Management of Pilonidal Sinus Disease with Oblique Excision and Bilateral Gluteus Maximus Fascia Advancing Flap

Abstract

We suggest that this surgical procedure may successfully be applied to a large majority of the patients. It does not lead to unnecessary excision of healthy tissue because of its significantly simpler nature compared with the full-layer flap technique and its S-type incision, it does not create a midline scar tissue, and it is able to flatten the gluteal sulcus.

Pilonidal Disease- Review Article

“…[9] • Surgical principles important for successful management of pilonidal sinus disease include unroofing or excising all midline pits and sinus tracts as well as placing any surgical incision off midline. [9] • Flattening/lateralization of the intergluteal sulcus, prevention of seroma formation, reduction of wound tension, and prevention of wound breakdown and scar formation have been suggested to accelerate wound healing and reduce recurrence [27] • Tension-free wound closure was important in the surgical treatment of pilonidal sinus. [21] • Recurrence is affected by a deep intergluteal sulcus, the effect of vacuum developing between the buttocks, and a midline incision scar [26] .…”

“…[27,28] • It may be performed as an outpatient procedure with low risk of primary failure or infection while accelerating healing and reducing the frequency of dressing changes.…”

“…[17] The reported recurrence level with primary midline closure after excision is 20%-42% [52,53] The reported recurrence level 0.9-5.6% in primary closure after oblique excision [27,54] Marsupialization (partial closure) Indication -absence of inflammation and that the case is not a recurrence [55] .…”

Pilonidal sinus- limberg versus karidakis flap our experience at SIMS, Shivamogga

“…3,4 A deep natal cleft with one of favourable factors enhance sacro-coccygeal pilonidal sinus, e.g., sweating, maceration, bacterial contamination and penetration of hairs. Obesity, trauma, local irritation and a sedentary lifestyle are usually associated with PS.…”

“…1,2 The pathogenesis of the disease is hypothesized to be related to the accumulation of weak and lifeless hair in the intergluteal region, which over time gives rise to foreign body reaction, causing abscess and sinus formation. 3,4 and surgical methods, recurrence rate remain high. Complete surgical removal of the pilonidal sinus or sinuses and appropriate reconstruction can lead to successful recovery.…”