Pilot Study: Application of Lateralized Z-plasty in Pilonidal Sinus Defect Closure

Pilonidal sinus (PS) is a chronic condition primarily affecting young adult men and characterized by recurrent abscess formation, discharge, and significant physical and psychosocial impacts. Traditional surgical methods, including basic Z-plasty, often fail to adequately address horizontal tension, leading to high recurrence and complication rates. This pilot study evaluated the efficacy of lateralized Z-plasty (LZP) for reducing horizontal wound tension and improving postoperative outcomes.

We conducted a retrospective review of patients presenting with sacrococcygeal PS who underwent LZP repair at our hospital. A 2-stage surgical approach involving precise sinus excision followed by reconstruction with LZP was used. The flap design incorporated a central limb oriented laterally, creating triangular flaps that were transposed to reduce tension. The outcomes assessed included complications, recurrence, and patient satisfaction.

Between September 2023 and March 2025, 14 consecutive patients who underwent 15 LZP procedures were included in this study. No cases of flap necrosis, hematoma, seroma, or infection were observed. The mean hospital stay was 14.1 days (range, 9-22 d), with a mean follow-up of 6.2 months (range, 2-18 mo). One patient experienced delayed wound healing, and 1 experienced recurrence, which was managed with contralateral LZP. All patients expressed satisfaction with their postoperative appearance.

The modified LZP technique shows promise as an effective alternative for PS treatment, offering reduced complications and improved functional and aesthetic outcomes, with potential for further optimization.