to normal activity, and prior history of surgery were evaluated. RESULTS: The mean age of the 5 patients (4 males and 1 female) was 22.7 years, and all had a history of previous surgery. The mean duration of symptoms was 4.2 years. Only one patient developed seroma. The mean hospital stay was 7.2 days, and the mean time to normal activity was 14.4 days. There was no recurrence. CONCLUSION: Modified Rhomboid excision and Limberg flap procedure is the optimal method for treating recurrent pilonidal sinus with low complication and recurrence rates.