Comparison of Limberg flap and tension-free primary closure during pilonidal sinus surgery

Pilonidal disease is an inflammatory disease seen in the intergluteal region. In this study, our aim was to compare the efficacy of the Limberg flap versus a tension-free primary closure.

A total of 93 patients were included in this study. The patients were assigned consecutively by the closed-envelope technique to one of two groups: 49 patients in group 1 (excision and Limberg flap) and 44 patients in group 2 (tension-free primary closure). Excision and reconstruction with the Limberg flap was performed in its classic form. For tension-free primary closure after excision of the sinus tract with an elliptical incision, the skin and subcutaneous tissue were released 2-3 cm away from the incision line. The subcutaneous tissue was closed twofold with 2/0 polyglactin sutures. The skin underwent 3/0 polypropylene mattress suturing.

The median age was 25 years (17-43 years). The median follow-up period was 29.5 months (8-43 months). There was no significant difference between the groups in terms of age, sex, follow-up time, or anesthesia method. One patient in each group experienced wound infection. During the first 6 months of follow-up there was no recurrence. However, at later visits recurrences were seen in two patients in each group (4.1% in group 1, 4.5% in group 2).

The lower rates of wound infection and recurrence associated with the Limberg flap reported elsewhere may be associated with healing of the tension-free procedure. In this study, tension-free primary closure was found to be as effective as the Limberg flap reconstruction.