The Outcome of Limberg Flap Reconstruction Procedure for Primary Natal Cleft Pilonidal Sinus Disease: Four Years’ Experience at a Teaching Hospital in Pakistan

Abstract

Background: Natal cleft pilonidal sinus disease is known for its high recurrence rate after surgery. Different surgical procedures are being used for its treatment and these vary from wide excision followed by healing with secondary intention to excision followed by reconstruction with a flap. Limberg flap reconstruction procedure has been used by many surgeons as their primary choice owing to its low recurrence rate and less postoperative complications.
 Objective: The objective of this study was to assess the outcome of Limberg flap reconstruction procedure in patients with primary natal cleft pilonidal sinus disease. 
 Methods: This descriptive case series was conducted at Ghurki trust teaching hospital, Lahore, Pakistan, between January 2015 to December 2018. 110 consecutive patients with primary natal cleft pilonidal sinus disease were included in this study. Informed consent was taken from these patients and all patients underwent Limberg flap reconstruction procedure. The evaluated outcomes of this procedure included duration of hospital stay, postoperative pain, primary healing, surgical site Infection, seroma formation, flap necrosis and, recurrence. 
 Results: The patients age ranged between 18 years to 60 years. The mean age was 26.6 ±8.6 years. 73 patients (66.36 %) were males and 23 patients (33.63%) were females. The duration of disease ranged between 1 month to 6 months with a mean of 3.7±1.7 months. The mean operating time was 47.50±5.14 minutes. The mean duration of hospital stay was 1.87±0.80 days. The mean postoperative pain score calculated by the visual analogue scale (VAS) twenty-four hours after the surgery was 3.45. 95 patients (86.36%) had complete primary healing without any complication. 9 patients (8.18%) had a surgical site infection and 6 patients (5.45 %) had seroma formation. No patient suffered from flap necrosis. 2 patients (1.81%) who had complete primary healing presented with recurrence of the disease within six months of the procedure with a period of one year of follow-up designated for every patient.
 Conclusion: Limberg flap reconstruction procedure is a safe and efficacious treatment option for primary natal cleft pilonidal sinus disease because it provides early complete primary healing in most patients, and shortens the duration of hospital stay thus reducing the cost of treatment. The pain scores fall in the moderate post-operative pain score category and the complication rates and the recurrence rates are very low.

Modified Limberg Flap in Pilonidal Sinus: Our Experience

“…Reconstruction of the pilonidal excision defect with a transposition Limberg flap has a short learning curve. The technique obliterates the natal cleft with large vascularised pedicle [7]. The flattening of natal cleft avoids scar in midline, reduces maceration , friction, and makes it easier for patients to maintain good hygiene.…”