Comparison of Limberg Flap and Karydakis Flap Repair in Pilonidal Sinus Surgery: A Prospective Case-Control Study

Abstract

BackgroundPilonidal sinus disease (PSD) is a chronic inflammation and infection of the sacrococcygeal region. It often affects young adult males and produces clinical findings with abscess and discharge in the sacrococcygeal region or painful sinus tract in the natal cleft. The best surgical technique for sacrococcygeal PSD is still disputed. This study aimed to compare the Karydakis flap technique (KFT) and Limberg flap technique (LFT) used in the surgical treatment of the sacrococcygeal pilonidal sinus. MethodologyA total of 140 patients diagnosed with pilonidal sinus between 2010 and 2012 were included in the study. The patients were divided into two groups, namely, LFT (n = 73) and KFT (n = 67). Preoperative findings of the patients, surgical findings, and short and long-term postoperative findings were recorded and statistically compared. ResultsRegarding cosmetic results, the Karydakis flap was better than the Limberg flap with a faster return to normal life. There was no statistical difference between the two groups concerning wound dehiscence, postoperative visual analog scale scores, seroma formation, and recurrence. ConclusionsConsidering the faster return to normal life and greater cosmetic satisfaction of the patients, the KFT should be chosen instead of the LFT as the standard technique in pilonidal sinus surgery.

Clinical presentation and management outcome of pilonidal sinus disease

“…For instance, cystectomy, curettage of the cyst, cystectomy with marsupialization of the resultant defect, excision of the sinus, surgical excision of the entire diseased tissues, and allowing the resultant wound to heal by secondary intention. Moreover, Bascom surgery, the use of the Karydakis ap, and, more popularly, the use of the Limberg ap [25][26][27][28][29][30]. e use of the Limberg ap ensures adequate excision of the pathology and subsequent reconstruction in the standard o -midline fashion.…”

Propeller Flap Reconstruction Following Pilonidal Cyst Excision

“…15 In comparison to other techniques such as the Karydakis flap technique and the Limberg flap technique, the propeller flap can be performed with comparable operative time and no postoperative hospitalization. 36,37 Similar to the Limberg flap technique, the propeller flap flattens the natal cleft and places scars away from midline unlike the Karydakis flap technique. However, the propeller flap adds the advantage of identified well-vascularized tissue in comparison to a random-pattern blood supply.…”

“…However, the propeller flap adds the advantage of identified well-vascularized tissue in comparison to a random-pattern blood supply. 23,36,37 Overall, the propeller flap demonstrates a viable option for pilonidal disease reconstruction due to its ability to decrease postoperative length of stay while maintaining short duration to functional recovery and minimizing complications. By utilizing the perforator propeller flap, the procedure builds on its strengths as an advantageous option for pilonidal disease reconstruction, given that it has the potential to reduce financial burden and patient morbidity through elimination of the postoperative hospital stay.…”

Outcomes of pediatric pilonidal disease treatment: excision with off-midline flap reconstruction versus endoscopic pilonidal sinus treatment

“…Thus, the optimal treatment decreases the risk of recurrence and future reintervention, while also minimizing treatment-related morbidity. While prior studies have sought to determine the optimal treatment option, debate still remains regarding the most effective approach to achieving these goals [ 8 – 10 ]. Current treatment options include non-operative (e.g., hygiene/lifestyle modification, laser epilation), minimally invasive (e.g., sinusectomy/Gips procedure, endoscopic debridement), and excisional/reconstructive techniques (e.g., secondary healing, negative pressure wound therapy, midline primary closure, off-midline flap reconstruction) [ 11 – 15 ].…”

“…In this context, prior studies have sought to compare excision with midline primary closure to minimally invasive techniques, or various off-midline flap reconstruction techniques to one another [ 8 , 22 – 26 ]. However, in the pediatric population, little is known regarding direct comparison of minimally invasive endoscopic pilonidal sinus treatment (EPSiT) with excision and OMF reconstruction [ 11 ].…”