Rhomboid flap versus fasciocutaneous V-Y advancement flap in treatment of pilonidal sinus

ABSTRACT

Pilonidal sinus of the natal cleft is one of the common surgical problems and represents a challenge to many surgeons, because the high incidence of recurrence and long postoperative morbidity course. Although many methods of surgical and non surgical approaches have been proposed to overcome these problems, an optimal treatment modality has not been achieved yet. Evaluation of two different types of surgical procedures for surgical treatment of Sacrococcygeal pilonidal sinus; Rhomboid flap technique and V-Y advancement flap technique, comparing the results of each one separately. 30 patients with chronic pilonidal sinus disease were admitted to surgical department in Ain Shams University hospital during the period from December 2002 to August 2003. The patients were divided into two groups. Group [A]. 15 patients, 13 of them were classic cases while 2 cases were recurrent cases. This group was treated by excision of the sinus and closure the wound by Rhomboid flap technique. Group [B] 15 patients, 12 of them were classic cases while 3 cases were recurrent cases. This group was treated by excision of the sinus, and closure the wound by V-Y advancement flap technique. In group [A], mean hospital stay was 5 days, mean healing time was 15 days, and only 2 cases developed wound infection, while in group [B], mean hospital stay was 7 days, mean healing time was 17 days, and only one case of wound infection. No recurrence detected in both groups during the whole period of follow up [12 months]. Treatment of chronic pilonidal sinus of the natal cleft can be efficient using one of the both techniques mentioned above, as both techniques having the same principles [flattening of the natal cleft and keeping the scar away from the midline]. We advise the use of one of both techniques for the treatment of chronic pilonidal sinus disease, specially the V-Y flap advancement for treatment of recurrent complex cases allowing removal of all pathological tissues, and rhomboid flap for simple classic cases