title: Superiority of asymmetric modified Limberg flap for surgical treatment of pilonidal disease.
abstract: OBJECTIVE
  Cases treated surgically using wide excision plus classic Limberg flap or wide excision plus asymmetric modified Limberg flap were compared with respect to complications and patient comfort in the postoperative period.
  
  
  METHODS
  In this prospective, randomized study, 68 of 70 patients were followed for a mean of 29.22 (range, 6-44) months after wide excision plus classic Limberg flap (Group 1, n=35) and after asymmetric modified Limberg flap closure (Group 2, n=33).
  
  
  RESULTS
  There were significantly more macerations in Group 1 (P<0.001). All macerations were detected on the lower part of the incision left on the intergluteal sulcus, and infections occurred subsequent to maceration. The infection rate was statistically higher in Group 1 than in Group 2 (P=0.028). We noted that as a result of these complications, time to suture removal (P=0.001), discharge from hospital (P=0.001), and time off from work (P=0.001) were significantly longer for Group 1 than for Group 2. There were two recurrences in the inferior part of the suture line in Group 1 and none in Group 2, which showed no statistical difference (P=0.493).
  
  
  CONCLUSIONS
  The deep intergluteal sulcus and midline gap were slightly flattened over the anococcygeal region. The vacuum effect was decreased, and there were less macerations and fewer infections. Time off from work and discharge time from hospital were shortened by eliminating the moisture effect and reducing complications by lateralizing the lower part of the suture line.
authors.affiliation: Department of Surgery, School of Medicine, Zonguldak Karaelmas University, Zonguldak, Turkey. alpercihan@yahoo.com
authors.forename: Alper
authors.initials: A
authors.lastname: Cihan
authors.forename: Bulent Hamdi
authors.initials: BH
authors.lastname: Ucan
authors.forename: Mustafa
authors.initials: M
authors.lastname: Comert
authors.forename: Ali
authors.initials: A
authors.lastname: Cesur
authors.forename: Guldeniz Karadeniz
authors.initials: GK
authors.lastname: Cakmak
authors.forename: Oge
authors.initials: O
authors.lastname: Tascilar
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010864:Pilonidal Sinus / Q000601:surgery*; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D012008:Recurrence; D013524:Surgical Flaps; D016896:Treatment Outcome