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The rhomboid flap for pilonidal disease
P J Arumugam1, T V Chandrasekaran, A R Morgan
1Colorectal Unit, Singleton Hospital, Sketty, Swansea SE2 8QA, UK.
Introduction:
There have been many surgical techniques described for the treatment of pilonidal sinuses. Recurrent disease causes significant morbidity particularly with time from work.
Aim:
To assess the rhomboid flap's role in promoting one-stage primary healing in pilonidal disease and to evaluate the morbidity and recurrence.
Methods:
Fifty-three patients were prospectively recruited of which 27 had previous multiple abscess formation requiring surgical drainage from their pilonidal disease, although none had acute disease at the time of surgery. By using the transposition flap, we were able to obliterate the natal cleft and therefore the rolling action of the buttocks between the cleft in these patients and thereby remove one of the factors involved in pilonidal disease. Hospital stay, healing time, wound infection, wound breakdown and recurrence were noted.
Results:
There were 47 males and 6 females with a median age of 28 years (range 16-64 years). Median follow-up was 24 months (range 3-36 months). Post-operative morbidity involved superficial wound infection in 7 (13%) which settled with out-patient dressings. There were four recurrences (7%), two occurred between the flap and the anal canal, and the other two in the flap margin needing intervention. All the patients healed their wounds and the median healing time was 14 days.
Conclusion:
As this condition affects a predominantly young population causing significant time off from work, we feel that the Rhomboid Flap is useful for difficult cases in that it allows early return to full activity and does not necessitate prolonged postoperative care.
Insights
The rhomboid flap offers a one-stage surgical solution for pilonidal disease, achieving primary healing with a low recurrence rate. This technique facilitates a quicker return to daily activities for affected patients.
Area of Science:
- Surgical innovation in proctology and reconstructive surgery.
- Management of chronic and recurrent conditions.
Background:
- Pilonidal sinus disease presents diverse surgical challenges.
- Recurrence leads to significant patient morbidity and lost work time.
Purpose of the Study:
- To evaluate the rhomboid flap for one-stage primary healing of pilonidal disease.
- To assess the flap's associated morbidity and recurrence rates.
Main Methods:
- Prospective study of 53 patients with pilonidal disease.
- Utilized a transposition rhomboid flap to close natal cleft.
- Monitored hospital stay, healing time, infection, breakdown, and recurrence.
Main Results:
- Median follow-up of 24 months in a cohort of 53 patients (47 male, 6 female).
- Superficial wound infection in 13% (7/53), with 7% (4/53) recurrence.
- Median healing time was 14 days, with all wounds achieving primary closure.
Conclusions:
- The rhomboid flap is effective for complex pilonidal disease cases.
- It enables early return to activity with minimal postoperative care.
- Low recurrence and morbidity rates support its use in young, active populations.