title: Primary wound closure with a Limberg flap vs. secondary wound healing after excision of a pilonidal sinus: a multicentre randomised controlled study.
abstract: OBJECTIVE
  Off-midline procedures seem to be the best method of primary wound closure after excision of a pilonidal sinus. Primary wound closure with a Limberg flap was compared to secondary wound healing.
  
  
  METHODS
  From January 2006 to July 2012, 102 patients with given informed consent (mean age 28 years, men 81%) who had excision of a pilonidal sinus in three hospitals in Switzerland were randomised to group L (Limberg flap, n = 51) or to group E (excision only, n = 51). Primary endpoint was duration of incapacity for work. Follow-up was at 3 weeks and at 1 year postoperative (95% follow-up).
  
  
  RESULTS
  Both groups were comparable with regard to patient characteristics. The median (range) operation time was 60 (30-80) min in group L vs. 30 (10-75) min in group E (p < 0.001). No significant differences were found in postoperative pain and painkiller intake; pain, percentage of patients at work and overall satisfaction at 3 weeks postoperative; and overall duration of incapacity for work and overall satisfaction at 1-year follow-up. The complication rate was 49% in group L vs. 12% in group E (p < 0.001). Complications in group L were seroma (6%), wound dehiscence (45%), skin necrosis (10%), hematoma (6%), infection (4%) and recurrent disease (13%). Complications in group E were recurrent disease (6%) and wound healing disorder (6%).
  
  
  CONCLUSIONS
  After excision of a pilonidal sinus, primary wound closure with a Limberg flap has no advantage over secondary wound healing. The main reason for this conclusion is the relatively high complication rate of primary wound closure with a Limberg flap.
authors.affiliation: Department of General, Visceral, Vascular, and Thoracic Surgery, Hospital of Baselland, affiliated to the University of Basel, Rheinstrasse 26, 4410, Liestal, Switzerland.
authors.forename: S A
authors.initials: SA
authors.lastname: Käser
authors.forename: R
authors.initials: R
authors.lastname: Zengaffinen
authors.forename: M
authors.initials: M
authors.lastname: Uhlmann
authors.forename: C
authors.initials: C
authors.lastname: Glaser
authors.forename: C A
authors.initials: CA
authors.lastname: Maurer
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010149:Postoperative Pain / Q000209:etiology; D017060:Patient Satisfaction; D010864:Pilonidal Sinus / Q000601:surgery*; D012008:Recurrence; D012445:Sacrococcygeal Region / Q000601:surgery*; D013524:Surgical Flaps / Q000009:adverse effects*; D016896:Treatment Outcome; D014945:Wound Healing; D055815:Young Adult