Efficacy of Plastic Reconstruction (Limberg Rhomboid Flap) in Management of Sacrococcygeal Pilonidal Sinus

Mohamed Aly Elhorbity

doi:doi:10.11648/j.ass.20180601.16

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Efficacy of Plastic Reconstruction (Limberg Rhomboid Flap) in Management of Sacrococcygeal Pilonidal Sinus

Mohamed Aly Elhorbity

Published in Advances in Surgical Sciences (Volume 6, Issue 1)

Received: 22 May 2018 Accepted: 12 June 2018 Published: 4 July 2018

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Abstract

Sacrococcygeal pilonidal sinus disease is a common condition usually seen in young adult males. The definitive treatment of sacrococcygeal pilonidal sinus is a surgical excision of all sinus tracts. The surgical procedures range from simple excision with or without primary closure to complex flap reconstruction. However, no single operative intervention is superior to another based upon overall rate of healing, time away from work, and risk of recurrence. Between January 2014 and march 2017, a total of 30 patients (28 male and 2 female) aged between 17 and 40 years old complaining from sacrococcygeal pilonidal sinus, 10 cases are recurrent after previous operation (6 recurrent cases after excision and simple primary closure and the another 4 recurrent cases after excision and lay open the wound to heal with secondary intension). Another 12 cases diagnosed several months after drainage of previous surgical drainage of pilonidal abscess with persistent non healed sinus and the remaining 8 cases are chronic pilonidal sinus with no history of previous abscess or operations. All cases after proper investigation managed with Limberg rhomboid flap for wound closure after surgical excision of the sacrococcygeal pilonidal sinus. The mean operative time was ranged from 50 to 70 minutes (average 60 minutes). Most cases (25 patients) received spinal anesthesia and the remaining (5 patient) received general anesthesia according to their desire. All patients discharged home 24 h to 48 after the operation and only one recurrent case need admission again for reoperation within 6 months. No recorded cases of wound infection, or flap necrosis were observed. All patients returned to work from 2 to 4 weeks after the operation with minimal postoperative pain with no wound tension or irritability and all were satisfied. The present investigation was concluded that the sacrococcygeal pilonidal sinus is chronic disease and surgeons have been treating it by different modalities range from lay open technique to wound closure either simple or based on plastic flap reconstruction. Limberg rhomboid flap reconstruction after excision of sacrococcygeal pilonidal sinus is meticulous, safe, easy to be done, low operative time, low post-operative pain, low hospital stays, early return of the patient to work, suitable to primary and recurrent cases with low local recurrent and meet acceptance from the patient preoperative during discussion with the patient for writing the surgical consent and postoperative due to the previous benefits.

Published in	Advances in Surgical Sciences (Volume 6, Issue 1)
DOI	10.11648/j.ass.20180601.16
Page(s)	31-35
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2018. Published by Science Publishing Group

Keywords

Plastic Reconstruction, Limberg Rhomboid Flap, Sacrococcygeal Pilonidal Sinus

References

[1]	Hodges RM. (1880): Pilonidal sinus. Boston Med Surg J., 103:485–586.
[2]	Khanna A, Rombeau JL (2011): Pilonidal disease. Clin Colon Rectal Surg., 24(1):46-53.
[3]	Al-Hassan HK, Francis IM, Neglen P. (1990): Primary closure or secondary granulation after excision of pilonidal sinus. Acta Chir Scand., 156 (3):695–699.
[4]	Al-Khamis A, McCallum I, King PM, Bruce J. (2010): Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Cochrane Database Syst Rev. 20 (1): CD006213. doi: 10. 1002/14651858. CD006213. pub3.
[5]	Ardelt M, Dittmar Y, Rauchfuss F, Fahrner R, Scheuerlein H, Settmacher U. (2015): Classic Limberg Flap Procedure for Treatment of a Sacrococcygeal Pilonidal Sinus Disease - Explanation of the Surgical Technique. Zentralbl Chir., 140(5):473-5 doi: 10. 1055/s-0035-1557760. Epub 2015 Oct 20.
[6]	Abu Galala KH, Salam IM, Abu Samaan KR, El Ashaal YI, Chandran VP, Sabastian M, Sim AJ. (1999): Treatment of pilonidal sinus by primary closure with a transposed rhomboid flap compared with deep suturing: a prospective randomised clinical trial. Eur J Surg., 165(5):468-72.
[7]	Akca T, Colak T, Ustunso B, Kanik A, Aydin S. (2005): Randomized clinical trial comparing primary closure with the Limberg flap in the treatment of primary sacrococcygeal pilonidal disease. Brit J Surg., 92:1081–1084. doe: 10. 1002/bjs. 5074.
[8]	Mayo OH. (1833): Observations on injuries and diseases of the rectum, London: Burgess and Hill, London. p. 45-46.
[9]	Classic articles in colonic and rectal surgery. Louis A. Buie, M. D. 1890-1975: Jeep disease (pilonidal disease of mechanized warfare). Dis Colon Rectum. 1982 May-Jun; 25(4):384-90.
[10]	Muzi MG, Milito G, Cadeddu F, Nigro C, Andreoli F, Amabile D, Farinon AM. (2010): Randomized comparison of Limberg flap versus modified primary closure for the treatment of pilonidal disease. Am J Surg., 200(1):9–14. doi: 10. 1016/ j.amjsurg. 2009. 05. 036.
[11]	Azab AS, Kamal MS, Saad RA, Abou al Atta KA, Ali NA. (1984): Radical cure of pilonidal sinus by a transposition rhomboid flap. Br J Surg., 71(2):154-5.
[12]	Akin M, Gokbayir H, Kilic K, Topgul K, Ozdemir E, Ferahkose Z. (2008): Rhomboid excision and Limberg flap for managing pilonidal sinus: long-term results in 411 patients. Colorectal Dis., 10(9):945-8.
[13]	Boshnaq M, Phan YC, Martini I, Harilingam M, Akhtar M, Tsavellas G (2018): Limberg flap in management of pilonidal sinus disease: systematic review and a local experience, Acta Chirurgica Belgica, 118:2, 78-84, DOI: 10.1080/00015458.2018.1430218.

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APA Style

Mohamed Aly Elhorbity. (2018). Efficacy of Plastic Reconstruction (Limberg Rhomboid Flap) in Management of Sacrococcygeal Pilonidal Sinus. Advances in Surgical Sciences, 6(1), 31-35. https://doi.org/10.11648/j.ass.20180601.16

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Mohamed Aly Elhorbity. Efficacy of Plastic Reconstruction (Limberg Rhomboid Flap) in Management of Sacrococcygeal Pilonidal Sinus. Adv. Surg. Sci. 2018, 6(1), 31-35. doi: 10.11648/j.ass.20180601.16

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AMA Style

Mohamed Aly Elhorbity. Efficacy of Plastic Reconstruction (Limberg Rhomboid Flap) in Management of Sacrococcygeal Pilonidal Sinus. Adv Surg Sci. 2018;6(1):31-35. doi: 10.11648/j.ass.20180601.16

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@article{10.11648/j.ass.20180601.16,
  author = {Mohamed Aly Elhorbity},
  title = {Efficacy of Plastic Reconstruction (Limberg Rhomboid Flap) in Management of Sacrococcygeal Pilonidal Sinus},
  journal = {Advances in Surgical Sciences},
  volume = {6},
  number = {1},
  pages = {31-35},
  doi = {10.11648/j.ass.20180601.16},
  url = {https://doi.org/10.11648/j.ass.20180601.16},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ass.20180601.16},
  abstract = {Sacrococcygeal pilonidal sinus disease is a common condition usually seen in young adult males. The definitive treatment of sacrococcygeal pilonidal sinus is a surgical excision of all sinus tracts. The surgical procedures range from simple excision with or without primary closure to complex flap reconstruction. However, no single operative intervention is superior to another based upon overall rate of healing, time away from work, and risk of recurrence. Between January 2014 and march 2017, a total of 30 patients (28 male and 2 female) aged between 17 and 40 years old complaining from sacrococcygeal pilonidal sinus, 10 cases are recurrent after previous operation (6 recurrent cases after excision and simple primary closure and the another 4 recurrent cases after excision and lay open the wound to heal with secondary intension). Another 12 cases diagnosed several months after drainage of previous surgical drainage of pilonidal abscess with persistent non healed sinus and the remaining 8 cases are chronic pilonidal sinus with no history of previous abscess or operations. All cases after proper investigation managed with Limberg rhomboid flap for wound closure after surgical excision of the sacrococcygeal pilonidal sinus. The mean operative time was ranged from 50 to 70 minutes (average 60 minutes). Most cases (25 patients) received spinal anesthesia and the remaining (5 patient) received general anesthesia according to their desire. All patients discharged home 24 h to 48 after the operation and only one recurrent case need admission again for reoperation within 6 months. No recorded cases of wound infection, or flap necrosis were observed. All patients returned to work from 2 to 4 weeks after the operation with minimal postoperative pain with no wound tension or irritability and all were satisfied. The present investigation was concluded that the sacrococcygeal pilonidal sinus is chronic disease and surgeons have been treating it by different modalities range from lay open technique to wound closure either simple or based on plastic flap reconstruction. Limberg rhomboid flap reconstruction after excision of sacrococcygeal pilonidal sinus is meticulous, safe, easy to be done, low operative time, low post-operative pain, low hospital stays, early return of the patient to work, suitable to primary and recurrent cases with low local recurrent and meet acceptance from the patient preoperative during discussion with the patient for writing the surgical consent and postoperative due to the previous benefits.},
 year = {2018}
}

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TY  - JOUR
T1  - Efficacy of Plastic Reconstruction (Limberg Rhomboid Flap) in Management of Sacrococcygeal Pilonidal Sinus
AU  - Mohamed Aly Elhorbity
Y1  - 2018/07/04
PY  - 2018
N1  - https://doi.org/10.11648/j.ass.20180601.16
DO  - 10.11648/j.ass.20180601.16
T2  - Advances in Surgical Sciences
JF  - Advances in Surgical Sciences
JO  - Advances in Surgical Sciences
SP  - 31
EP  - 35
PB  - Science Publishing Group
SN  - 2376-6182
UR  - https://doi.org/10.11648/j.ass.20180601.16
AB  - Sacrococcygeal pilonidal sinus disease is a common condition usually seen in young adult males. The definitive treatment of sacrococcygeal pilonidal sinus is a surgical excision of all sinus tracts. The surgical procedures range from simple excision with or without primary closure to complex flap reconstruction. However, no single operative intervention is superior to another based upon overall rate of healing, time away from work, and risk of recurrence. Between January 2014 and march 2017, a total of 30 patients (28 male and 2 female) aged between 17 and 40 years old complaining from sacrococcygeal pilonidal sinus, 10 cases are recurrent after previous operation (6 recurrent cases after excision and simple primary closure and the another 4 recurrent cases after excision and lay open the wound to heal with secondary intension). Another 12 cases diagnosed several months after drainage of previous surgical drainage of pilonidal abscess with persistent non healed sinus and the remaining 8 cases are chronic pilonidal sinus with no history of previous abscess or operations. All cases after proper investigation managed with Limberg rhomboid flap for wound closure after surgical excision of the sacrococcygeal pilonidal sinus. The mean operative time was ranged from 50 to 70 minutes (average 60 minutes). Most cases (25 patients) received spinal anesthesia and the remaining (5 patient) received general anesthesia according to their desire. All patients discharged home 24 h to 48 after the operation and only one recurrent case need admission again for reoperation within 6 months. No recorded cases of wound infection, or flap necrosis were observed. All patients returned to work from 2 to 4 weeks after the operation with minimal postoperative pain with no wound tension or irritability and all were satisfied. The present investigation was concluded that the sacrococcygeal pilonidal sinus is chronic disease and surgeons have been treating it by different modalities range from lay open technique to wound closure either simple or based on plastic flap reconstruction. Limberg rhomboid flap reconstruction after excision of sacrococcygeal pilonidal sinus is meticulous, safe, easy to be done, low operative time, low post-operative pain, low hospital stays, early return of the patient to work, suitable to primary and recurrent cases with low local recurrent and meet acceptance from the patient preoperative during discussion with the patient for writing the surgical consent and postoperative due to the previous benefits.
VL  - 6
IS  - 1
ER  -

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Author Information

Mohamed Aly Elhorbity

Department of General Surgery, Benha Teaching Hospital, General Organization for Teaching Hospitals and Institutes, Benha, Egypt

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APA Style

Mohamed Aly Elhorbity. (2018). Efficacy of Plastic Reconstruction (Limberg Rhomboid Flap) in Management of Sacrococcygeal Pilonidal Sinus. Advances in Surgical Sciences, 6(1), 31-35. https://doi.org/10.11648/j.ass.20180601.16

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ACS Style

Mohamed Aly Elhorbity. Efficacy of Plastic Reconstruction (Limberg Rhomboid Flap) in Management of Sacrococcygeal Pilonidal Sinus. Adv. Surg. Sci. 2018, 6(1), 31-35. doi: 10.11648/j.ass.20180601.16

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AMA Style

Mohamed Aly Elhorbity. Efficacy of Plastic Reconstruction (Limberg Rhomboid Flap) in Management of Sacrococcygeal Pilonidal Sinus. Adv Surg Sci. 2018;6(1):31-35. doi: 10.11648/j.ass.20180601.16

Copy | Download

@article{10.11648/j.ass.20180601.16,
  author = {Mohamed Aly Elhorbity},
  title = {Efficacy of Plastic Reconstruction (Limberg Rhomboid Flap) in Management of Sacrococcygeal Pilonidal Sinus},
  journal = {Advances in Surgical Sciences},
  volume = {6},
  number = {1},
  pages = {31-35},
  doi = {10.11648/j.ass.20180601.16},
  url = {https://doi.org/10.11648/j.ass.20180601.16},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ass.20180601.16},
  abstract = {Sacrococcygeal pilonidal sinus disease is a common condition usually seen in young adult males. The definitive treatment of sacrococcygeal pilonidal sinus is a surgical excision of all sinus tracts. The surgical procedures range from simple excision with or without primary closure to complex flap reconstruction. However, no single operative intervention is superior to another based upon overall rate of healing, time away from work, and risk of recurrence. Between January 2014 and march 2017, a total of 30 patients (28 male and 2 female) aged between 17 and 40 years old complaining from sacrococcygeal pilonidal sinus, 10 cases are recurrent after previous operation (6 recurrent cases after excision and simple primary closure and the another 4 recurrent cases after excision and lay open the wound to heal with secondary intension). Another 12 cases diagnosed several months after drainage of previous surgical drainage of pilonidal abscess with persistent non healed sinus and the remaining 8 cases are chronic pilonidal sinus with no history of previous abscess or operations. All cases after proper investigation managed with Limberg rhomboid flap for wound closure after surgical excision of the sacrococcygeal pilonidal sinus. The mean operative time was ranged from 50 to 70 minutes (average 60 minutes). Most cases (25 patients) received spinal anesthesia and the remaining (5 patient) received general anesthesia according to their desire. All patients discharged home 24 h to 48 after the operation and only one recurrent case need admission again for reoperation within 6 months. No recorded cases of wound infection, or flap necrosis were observed. All patients returned to work from 2 to 4 weeks after the operation with minimal postoperative pain with no wound tension or irritability and all were satisfied. The present investigation was concluded that the sacrococcygeal pilonidal sinus is chronic disease and surgeons have been treating it by different modalities range from lay open technique to wound closure either simple or based on plastic flap reconstruction. Limberg rhomboid flap reconstruction after excision of sacrococcygeal pilonidal sinus is meticulous, safe, easy to be done, low operative time, low post-operative pain, low hospital stays, early return of the patient to work, suitable to primary and recurrent cases with low local recurrent and meet acceptance from the patient preoperative during discussion with the patient for writing the surgical consent and postoperative due to the previous benefits.},
 year = {2018}
}

Copy | Download

TY  - JOUR
T1  - Efficacy of Plastic Reconstruction (Limberg Rhomboid Flap) in Management of Sacrococcygeal Pilonidal Sinus
AU  - Mohamed Aly Elhorbity
Y1  - 2018/07/04
PY  - 2018
N1  - https://doi.org/10.11648/j.ass.20180601.16
DO  - 10.11648/j.ass.20180601.16
T2  - Advances in Surgical Sciences
JF  - Advances in Surgical Sciences
JO  - Advances in Surgical Sciences
SP  - 31
EP  - 35
PB  - Science Publishing Group
SN  - 2376-6182
UR  - https://doi.org/10.11648/j.ass.20180601.16
AB  - Sacrococcygeal pilonidal sinus disease is a common condition usually seen in young adult males. The definitive treatment of sacrococcygeal pilonidal sinus is a surgical excision of all sinus tracts. The surgical procedures range from simple excision with or without primary closure to complex flap reconstruction. However, no single operative intervention is superior to another based upon overall rate of healing, time away from work, and risk of recurrence. Between January 2014 and march 2017, a total of 30 patients (28 male and 2 female) aged between 17 and 40 years old complaining from sacrococcygeal pilonidal sinus, 10 cases are recurrent after previous operation (6 recurrent cases after excision and simple primary closure and the another 4 recurrent cases after excision and lay open the wound to heal with secondary intension). Another 12 cases diagnosed several months after drainage of previous surgical drainage of pilonidal abscess with persistent non healed sinus and the remaining 8 cases are chronic pilonidal sinus with no history of previous abscess or operations. All cases after proper investigation managed with Limberg rhomboid flap for wound closure after surgical excision of the sacrococcygeal pilonidal sinus. The mean operative time was ranged from 50 to 70 minutes (average 60 minutes). Most cases (25 patients) received spinal anesthesia and the remaining (5 patient) received general anesthesia according to their desire. All patients discharged home 24 h to 48 after the operation and only one recurrent case need admission again for reoperation within 6 months. No recorded cases of wound infection, or flap necrosis were observed. All patients returned to work from 2 to 4 weeks after the operation with minimal postoperative pain with no wound tension or irritability and all were satisfied. The present investigation was concluded that the sacrococcygeal pilonidal sinus is chronic disease and surgeons have been treating it by different modalities range from lay open technique to wound closure either simple or based on plastic flap reconstruction. Limberg rhomboid flap reconstruction after excision of sacrococcygeal pilonidal sinus is meticulous, safe, easy to be done, low operative time, low post-operative pain, low hospital stays, early return of the patient to work, suitable to primary and recurrent cases with low local recurrent and meet acceptance from the patient preoperative during discussion with the patient for writing the surgical consent and postoperative due to the previous benefits.
VL  - 6
IS  - 1
ER  -

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