The application of the Limberg flap repair technique in the surgical treatment of pilonidal sinus disease

Pilonidal sinus disease (PNSD) challenged surgeons for decades. Limberg flap repair (LFR) is a common treatment for PNSD. The purpose of this study was to observe the effect and risk factors of LFR in PNSD. A retrospective study was conducted on the PNSD patients who visited two medical centers and four departments in the People's Liberation Army General Hospital and were taking LFR treatment between 2016 and 2022. The risk factors, the effect of the operation, and complications were observed. The effects of known risk factors on the surgical results were compared. There were 37 PNSD patients: male/female ratio of 35:2, average age: 25.1 ± 7.9 years. Average BMI: 25.2 ± 4.0 kg/m², average wound healing time: 15.4 ± 3.4 days. 30 patients (81.0%) healed in stage one and 7 (16.3%) had postoperative complications. Only 1 patient (2.7%) had a recurrence while others were healed after dressing-changing. There was no significant difference in age, BMI, preoperative debridement history, preoperative sinus classification, Wound area, Negative pressure drainage tube, prone time (<3d) and treatment effect. Squat defecate and premature defecation were associated with treatment effect, and they were independent predictors of treatment effect in the multivariate analysis. LFR has a stable therapeutic outcome. Compared with other skin flaps, the therapeutic effect of this flap is not significantly different, but the design is simple and is not affected by the known risk factors before operation. However, it is necessary to avoid the influence of two independent risk factors, squatting defecation and premature defecation, on the therapeutic effect.     

Randomised clinical trial to test the phenolization in sacrococcygeal pilonidal disease

To test the efficacy and safety of phenolization in uncomplicated Sacrococcygeal pilonidal disease (SPD) the phenolization in uncomplicated SPD is feasible and secure in selected patients in observational studies. The greatest benefits are obtained to reduce the length of sick leave (LSL) and complications. Single-center randomised controlled clinical trial. Patients were recruited at University Hospital of Tarragona Joan XXIII of Spain. Patients were randomised into two treatment groups. All patients with uncomplicated sacrococcygeal disease, localised in the midline and with only 1 fistulous orifice. The patients were randomly assigned to the phenolization group (PhG) or conventional-surgery group (CsG). Both groups were managed without admission. The main endpoint was the recurrence of sacrococcygeal disease. Secondary endpoints included time of sick leave, complications, and readmission. 124 patients were included in the study. No disease recurrence was observed in either group. Clinical follow-up was carried out with a mean of 493.8 days (SD 6.59). The LSL was shorter in the PhG (mean 19.63 days, SD 28.15) than in the CSG (43.95 days, SD 38.60). The LSL reduction was −24.31 days (P .002). The phenolization in selected SPD is a safe and feasible procedure in selected patients. This approach could become the standard of care for patients with selected Sacrococcygeal pilonidal.     

The versatile rhomboid (Limberg) flap

The rhomboid (Limberg) flap can be used to close defects almost anywhere on the body. It is versatile in that a random pattern flap can be raised from any one or all corners of the rhomboid. The defect is filled with tissue of the same thickness and colour, and with good vascularity. The present paper demonstrates the versatility of the rhomboid flap.     

Modified Limberg flap reconstruction compares favourably with primary repair for pilonidal sinus surgery

Background: The present study analyses the results of wide excision with primary closure (PC), wide excision with classical Limberg flap reconstruction (LF) and wide excision with modified Limberg flap reconstruction (MLF) in the surgical treatment of sacrococcygeal pilonidal disease. Methods: One hundred and sixty‐two well‐documented patients who were operated on for pilonidal disease and followed for more than 1 year were analysed retrospectively. Group 1 was composed of patients with excision plus PC (n = 78) while group 2 included those with excision plus a LF reconstruction (n = 40), and group 3 included those with excision plus a MLF reconstruction (n = 44). Results: There were no significant differences among the three groups with respect to age, sex distribution, frequency of recurrent disease, or follow‐up periods (P > 0.05 for all comparisons). Significant disadvantages regarding postoperative infection rate, mobilization time, discharge from hospital, and time off work were noted for primary closure, compared with both LF and MLF reconstructions. Following a median follow‐up period of 4.2 years, 14 recurrences (17.9%) developed in the PC group, three (7.5%) in the LF group, and none (0%) in the MLF group. The zero recurrence rate in the MLF group was significantly lower than that in the PC group (P = 0.003). On the other hand, the recurrence rate in the LF was not found to differ significantly from that in the PC group (P = 0.126). Comparing the LF and MLF groups, none of the surgical end points reached a statistically significant difference (P > 0.05 for all comparisons). Conclusions: For the surgical treatment of sacrococcygeal pilonidal disease, excision plus a classical or modified Limberg flap reconstruction proved to be superior to excision plus primary closure in terms of infection, mobilization time, discharge from hospital and time off work. Additionally, MLF reconstruction resulted in a statistically lower recurrence rate when compared with PC.     

Management of sacrococcygeal pilonidal sinus disease

The ideal treatment for patients who suffer from pilonidal sinus disease should lead to a cure with a rapid recovery period allowing a return to normal daily activities, with a low level of associated morbidity. A variety of different surgical techniques have been described for the primary treatment of pilonidal sinus disease and current practice remains variable and contentious. Whilst some management options have improved outcomes for some patients, the complications of surgery, particularly related to wound healing, often remain worse than the primary disease. This clinical review aims to provide an update on the management options to guide clinicians involved in the care of patients who suffer from sacrococcygeal pilonidal sinus disease.     

Simple excision and primary closure of pilonidal sinus: a simple modification of conventional technique with excellent results

OBJECTIVE: Pilonidal sinus (PNS) is a common condition, which warrants surgical intervention. A number of surgical options have been suggested with variable recurrence rate. This study proposes a modification of a standard method. METHODS: A total of 51 patients with sacrococcygeal PNS were sequentially treated by the standard method devised by one Consultant Colorectal Surgeon (IA). The principle is based on: 1, after excising the PNS ensure obliteration of the natal cleft by releasing the fat pad from the gluteal fascia; 2, avoid tension and 3, encourage patients to lie on their back immediately after the operation. RESULTS: Follow-up was available from 51 patients ranging from 14 to 49 months. All patients were discharged within 48 h. There was only one recurrence, which was successfully treated. CONCLUSION: Our results suggest that PNS can be successfully treated by our hitherto undescribed method, patients can be discharged early and there is very low recurrence rate.     

扩张皮肤软组织修复缺损中菱形皮瓣的应用

目的 探讨菱形皮瓣设计对扩张皮瓣中问松弛部分的充分利用.方法扩张后的皮肤软组织在设计旋转皮瓣修复缺损时,如果中间松弛部分不能充分利用.在旋转皮瓣上再次设计菱形皮瓣来充分利用扩张后的皮肤软组织,菱形皮瓣的尖部设计在扩张最充分部分,皮瓣蒂部设计在旋转皮瓣的切口侧,要注意保证菱形皮瓣与旋转皮瓣形成的复合皮瓣的长度与蒂的宽度比例在2.5:1.0.结果 11例在旋转皮瓣上再次设计菱形皮瓣,复合皮瓣的长宽比例最大达到3:1,多数在2.5:1.0.皮瓣全部存活,有1例皮瓣尖部小面积血运障碍,1例菱形皮瓣尖部早先轻度淤血.结论 该设计较充分、合理的利用了扩张后的皮肤软组织,最大可能的修复了缺损.复合皮瓣设计,一是注意长宽比例,二是尽量选择蒂部有知名血管的轴型皮瓣以策安全.只要设计合理,该方法是安全的,值得推广.     

菱形皮瓣张力最小化原则的临床应用

目的评价菱形皮瓣张力最小化原则的临床应用特点及修复不同部位皮肤缺损的术后效果。方法自1999年9月至2005年6月,应用菱形皮瓣修复面、躯干及四肢部的皮肤缺损患者17例。根据各部位的不同情况,应用张力最小化原则设计菱形皮瓣,转移修复皮肤缺损。结果术后随访17例患者1个月至3年,皮瓣全部成活,切口愈合良好,瘢痕增生不明显,修复的外形满意。结论菱形皮瓣张力最小化原则的修复方法是优化的手术方法,值得临床推广应用。     

菱形皮瓣张力最小化原则的临床应用

目的评价菱形皮瓣张力最小化原则的临床应用特点及修复不同部位皮肤缺损的术后效果。方法自1999年9月至2005年6月，应用菱形皮瓣修复面、躯干及四肢部的皮肤缺损患者17例。根据各部位的不同情况，应用张力最小化原则设计菱形皮瓣，转移修复皮肤缺损。结果术后随访17例患者1个月至3年，皮瓣全部成活，切口愈合良好，瘢痕增生不明显，修复的外形满意。结论菱形皮瓣张力最小化原则的修复方法是优化的手术方法。值得临床推广应用。     

皮下组织蒂的改良菱形皮瓣在面部皮肤缺损修复中的应用

目的介绍一种皮下组织蒂的改良菱形皮瓣及其在面部皮肤缺损中的应用和效果。方法于面部各种缺损的附近设计以皮下组织为蒂的改良菱形皮瓣,即在改良菱形皮瓣的尾部作“V”形切口,小范围剥离后行皮瓣无张力转移。皮瓣面积为1.5 cm×2.0 cm~4.0 cm×4.5 cm。结果本组16例患者,切口均Ⅰ期愈合,皮瓣全部成活。随访12例患者1.5个月至1.5年,面部形态满意,术区平整,无“猫耳朵”形成,切口瘢痕不明显。结论应用皮下组织蒂的改良菱形皮瓣修复面部皮肤缺损,方法简便易行,术后效果较好。     

Limberg flap in management of pilonidal sinus disease: systematic review and a local experience

Objectives: To review published evidence of Limberg flap (LF) use in pilonidal sinus disease (PSD). We also included our local experience of LF.

Methods: Medline and Embase database were searched for the words ‘pilonidal, sinus, Limberg, flap’. Non-English articles and those not-related to our scope of search were omitted. We included a retrospective study of patients underwent LF in our district hospital. Data including length of hospital stay, post-operative complications and recurrence were collected.

Results: Literature review revealed 68 studies (22 case series, 35 comparative studies, nine RCTs and two meta-analyses). Recurrence rate was 0–7.4% in case series. Recurrence rate in comparative studies was 0–8.3%, compared to 4–37.7% for primary closure and 0–11% for Karydakis flap. RCTs showed that LF or its modification is superior to primary closure, with comparable results to Karydakis flap. About 26 patients included in the cohort study (16 male, average age 27 years). Six patients presented with recurrent disease. Post-operative length of hospital stay was four to seven days. Post-operative complication rate was 11.5% – [two partial wound dehiscence, one wound infection]. Recurrence rate was 7.7%. Average follow-up was 18 months.

Conclusions: Limberg flap presents a safe and effective method that can be offered for patients with primary or recurrent PSD.