Outcome of the rhomboid flap for recurrent pilonidal disease

Pilonidal sinus is a common chronic disease of the sacrococcygeal region. Treatment varies according to the clinical presentation of the disease. Although many surgical methods have been suggested, an ideal method is still lacking because of high recurrence rates. Recurrent disease causes significant morbidity, particularly missing time from work. The aim of this study was to assess the rhomboid flap's role in promoting primary healing in recurrent pilonidal disease and to evaluate morbidity and recurrence.

This prospective study included 60 patients who were treated with the use of a rhomboid flap closure for recurrent sacrococcygeal pilonidal sinus at Tanta University Hospital, Egypt, from January 2000 to October 2006. The follow-up period ranged from 6 months to 7 years, with the mean follow-up period about 2.5 years.

There were 46 males and 14 females with a median age of 18 years (range = 16-38 years). The mean hospital stay was 6 days (range = 5-11 days). Four patients had to be hospitalized for 1-2 weeks due to superficial wound infection; they recovered with injected antibiotics. The mean time to return to work after discharge from the hospital was 15 days (range = 12-26 days). Postoperative morbidity involved superficial wound infection in 9 patients (15%). There were six recurrences (10%). Eleven patients (18.3%) had numbness over the flap and 12 patients (20%) were not pleased with the cosmetic appearance of the scars.

Our study favors the rhomboid flap for recurrent sacrococcygeal pilonidal sinus, especially for complex sinuses, and found it suitable for cases where simpler operations have failed. It allows early return to full activity, does not necessitate prolonged postoperative care, and has very low recurrence and complications rates which may outweigh the disadvantages related to an unfavorable cosmetic appearance.