Short-term clinical outcomes of double-modified Limberg flap transplantation in treatment of sacrococcygeal pilonidal sinus_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIU Dingsheng ¹ ,  ZHANG Hong ¹ , CONG Jinchun ¹ , LING Yunzhi ² , CUI Mingming ¹ , CHEN Chunsheng ¹

1. Department of Colorectal Surgery, Shengjing Hospital, China Medical University, Shenyang 110004, P.R.China;
2. Department of General Surgery, Chaoyang Central Hospital, Chaoyang, Liaoning 122000, P.R.China;

Corresponding author：

ZHANG Hong, Email: haojiubujian1203@sina.cn

Keywords：

sacrococcygeal pilonidal sinus; double-modified Limberg flap transplantation; classical Limberg flap transplantation

DOI：

10.7507/1007-9424.201608106

Video：

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Objective To investigate short-term clinical outcomes of double-modified Limberg flap transplantation in treatment of sacrococcygeal pilonidal sinus. Methods One hundred patients with sacrococcygeal pilonidal sinus from October 2010 to May 2015 in this hospital were included, and subsequently were divided into double-modified Limberg flap transplantation group (double-modified flap group,n=30), classical Limberg flap transplantation (classical flap group,n=30), and interrupted suture after resection group (interrupted suture group,n=40). The duration of operation, intraoperative bleeding, hospital stay, duration of return to work, recurrence rate, and incision complications rate were compared among these three groups. Results ① The age, gender, body mass index, and preoperative complications had no significant differences among these three groups (P>0.05). ② The intraoperative bleeding and the hospital stay had no significant differences among these three groups (P>0.05). Compared with the interrupted suture group, the durations of operation were significantly longer (P<0.05), the durations of return to work were significantly shorter (P<0.05), the recurrence rates were significantly lower (P<0.05) in the double-modified flap group and the classical flap group. The above indicators had no significant differences between the double-modified flap group and the classical flap group (P>0.05). ③ The incision hematoma and the part disruption of incision had no significant differences among these three groups (P>0.05). Compared with the interrupted suture group, the rates of incision infection and incision complete disruption were significantly lower (P<0.05) in the double-modified flap group and in the classical flap group. The incision maceration of the classical flap group was significantly higher than that of the interrupted suture group (P<0.05) or the double-modified flap group (P<0.05). No skin flap necrosis occurred in the double-modified flap group and the classical flap group. Conclusions Double-modified Limberg flap transplantation and classical Limberg flap transplantation have less complications and lower recurrence rate than interrupted suture after resection. Compare with classical Limberg flap transplantation, double-modified Limberg flap transplantation has a lower incision maceration rate. Because of limitation of sample size in this study, long-term clinical efficacy of double-modified Limberg flap transplantation needs to be confirmed by multicenter randomized controlled trials.

Citation： LIUDingsheng, ZHANGHong, CONGJinchun, LINGYunzhi, CUIMingming, CHENChunsheng. Short-term clinical outcomes of double-modified Limberg flap transplantation in treatment of sacrococcygeal pilonidal sinus. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(2): 238-243. doi: 10.7507/1007-9424.201608106 Copy

1.	Chintapatla S, Safarani N, Kumar S,et al. Sacrococcygeal pilonidal sinus: historical review, pathological insight and surgical options. Tech Coloproctol, 2003, 7(1): 3-8.
2.	Ozdemir H, Unal Ozdemir Z, Tayfun Sahiner I,et al. Whole natal cleft excision and flap: an alternative surgical method in extensive sacrococcygeal pilonidal sinus disease. Acta Chir Belg, 2014, 114(4): 266-270.
3.	Sabuncuoglu MZ, Sabuncuoglu A, Dandin O,et al. Eyedrop-shaped, modified Limberg transposition flap in the treatment of pilonidal sinus disease. Asian J Surg, 2015, 38(3): 161-167.
4.	Sit M, Aktas G, Yilmaz EE. Comparison of the three surgical flap techniques in pilonidal sinus surgery. Am Surg, 2013, 79(12): 1263-1268.
5.	Akinci OF, Coskun A, Uzunkoy A. Simple and effective surgical treatment of pilonidal sinus: asymmetric excision and primary closure using suction drain and subcuticular skin closure. Dis Colon Rectum, 2000, 43(5): 701-706.
6.	Akin M, Leventoglu S, Mentes BB,et al. Comparison of the classic Limberg flap and modified Limberg flap in the treatment of pilonidal sinus disease: a retrospective analysis of 416 patients. Surg Today, 2010, 40(8): 757-762.
7.	Ardelt M, Dittmar Y, Kocijan R,et al. Microbiology of the infected recurrent sacrococcygeal pilonidal sinus. Int Wound J, 2016, 13(2): 231-237.
8.	Sievert H, Evers T, Matevossian E,et al. The influence of lifestyle (smoking and body mass index) on wound healing and long-term recurrence rate in 534 primary pilonidal sinus patients. Int J Colorectal Dis, 2013, 28(11): 1555-1562.
9.	Bayhan Z, Zeren S, Duzgun SA,et al. Crystallized phenol application and modified Limberg flap procedure in treatment of pilonidal sinus disease: A comparative retrospective study. Asian J Surg, 2016, 39(3): 172-177.
10.	Kaya B, Eris C, Atalay S,et al. Modified Limberg transposition flap in the treatment of pilonidal sinus disease. Tech Coloproctol, 2012, 16(1): 55-59.
11.	Youssef T, EI-Awady S, Farid M. Tension-free primary closure compared with modified Limberg flap for pilonidal sinus disease: a prospective balanced randomized study. Egy J Surg, 2015, 34(2): 85-89.
12.	Inan A, Surgit O, Sen M,et al. One day surgery for pilonidal disease. Bratisl Lek Listy, 2011, 112(10): 572-574.
13.	Elshazly WG, Said K. Clinical trial comparing excision and primary closure with modified Limberg flap in the treatment of uncomplicated sacrococcygeal pilonidal disease. Alexandria J Med, 2012, 48(1): 13-18.
14.	Mahdy T. Surgical treatment of the pilonidal disease: primary closure or flap reconstruction after excision. Dis Colon Rectum, 2008, 51(12): 1816-1822.
15.	Gilani SN, Furlong H, Reichardt K,et al. Excision and primary closure of pilonidal sinus disease: worthwhile option with an acceptable recurrence rate. Ir J Mde Sci, 2011, 180(1): 173-176.
16.	Iesalnieks I, Ommer A, Petersen S,et al. German national guideline on the management of pilonidal disease. Langenbecks Arch Surg, 2016, 401(5): 599-609.
17.	Segre D, Pozzo M, Perinotti R,et al. The treatment of pilonidal disease:guidelines of the Italian Society of Colorectal Surgery. Tech Coloproctol, 2015, 19(10): 607-613.
18.	Zorlu M, Sahiner IT, Zobaci E, et al. Early results with the Mutaf technique: a nover off-midline approach in pilonidal sinus surgery. Ann Surg Treat Res, 2016, 90(5): 265-271.
19.	Dizen H, Yoldas O, Yildiz M,et al. Modified elliptical rotation flap for sacrococcygeal pilonidal sinus disease. ANZ J Surg, 2014, 84(10): 769-771.
20.	Dufourmentel C. Closure of limited loss of cutaneous substance. So-called LLL diamond-shaped L rotation-flap. Ann Chir Plast, 1962, 7(3): 60-66.
21.	贡钰霞, 周在龙, 邵万金, 等. 4 种手术方法治疗藏毛窦的疗效比较. 中国普外基础与临床杂志, 2014, 21(5): 623-626.
22.	Sevinç B, Karahan Ö, Okuş A,et al. Randomized prospective comparison of midline and off-midline closure techniques in pilonidal sinus surgery. Surgery, 2016, 159(3): 749-754.
23.	Yucel E,Tezcan L,Yilmaz OC,et al. “Flag Excision and Flap” procedure: a novel modification for off-midline closure after pilonidal sinus excision. Indian J Surg, 2015, 77(suppl 3): 1191-1195.
24.	Tokac M, Dumlu EG, Aydin MS,et al. Comparison of modified Limberg flap and Karydakis flap operations in pilonidal sinus surgery: prospective randomized study. Int Surg, 2015, 100(5): 870-877.
25.	Bali I, Aziret M, Sozen S,et al. Effectiveness of Limberg and Karydakis flap in recurrent pilonidal sinus disease. Clinics, 2015, 70(5): 350-355.

1. Chintapatla S, Safarani N, Kumar S,et al. Sacrococcygeal pilonidal sinus: historical review, pathological insight and surgical options. Tech Coloproctol, 2003, 7(1): 3-8.
2. Ozdemir H, Unal Ozdemir Z, Tayfun Sahiner I,et al. Whole natal cleft excision and flap: an alternative surgical method in extensive sacrococcygeal pilonidal sinus disease. Acta Chir Belg, 2014, 114(4): 266-270.
3. Sabuncuoglu MZ, Sabuncuoglu A, Dandin O,et al. Eyedrop-shaped, modified Limberg transposition flap in the treatment of pilonidal sinus disease. Asian J Surg, 2015, 38(3): 161-167.
4. Sit M, Aktas G, Yilmaz EE. Comparison of the three surgical flap techniques in pilonidal sinus surgery. Am Surg, 2013, 79(12): 1263-1268.
5. Akinci OF, Coskun A, Uzunkoy A. Simple and effective surgical treatment of pilonidal sinus: asymmetric excision and primary closure using suction drain and subcuticular skin closure. Dis Colon Rectum, 2000, 43(5): 701-706.
6. Akin M, Leventoglu S, Mentes BB,et al. Comparison of the classic Limberg flap and modified Limberg flap in the treatment of pilonidal sinus disease: a retrospective analysis of 416 patients. Surg Today, 2010, 40(8): 757-762.
7. Ardelt M, Dittmar Y, Kocijan R,et al. Microbiology of the infected recurrent sacrococcygeal pilonidal sinus. Int Wound J, 2016, 13(2): 231-237.
8. Sievert H, Evers T, Matevossian E,et al. The influence of lifestyle (smoking and body mass index) on wound healing and long-term recurrence rate in 534 primary pilonidal sinus patients. Int J Colorectal Dis, 2013, 28(11): 1555-1562.
9. Bayhan Z, Zeren S, Duzgun SA,et al. Crystallized phenol application and modified Limberg flap procedure in treatment of pilonidal sinus disease: A comparative retrospective study. Asian J Surg, 2016, 39(3): 172-177.
10. Kaya B, Eris C, Atalay S,et al. Modified Limberg transposition flap in the treatment of pilonidal sinus disease. Tech Coloproctol, 2012, 16(1): 55-59.
11. Youssef T, EI-Awady S, Farid M. Tension-free primary closure compared with modified Limberg flap for pilonidal sinus disease: a prospective balanced randomized study. Egy J Surg, 2015, 34(2): 85-89.
12. Inan A, Surgit O, Sen M,et al. One day surgery for pilonidal disease. Bratisl Lek Listy, 2011, 112(10): 572-574.
13. Elshazly WG, Said K. Clinical trial comparing excision and primary closure with modified Limberg flap in the treatment of uncomplicated sacrococcygeal pilonidal disease. Alexandria J Med, 2012, 48(1): 13-18.
14. Mahdy T. Surgical treatment of the pilonidal disease: primary closure or flap reconstruction after excision. Dis Colon Rectum, 2008, 51(12): 1816-1822.
15. Gilani SN, Furlong H, Reichardt K,et al. Excision and primary closure of pilonidal sinus disease: worthwhile option with an acceptable recurrence rate. Ir J Mde Sci, 2011, 180(1): 173-176.
16. Iesalnieks I, Ommer A, Petersen S,et al. German national guideline on the management of pilonidal disease. Langenbecks Arch Surg, 2016, 401(5): 599-609.
17. Segre D, Pozzo M, Perinotti R,et al. The treatment of pilonidal disease:guidelines of the Italian Society of Colorectal Surgery. Tech Coloproctol, 2015, 19(10): 607-613.
18. Zorlu M, Sahiner IT, Zobaci E, et al. Early results with the Mutaf technique: a nover off-midline approach in pilonidal sinus surgery. Ann Surg Treat Res, 2016, 90(5): 265-271.
19. Dizen H, Yoldas O, Yildiz M,et al. Modified elliptical rotation flap for sacrococcygeal pilonidal sinus disease. ANZ J Surg, 2014, 84(10): 769-771.
20. Dufourmentel C. Closure of limited loss of cutaneous substance. So-called LLL diamond-shaped L rotation-flap. Ann Chir Plast, 1962, 7(3): 60-66.
21. 贡钰霞, 周在龙, 邵万金, 等. 4 种手术方法治疗藏毛窦的疗效比较. 中国普外基础与临床杂志, 2014, 21(5): 623-626.
22. Sevinç B, Karahan Ö, Okuş A,et al. Randomized prospective comparison of midline and off-midline closure techniques in pilonidal sinus surgery. Surgery, 2016, 159(3): 749-754.
23. Yucel E,Tezcan L,Yilmaz OC,et al. “Flag Excision and Flap” procedure: a novel modification for off-midline closure after pilonidal sinus excision. Indian J Surg, 2015, 77(suppl 3): 1191-1195.
24. Tokac M, Dumlu EG, Aydin MS,et al. Comparison of modified Limberg flap and Karydakis flap operations in pilonidal sinus surgery: prospective randomized study. Int Surg, 2015, 100(5): 870-877.
25. Bali I, Aziret M, Sozen S,et al. Effectiveness of Limberg and Karydakis flap in recurrent pilonidal sinus disease. Clinics, 2015, 70(5): 350-355.

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Short-term clinical outcomes of double-modified Limberg flap transplantation in treatment of sacrococcygeal pilonidal sinus

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