Treatment of adolescent pilonidal disease with a new modification to the Limberg flap: symmetrically rotated rhomboid excision and lateralization of the Limberg flap technique.
OBJECTIVE
Pilonidal disease is a common and frustrating problem among adolescents due to its high recurrence rate. The rhomboid excision and Limberg flap techniques promise successful results, but the lower part of the incision left on the intergluteal sulcus is prone to recurrences. Consequently, we have developed a new modification to this technique and have designed a descriptive prospective study to evaluate its efficiency.


METHODS
We conducted this prospective study between March 2011 and March 2012. All of the patients who were operated on for sacrococcygeal pilonidal disease were included in this study. The surgical procedure primarily consisted of symmetrically rotated (clockwise) rhomboid excision and lateralization of the Limberg flap in order to keep the inferior corner of the suture line apart from the intergluteal sulcus.


RESULTS
A total of 15 adolescents (8 boys and 7 girls) were included in the study group. Of the patients, 47% were normal, 13% were overweight, and 40% were obese. Five patients were operated on under general anesthesia, and 10 were operated on under spinal anesthesia. The length of the flap margins ranged from 2.5 to 7 cm (median=4 cm). The median duration of hospitalization was 5 days, and the median duration of suction drainage was 4 days. The median postoperative follow-up period was 4 months (ranging from 1 to 12 months), and we did not encounter any wound infection or recurrent disease during this period. Only one patient had wound hematoma as a result of drain breakdown and was treated with wound care without any additional complications.


CONCLUSIONS
Although the number of patients in this study was small and the follow-up period was short, we obtained satisfactory results without any recurrence by performing a symmetrically rotated rhomboid excision and lateralized Limberg flap procedure.
Dr. Sami Ulus Children's Hospital, Department of Pediatric Surgery, Ankara, Turkey. drafsarlar@yahoo.com
Cağatay Evrim
CE
Afşarlar
Engin
E
Yılmaz
Ayşe
A
Karaman
Ibrahim
I
Karaman
Ismet Faruk
IF
Ozgüner
Derya
D
Erdoğan
Yusuf Hakan
YH
Cavuşoğlu
Haşim Ata
HA
Maden
D000293:Adolescent; D000768:Anesthesia, General; D000775:Anesthesia, Spinal; D005260:Female; D005500:Follow-Up Studies; D006406:Hematoma / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009765:Obesity / Q000150:complications; D050177:Overweight / Q000150:complications; D010864:Pilonidal Sinus / Q000150:complications / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012399:Rotation; D055502:Secondary Prevention; D013396:Suction / Q000706:statistics & numerical data; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000517:prevention & control
Adolescent; Limberg flap; Modified Limberg flap; Obesity; Pilonidal disease