Comparative study between ‘Limberg flap’ and ‘excision with secondary wound healing’ in the management of sacrococcygeal pilonidalsinus
DOI:
https://doi.org/10.18203/2349-2902.isj20250569Keywords:
Pilonidal sinus, Excision, Secondary healing, Limberg flap, Wound healingAbstract
Background: We conducted this comparative study between ‘Limberg flap’ and ‘excision with secondary wound healing’ to have a more informative data as far as surgical outcome is concerned for patients of sacro-coccygeal pilonidal sinus.
Methods: This study was conducted as prospective observational study on patients of sacrococcygeal pilonidal sinus admitted in the Department of General Surgery, People’s Hospital, who have been selected for operative intervention by either of two procedures during the study period of 18 months. Depending upon surgical procedure, patients were divided into two groups, group A- Limberg flap (study group) and group B- excision with secondary wound healing (control group).
Results: Mean duration of surgery was significantly higher in cases managed using Limberg flap technique as compared to excision and secondary healing. Mean pain scores, wound infection, time to wound healing, duration of hospital stay and time to return to normal activity were significantly lower in cases managed using Limberg flap as compared to excision at all the follow up (p<0.05). Mean patient satisfaction was found to be significantly higher in cases following Limberg flap group (p<0.05).
Conclusions: Rhomboid excision with Limberg’s flap technique is better technique as compared to open excision with secondary healing technique in terms of less post-operative pain, less complications, early recovery, early wound healing, short duration of hospital stay, early return to normal activity and higher patient satisfaction. The only disadvantage with Limberg flap technique is higher mean duration of surgery, attributed to additional time required for raising and suturing of flap following excision.
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References
Nixon AT, Garza RF. Pilonidal Cyst and Sinus. In: StatPearls. Treasure Island (FL): StatPearls Publishing. 2023.
Patey DH, Scarff RW. Pathology of postanal pilonidal sinus; its bearing on treatment. Lancet. 1946;2(6423):484-6. DOI: https://doi.org/10.1016/S0140-6736(46)91756-4
Rajasekharan D, Nagaraja JB, Subbarayappa S. Pilonidal sinus in South India: A retrospective review. Indian J Colo-Rectal Surg. 2019;2(3):71-6. DOI: https://doi.org/10.4103/IJCS.IJCS_1_20
Berry DP. Pilonidal sinus disease. J Wound Care. 1992;1(3):29-32. DOI: https://doi.org/10.12968/jowc.1992.1.3.29
Jensen SL, Harling H. Prognosis after simple incision and drainage for a first-episode acute pilonidal abscess. Br J Surg. 1988;75(1):60-1. DOI: https://doi.org/10.1002/bjs.1800750122
Chintapatla S, Safarani N, Kumar S, Haboubi N. Sacrococcygeal pilonidal sinus: historical review, pathological insight and surgical options. Tech Coloproctol. 2003;7:3-8. DOI: https://doi.org/10.1007/s101510300001
Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 2011;63(11):S240-52. DOI: https://doi.org/10.1002/acr.20543
Kilinçer C, Zileli M. Visual analog patient satisfaction scale. Balkan Med J. 2006;2006(3).
Kumar MS, Avadhani Geetha K, Sachin K. Open Method Versus Flap Closure in Pilonidal Sinus in a Rural Tertiary Care Hospital, Karnataka-A Cohort Study. J Clin Diagnost Res. 2021;10(3):SO19-22. DOI: https://doi.org/10.7860/IJARS/2021/48621.2670
Akhtar N, Ullah S, Sabir M. Outcome of the limberg’s flap technique in the treatment of pilonidal sinus. J Sheikh Zayed Med Coll. 2017;8(1):1105-7.
Meena OK, Kalwaniya DS, Arya SV, Kuppuswami M, Bajwa JS, Pradhan RS, et al. A comparative study of excision with primary closure versus Limberg flap in pilonidal sinus. Int Surg J. 2019;6:4282-9. DOI: https://doi.org/10.18203/2349-2902.isj20195194
Demmer W, Sorg H, Steiert A, Hauser J, Tilkorn DJ. Wound healing and therapy in soft tissue defects of the hand and foot from a surgical point of view. Med Sc. 2021;9(4):71. DOI: https://doi.org/10.3390/medsci9040071
Aziz M, Choudhary TJ, Zahid J, Qureshi KH. Surgical excision with secondary healing versus Limberg transposition flap in the management of Sacrococcygeal Pilonidal Disease. Esculapio J SIMS. 2017;13(1):10-3.
Chopade SP, Adhikari GR. Comparative study of Limberg flap reconstruction with wide-open excision and healing by secondary intention in the Management of Pilonidal Sinus: our experience at a tertiary Care Center in India. Cureus. 2022;14(6). DOI: https://doi.org/10.7759/cureus.26396
Jabbar MS, Bhutta MM, Puri N. Comparison between primary closure with Limberg Flap versus open procedure in treatment of pilonidal sinus, in terms of frequency of post-operative wound infection. Pak J Med Sci. 2018;34(1):49. DOI: https://doi.org/10.12669/pjms.341.13929
Berthier C, Bérard E, Meresse T, Grolleau JL, Herlin C, Chaput B. A comparison of flap reconstruction vs the laying open technique or excision and direct suture for pilonidal sinus disease: A meta‐analysis of randomised studies. Int Wound J. 2019;16(5):1119-35. DOI: https://doi.org/10.1111/iwj.13163
Käser SA, Zengaffinen R, Uhlmann M, Glaser C, Maurer CA. Primary wound closure with a Limberg flap vs. secondary wound healing after excision of a pilonidal sinus: a multicentre randomised controlled study. Coloproctology. 2015;37:373-80. DOI: https://doi.org/10.1007/s00053-015-0049-0
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