Combined Horizontal Split Gluteus Maximus Muscle Flap and Fasciocutaneous Limberg Flap for Reconstruction of Recurrent Sacrococcygeal Pilonidal Sinus | ||||
The Egyptian Journal of Plastic and Reconstructive Surgery | ||||
Article 16, Volume 44, Issue 2, April 2020, Page 361-367 PDF (10.98 MB) | ||||
Document Type: Original Article | ||||
DOI: 10.21608/ejprs.2020.113499 | ||||
View on SCiNiTO | ||||
Author | ||||
Mahfouz I. Ahmad* | ||||
The Department of Plastic Surgery, Faculty of Medicine, Zagazig University, Egypt | ||||
Abstract | ||||
disease. The exact etiology of the disease is still unknown but the most accepted theory is an acquired condition characterized by infected sinus in the natal cleft area contains lifeless hair tuft. Multiple techniques were prescribed for its treatment however the ideal method still not yet defined. Patients and Methods: Fifty eight male patients who underwent excision of their recurrent pilonidal sinus disease and the resulting defects were reconstructed using combined horizontal split gluteus maximus flaps and rhomboid flaps. Outcomes were revised from patient's files case and followed up in outpatient clinic and via questionnaires. Results: The mean hospital stay was three days. The mean time to return to work was 16 days. Partial wound dehiscence's occurred in two patients. Distal end flap necrosis occurred in one patient. There were no flap losses, no recurrences, no infections, no loss of function and no seromas during a mean follow-up period of 24 months. All patients were satisfied with the results. Conclusion: In comparison with other techniques, it has a comparable operative time and hospital stays. It has minimal and acceptable complication rates and no recurrences. We can conclude that this procedure of combined split gluteus maximus muscle flap and rhomboid flap provides an excellent, effective, easy and feasible method of choice for reconstructing defects of recurrent pilonidal sinus disease. | ||||
Keywords | ||||
Pilonidal sinus disease; Recurrent; Split gluteus maximus flap; Rhomboid flap | ||||
References | ||||
1- Lim J. and Shabbir J.: Pilonidal sinus disease - A literature review. World J. Surg. Surgical Res., 1117: 1, 2019. 2- Harlak A., Mentes O., Kilic S., Coskun K., Duman K. and Yilmaz F.: Sacrococcygeal pilonidal disease: Analysis of previously proposed risk factors. Clinics (Sao Oaulo), 65: 125, 2010. 3- Duman K., Ozdemir Y. and Dandin O.: Pilonidal sinus disease - Etiological factors, pathogenesis and clinical features. Arch. Clin. Exp. Surg., 5: 228, 2016. 4- Yoldas K., Karaca C., Unalp O., Uguz A., Caliskan C., Akgun E. and Korkut M.: Recurrent pilonidal sinus: Lay open or flap closure, does it siffer?. Int. Surg., 98: 319, 2013. 5- Bascom J.U.: Repeat pilonidal operations. Am. J. Surg., 154: 118, 1987. 6- Elbanna H.G., Emile S.H., Youssef M., Thabet W., Abd El-Hamed T.M. and Ghnnam W.M.: Novel approach of treatment of pilonidal sinus disease with thrombin gelatin matrix as a sealant. Dis. Colon. Rectum., 59: 775, 2016. 7- Biter L.U., Beck G.M., Mannaerts G.H., Stok M.M., Ham A.C. and Grotenhuis B.A.: The use of negative-pressure wound therapy in pilonidal sinus disease: A randomized controlled trial comparing negative-pressure wound therapy versus standard open wound care after surgical excision. Dis. Colon. Rectum., 57: 1406, 2014. 8- Gurel N.S., Cu N.K. and Canbek S.: Elliptical rotation flap for pilonidal sinus. Am. J. Surg., 187: 300, 2004. 9- Venus M.R. and Titley O.G.: Outcomes in the repair of pilonidal sinus disease excision wounds using a parasacral perforator flap. Ann. R. Coll. Surg. engl., 94: 12, 2012. 10- Elalfy K., Emile S., Lotfy A., Youssef M. and Elfeki H.: Bilateral gluteal advancement flap for treatment of recurrent sacrococcygeal pilonidal disease: A prospective cohort study. Int. Sur., 29: 1, 2016. 11- Nelson R. and Lalonde D.: Treatment of the chronic pilonidal sinus wound with a local perforator-assisted transposition flap. Plast. Reconstr. Surg., 122: 47, 2008. 366 Vol. 44, No. 2 / Reconstruction of Pilonidal Sinus 12- Azab A.S., Kamal M.S., Saad R.A., Aboual Ata K.A. and Ali N.A.: Radical cure of pilonidal sinus by a transposition Rhomboid flap. Br. J. Surg., 71: 154, 1984. 13- Topgül K., Ozdemir E., Kilic K., Gökbayir H. and Ferahkös¸e Z.: Long-term results of Limberg flap procedure for treatment of pilonidal sinus: A report of 200 cases. Dis. Colon. Rectum., 46: 1545, 2003. 14- Daphan C., Tekelioglu M.H. and Sayilgan C.: Limberg flap repair for pilonidal sinus disease. Dis. Colon. Rectum., 47: 233, 2004. 15- Mentes B.B., Leventoglu S., Cihan A., Tatliciouglu E., Akin M. and Oguz M.: Modified limberg transposition flap for sacrococcygeal pilonidal sinus. Surg. Today, 34: 419, 2004. 16- Abdou M., Darwish A. and Hassanin A.: Reconstruction following excision of sacrococcygeal pilonidal sinus with a perforator-based fasciocutaneous limberg flap. J. Plast. Reconstr. Aesthet., Surg., 63: 1176, 2010. 17- Saydam M., Ozturk O., Sinan H., Balta A.Z., Demir P., Ozer M.T. and Demirbas S.: Comparison of modified Limberg flap transposition and lateral advancement flap transposition with Burrow’s triangle in the treatment of pilonidal sinus disease. Am. J. Surg., 210: 772, 2015. 18- Tan K.J., Lim C.T. and Lim Y.T.: The use of muscle flaps in the salvage of infected exposed implants for internal fixation. J. Bone Joint Surg., 92: 401, 2010. 19- Sakuraba M., Umezawa H., Miyamoto S. and Gulbins H.: Reconstructive surgery for bronchopleural fistula and empyema: New application of free fascial patch graft combined with free flap. Plast. Reconstr. Surg., 54 (3): 212, 2017. 20- Karydakis G.E.: Easy and successful treatment of pilonidal sinus after explanation of its causative processes. Aust. NZ. J. Surg., 62: 385, 1992. 21- Mosquera D.A. and Quayle J.B.: Bascom’s operation for pilonidal sinus. J. R. Soc. Med., 88: 45, 1995. 22- Perez-Curri J.A., Temple W.J. and Ketcham A.S.: Gluteus maximus myocutaneous flap for the treatment of recalcitrant pilonidal disease. Dis. Colon. Rectum., 27: 262, 1984. 23- Rosen W. and Davidson J.S.: Gluteus maximus musculocutaneous flap for treatment of recalcitrant pilonidal disease. Ann. Plast. Surg., 37: 293, 1996. 24- Ali M.Z., Swati M.J. and Ali F.Z.: Split gluteus maximus turn-over flap for sacral pressure ulcer. Internet. J. Surg., 13: 1, 2007. 25- Roy N. and Varghese B.K.: Split gluteus maximus musculocutaneous islanded flap based on inferior gluteal artery for all sacral sore management: A new technique Intern. J. Scien. Res., 7: 1995, 2018. 26- Vincent P.L., Pinatel B., Viard R., Comparin J.P., Gir P. and Voulliaume D.: The gluteus maximus inferior splitmuscle flap for the cover of ischiatic pressure ulcers: Study of 61 cases. Ann. Chir. Plast. Esthet., 61: 845, 2016. 27- Weizhong L., Zheng Z. and Zuojun Z.: Application of split gluteus maximus muscle-adipofascial turnover flap and subcutaneous tension-reducing suture technique in repair of decubitus ulcers. Int. Surg., 99: 447, 2014. Egypt, J. Plast. Reconstr. Surg., April 2020 367 28- Acarturk T.O., Parsak C.K., Sakman G. and Demircan O.: Superior gluteal artery perforator flap in the reconstruction of pilonidal sinus. J. Plast. Reconstr. Aesthet. Surg., 63: 133, 2010. 29- El-Khatib H.A. and Al-Basti H.B.: A perforator-based bilobed fasciocutaneous flap: An additional tool for primary reconstruction following wide excision of sacrococcygeal pilonidal disease. J. Plast. Reconstr. Aesthet. Surg., 62: 494, 2009. 30- Omer Y., Hayrettin D., Murat C., Mustafa Y. and Evren D.D.: Comparison of modified limberg flap and modified elliptical rotation flap for pilonidal sinus surgery: A retrospective cohort study. Int. Surg., 16: 74, 2015. 31- Tokac M., Dumlul E.G., Aydin M.S., Yalcın A. and Kilic M.: Comparison of modified limberg flap and karydakis flap operations in pilonidal sinus surgery: Prospective randomized study. Int. Surg., 100: 870, 2015 | ||||
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