The Evaluation of a Modified Dufourmentel Flap after S‐Type Excision for Pilonidal Sinus Disease

Abstract

Purpose. The use of an S-type oblique excision with a bilateral gluteus maximus advancement flap has recently been described for the surgical treatment of sacrococcygeal pilonidal sinus (SPS). Its use in wide lesions has been limited due to the need for a full-thickness flap. We describe the use of an S-type oblique incision together with the Dufourmentel flap in wide lesions. Method. Twenty-one patients were treated using a technique including an S-shaped oblique excision of the sinus tract and a broad-pedicled full-thickness flap resembling a Dufourmentel flap to close the defect. Results. Of the 21 patients, 19 (90.5%) were male and 2 (9.5%) were female. Their mean age was 24.0 ± 6.1 (range 15–36) years. The mean follow-up period was 14.0 ± 5.8 (range 6–23) months. The postoperative complication rate was 4.8% (one patient), and recurrence was seen in one patient (4.8%). The mean return-to-work time was 13.5 ± 1.9 (range 10–18) days. None of the patients reported dissatisfaction with the cosmetic results. Conclusions. This new technique achieved low morbidity and recurrence rates. We anticipate that this will become an important technique in the surgical treatment of SPS if the observed success is confirmed by randomized prospective trials.

Dufourmentel rhomboid flap in the radical treatment of extensive, complex or recurrent sacrococcygeal pilonidal disease: Case series with follow up

“…We have been using the Dufourmentel technique since 1984 and preliminary results were published in 1991, being one of the first series published about this technique. The present series was one of the few to provide evidence about the Dufourmentel rhomboid flap, composed only of patients with extensive, complex and recurrence SPD, and with a significant number of patients . Although there are a significant number of publications in which results are reported using the rhomboid flap for the treatment of SPD, most concern the use of the Limberg flap (Table ).…”

“…(Table ). Moreover, there is some evidence supporting the use of the Dufoumentel rhomboid flap over the Limberg flap, with advantages such as flexibility, simplicity of reconstruction, repeatability and good outcomes in terms of the recurrence rate being reported …”

“…When comparing our data with other series of the Dufourmentel rhomboid flap, with the exception of Lieto et al ’s series ( n = 310), only a small amount of patients have been used in other series. The follow‐up period of those series was between 1 and 3 years, thus the reported recurrence rate (0–4.8 per cent) should be viewed with caution, particularly if the series are composed by patients with different degrees of disease severity. This should also be considered for the variable postoperative morbidity (4.8–14.3 per cent), as the postoperative morbidity in our series (13.7 per cent) was in the range published, but corresponded to that of patients with extensive, complex and recurrent SPD.…”

“…Although there are a significant number of publications in which results are reported using the rhomboid flap for the treatment of SPD, most concern the use of the Limberg flap (Table ). This draws attention to the small number of publications related to the use of the Dufourmentel flap ( n = 5), which involve only a total of 435 patients operated on with this technique (Table 1) . However, existing evidence related to recurrence for flap techniques is 0–10 per cent, and evidence related to postoperative morbidity for flap techniques is 4.5–40 per cent .…”

S-Shaped Wide Excision with Primary Closure for Extensive Chronic Pilonidal Sinus Disease

“…Some similar techniques do exist in the literature. In the study by Yildar et al, a second skin incision is performed after an S-type excision for flap reconstruction [ 16 ]. Krand and coworkers applied gluteus maximus fascia advancing flap reconstruction—as they stated—on patients with PSD who did not have extensive gluteal involvement [ 17 ].…”