USE OF LIMBERG FLAP FOR PILONIDAL SINUS–A VIABLE OPTION

Authors

  • Muhammad Nadeem Aslam
  • Sidra Shoaib
  • Abdul Majeed Choudhry

Abstract

Background: Pilonidal sinus disease has been treated for a long time with conventional openexcision technique. The rhomboid flap of Limberg is a transposition flap that has been pleaded fortreatment of this condition. Methods: We present our experience with the Limberg technique forboth primary and recurrent pilonidal sinuses. One hundred and ten patients, with pilonidal sinusdisease were treated with rhombic excision and Limberg transposition flaps. All sinus tracts wereresected en bloc, and the fasciocutaneous Limberg flap was prepared from the gluteal region andclosed it with a suction drain. Results: Full primary healing was obtained in 110 patients, 1 patienthad minimal necrosis of flap and 2 had gaping of flap. Minor infection occurred in 3 patients. Butall these complications healed uneventfully. The average hospital stay was 3 days. Follow upperiod was 1 year and 1 recurrence occurred. Conclusions: Limberg transposition flap is apromising surgical technique to treat pilonidal sinus.Keywords: Pilonidal sinus, Limberg flap, rhomboid transposition flap, fasciocutaneous flap, primary

References

McCallum I, King PM, Bruce J. Healing by primary versus

secondary intention after surgical treatment for pilonidal sinus.

Cochrane Database Syst Rev 2007(4):CD006213.

Sondenaa K, Andersen E, Nesvik I, Soreide JA. Patient

characteristics and symptoms in chronic pilonidal sinus disease.

Int J Colorectal Dis 1995;10(1):39–42.

Hull TL, Wu J. Pilonidal disease. Surg Clin North Am

;82:1169–85.

Clothier PR, Haywood IR. The natural history of the post anal

(pilonidal) sinus. Ann R Coll Surg Engl 1984;66(3):201–3.

Brearley R. Pilonidal sinus; a new theory of origin. Br J Surg

;43:62–8.

Bascom J. Pilonidal disease: origin from follicles of hairs and

results of follicle removal as treatment. Surgery. 1980;87:567–72.

Patel MR, Bassini L, Nashad R, Anselmo MT. Barber's

interdigital pilonidal sinus of the hand: a foreign body hair

granuloma. J Hand Surg Am 1990;15:652–5.

Chiedozi LC, Al-Rayyes FA, Salem MM, Al-Haddi FH, AlBidewi AA. Management of pilonidal sinus. Saudi Med J

;23:786–8.

Mohamed HA, Kadry I, Adly S. Comparison between three

therapeutic modalities for non-complicated pilonidal sinus

disease. Surgeon 2005;3(2):73–7.

Jamal A, Shamim M, Hashmi F, Qureshi MI. Open excision with

secondary healing versus rhomboid excision with Limberg

transposition flap in the management of sacrococcygeal pilonidal

disease. J Pak Med Assoc 2009;59:157–60.

Azab AS, Kamal MS, Saad RA, Abou al Atta KA, Ali NA.

Radical cure of pilonidal sinus by a transposition rhomboid flap.

Br J Surg 1984;71(2):154–5.

Kapan M, Kapan S, Pekmezci S, Durgun V. Sacrococcygeal

pilonidal sinus disease with Limberg flap repair. Tech

Coloproctol 2002;6(1):27–32.

Ertan T, Koc M, Gocmen E, Aslar AK, Keskek M, Kilic M. Does

technique alter quality of life after pilonidal sinus surgery? Am J

Surg 2005;190:388–92.

Katsoulis IE, Hibberts F, Carapeti EA. Outcome of treatment of

primary and recurrent pilonidal sinuses with the Limberg flap.

Surgeon 2006;4(1):7–10, 62.

Mentes O, Bagci M, Bilgin T, Ozgul O, Ozdemir M. Limberg

flap procedure for pilonidal sinus disease: results of 353 patients.

Langenbecks Arch Surg 2008;393:85–9.

Akin M, Gokbayir H, Kilic K, Topgul K, Ozdemir E, Ferahkose

Z. Rhomboid excision and Limberg flap for managing pilonidal

sinus: long-term results in 411 patients. Colorectal Dis

;10:945–8.

Ersoy E, Onder Devay A, Aktimur R, Doganay B, Ozdogan M,

Gundogdu RH. Comparison of the short-term results after

Limberg and Karydakis procedures for pilonidal disease:

Randomized prospective analysis of 100 patients. Colorectal Dis

;11:705–10.

Urhan MK, Kucukel F, Topgul K, Ozer I, Sari S. Rhomboid

excision and Limberg flap for managing pilonidal sinus: results of

cases. Dis Colon Rectum 2002;45:656–9.

Mentes BB, Leventoglu S, Cihan A, Tatlicioglu E, Akin M, Oguz

M. Modified Limberg transposition flap for sacrococcygeal

pilonidal sinus. Surg Today 2004;34:419–23.

Published

2009-12-01