title: Modified Limberg transposition flap for sacrococcygeal pilonidal sinus.
abstract: OBJECTIVE
  To investigate the results of wide rhomboid excision with Limberg transposition flap reconstruction to treat pilonidal sinus.
  
  
  METHODS
  We analyzed the well-documented records of 238 patients with sacrococcygeal pilonidal sinus who underwent wide excision with a Limberg transposition flap and were followed up for longer than 1 year postoperatively. After the first 40 operations, we modified this flap reconstruction by tailoring the rhomboid excision asymmetrically to place the lower pole of the flap 1-2 cm lateral to the midline. Wound infection rates, hospitalization, time required for free mobilization, and recurrence rates were recorded.
  
  
  RESULTS
  Postoperative infection developed in two patients (0.8%), which was easily managed by wound care, antibiotics, removal of skin staples, prolonged drainage, or a combination of these treatments. The mean hospitalization was 2.10 +/- 0.20 days (range 1-3 days), and the mean time required for recovery and return to daily activities was 8.00 +/- 2.50 days (range 4-17 days). There were only three recurrences (1.26%) after a mean follow-up of 29.20 +/- 3.10 months (range 12-38 months). Since we started performing our modification of the technique by lateralization of the inferior apex, no further recurrences have been seen. The recurrence rate differed significantly between the classical Limberg flap group and the modified Limberg flap group ( P = 0.004)
  
  
  CONCLUSIONS
  These results provide further evidence that wide excision with a Limberg transposition flap reconstruction is an effective surgical method for primary or recurrent pilonidal sinus, associated with a low complication rate, short hospitalization and disability, and a low recurrence rate. A modification of the technique was devised to further enhance wound healing and reduce the risk of recurrence.
authors.affiliation: Colorectal Surgery Division, Department of Surgery, Gazi University Medical School, 67.Sokak, 16/7 Emek, 06510 Ankara, Turkey.
authors.forename: B Bülent
authors.initials: BB
authors.lastname: Mentes
authors.forename: Sezai
authors.initials: S
authors.lastname: Leventoglu
authors.forename: Alper
authors.initials: A
authors.lastname: Cihan
authors.forename: Ertan
authors.initials: E
authors.lastname: Tatlicioglu
authors.forename: Murat
authors.initials: M
authors.lastname: Akin
authors.forename: Mehmet
authors.initials: M
authors.lastname: Oguz
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D010864:Pilonidal Sinus / Q000601:surgery*; D012445:Sacrococcygeal Region; D013524:Surgical Flaps; D013536:Suture Techniques