Inferiorly based lotus petal flap & laser therapy in difficult pilonidal sinus management

To assess the efficacy of the lotus petal flap in difficult pilonidal sinus management.

Pilonidal sinuses may be difficult to treat. Five year recurrence rates range from 18% to 50% Recurrence rates fall with primary closure rather than healing by secondary intention. Techniques such as z-plasty however, distort natal architecture. The lotus petal flap taken from the superior buttock fills dead space whilst conforming to the natural concave appearance of the natal cleft. The contralateral buttock is spared. It is straightforward and reproducible. Multiple perforators make it robust and promote wound healing in this difficult group.

We present a series of 14 patients who had a lotus petal flap reconstruction following pilonidal sinus excision between 2007 and 2015. The majority of these patients had previous multiple failed attempts at eradication. Recurrence rates, re-operation rates, time for complete healing, wound breakdown, discharge, infection, cosmesis and patient comfort were assessed.

Many patients had coarse hair; felt to predispose to recurrence of symptoms, poor hygiene and prolonged wound healing. 50% of patients underwent Alexandrite laser (755 nm wavelength) for a minimum of 6 treatments. There was excellent compliance and good patient outcome. Overall in this complex patient group only 14% had prolonged wound healing and recurrence rates were lower than those in the literature.

The lotus petal flap is an excellent choice for problematic pilonidal sinus reconstruction. When combined with tumour like excision, meticulous surgical technique and complimentary laser hair removal results can be improved further.