title: V-Y advancement flap closures for complicated pilonidal sinus disease.
abstract: OBJECTIVE
  Hair entry into the midline is the generally accepted theory in pilonidal sinus formation. This theory is also involved in the pathogenesis of the recurrence after different types of operations for pilonidal sinus disease. The relationship of the suture lines and the midline was evaluated in this study.
  
  
  METHODS
  Thirty-four patients with stage 4 or recurrent pilonidal sinus disease who underwent V--Y advancement flap closure were randomized into two groups: vertical suture line unrelated to midline (VLUM, n=18) and vertical suture line related to midline (VLRM, n=16).
  
  
  RESULTS
  None of the patients with or without a suction drain developed flap necrosis, local haematomas or seromas. The median length of the postoperative hospital stay was 3 days for theVLRM group and the VLUM group (p>0.05). The median follow-up period was 32 months. During the follow-up period, two recurrences were determined 22 and 15 months after operation in the VLRM group. Recurrences were situated in the scar tissue over the midline.
  
  
  CONCLUSIONS
  Routine application of suction drains is not recommended after V--Y advancement flap closure. Avoidance of the relationship of the postoperative suture line and the midline, if possible, offers a safe method of definitive reconstruction.
authors.affiliation: First Department of Surgery, Ankara Numune Training and Research Hospital, 06100, Sihhiye, Ankara, Turkey.
authors.forename: Huseyin
authors.initials: H
authors.lastname: Berkem
authors.forename: Serdar
authors.initials: S
authors.lastname: Topaloglu
authors.forename: Hakan
authors.initials: H
authors.lastname: Ozel
authors.forename: Fatih M
authors.initials: FM
authors.lastname: Avsar
authors.forename: Yigit
authors.initials: Y
authors.lastname: Yildiz
authors.forename: Bulent C
authors.initials: BC
authors.lastname: Yuksel
authors.forename: Suleyman
authors.initials: S
authors.lastname: Hengirmen
authors.forename: Nusret
authors.initials: N
authors.lastname: Akyurek
mesh_terms: D000293:Adolescent; D000328:Adult; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006406:Hematoma / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D010864:Pilonidal Sinus / Q000601:surgery*; D011183:Postoperative Complications; D012008:Recurrence; D013524:Surgical Flaps; D013536:Suture Techniques; D016896:Treatment Outcome