Comparison of Modified Limberg’s flap with Primary midline closure, for pilonidal sinus disease: A Retrospective Study
European Journal of Molecular & Clinical Medicine,
2023, Volume 10, Issue 3, Pages 574-581
Abstract
Sacrococcygeal Pilonidal sinus disease (PSD) is an infection of skin and subcutaneous tissues in natal cleft of buttocks, which is formed by anchorage of deep layers of skin overlying the coccyx to the anococcygeal raphe. It affects predominantly young males of working group. The disease is known for its long duration of lagging symptoms and a propensity towards chronicity, leading to significant loss of working hours besides being a economic burden on society. Many procedures have been devised and others are still being evolving, rather being ratiocinating in isolation, striving for the ever alluding perfect. Rhomboid or limberg’s flap is one of the procedures that offers all the advantages of off-midline closure with a surgical site infection and recurrence rate in ranges of 0%-6%. It flattens the cleft and a healthy flap covers the excissed area. Recently modified Limberg’s flap has been shown to fair better in post operative wound complications and recurrences. This study was undertaken to study the benefits of modified limberg’s flap as compared to primary midline closure.Methods: The patients were divided into two groups a Limberg’s Flap Procedure Group (LFG) and Primary Midline Closure group (PMC). Out of 86 Patients, 31 in LFG and 55 in PMC were included in the final results. Patients were analysed for the surgical site infections, recurrence rate and time to complete wound healing and length of stay in hospital. All the procedure were done by same surgical team. Only chronic symptomatic PSD patients were included in this study.
Results: 65(86%) were males and 11(14%) females. No significant difference was observed between treatment groups as regarding the distribution of demographic parameters such as age, sex & BMI. The median BMI was however in range of 28-29kg/m2 which falls in obese criteria according to revised guidelines for Indian population. The median duration of symptoms before patient underwent treatment was about a year in both groups. The duration of surgery in LFP about a hour, mean 50±9.6 which was significantly longer than the PMC, mean 30±6.5 minutes p>0.001; the reason being the extra time needed for flap preparation and the need for a perfect marking, so that the alignment matches seamlessly. Minor wound infections, were present in 6(19%) of the LFP as against 17(38%) patients. 1(3%) patient had a complete wound dehiscence in LFP as against 5(11%)in PMC group. The median time of complete wound healing was 14 (9-24) days in LFP versus 22(19-35) days in PMC group, the difference was significant with a P-value of 0.02. Patients with LFP had a longer hospital stay median of 3 (2-6) days as against 2(2-3) days in PMC group, the difference however was not statistically significant. The recurrence at the median follow-up of 1 year was 1(3%) for LFP and 4(9%) for PMC with a P value of 0.64.
Conclusion: LFP is preferred approach in patients with chronic PSD with low incidence of overall recurrences, a low wound infection rates and a shorter overall healing time. The operative time is however longer when compared to PMC
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