BACKGROUND: To compare classical Limberg flap (CLF) and modified Limberg flap (MLF) techniques in pilonidal sinus surgery among adult patients.
METHODS: A total of 236 patients who underwent pilonidal surgery with use of CLF (N.=119, mean(SD) age: 29.1(8.1) years, 92.4% were males) or MLF (N.=117, mean(SD) age: 28.7(8.0) years, 89.7% were males) techniques were included in this retrospective study. Data on demographics and anthropometrics, disease characteristics, surgery related parameters [usage of drainage catheter and postoperative antibiotic treatment, length of hospitalization (LOS, day), time to suture removal (day), time off work (day), wound infection, wound breakdown and wound maceration], follow up duration (month) and recurrence rates were recorded and compared with respect to flap techniques. Multivariate logistic regression analysis was performed to determine risk factors for recurrence wound infection, breakdown and maceration.
RESULTS: CLF technique was associated with higher rate of wound maceration (11.8% vs. 3.4%, P=0.016), shorter time to suture removal [median (min-max) 10.0 (5.0-26.0) days vs. 12.0 (6.0-28.0) days, P=0.00003] and longer amount of time off work [8.0 (6.0-9.0) days vs. 7.0 (3.0-9.0) days, P=0.000004] as compared with MLF technique. Logistic regression analysis revealed that older age was associated with decreased likelihood of experiencing recurrence (OR, 0.91, 95%CI: 0.84-0.995, P=0.038), while using MLF compared to CLF technique was associated with decreased likelihood of experiencing wound maceration (OR, 0.201 95%CI: 0.06-0.72, P=0.014).
CONCLUSIONS: Findings indicate MLF technique to be superior to CLF technique in terms of lesser likelihood of wound maceration and shorter time off work needed, while the two techniques seem to be similar in terms of wound infection, wound breakdown, LOS and recurrence rates.
KEY WORDS: Pilonidal sinus; Surgery; Surgical flaps; Wounds and injuries; Length of stay