Saturday, March 23, 2019
Standardization of modified Limberg flap technique by using an acetate template for the treatment of pilonidal disease
Our Dermatol Online 2019; 10(2): 112-115 DOI: 10.7241/ourd.20192.1
ABSTRACT
Background: Pilonidal disease is a common condition that usually affects young men. The disease presents with pain, cysts, abscesses, pits, sinus tracts, retained hairs and draining in the sacrococcygeal area. Various surgical techniques have been described in the treatment of pilonidal disease. Modified Limberg flap is a commonly used procedure, however, studies which compared the outcomes of modified Limberg flap technique have reported different results. Diverse geometric rhomboid excisions in shape and size, and varied lateralization distance can lead to differences in healing time, complication and recurrence rates. Standardization of the modified Limberg flap technique can help to compare the end results of the surgical intervention more accurately. Therefore, we developed an acetate template to draw a sketch map of Limberg/modified Limberg flap preoperatively, in order to standardize the procedure.
Materials and Methods: A Limberg/modified Limberg flap template was prepared by using an online drawing program. Rhomboid flaps with four different sizes were drawn. The template was printed onto an acetate sheet. With the help of a sewing needle, pin holes were performed on the acetate template. The borders of the rhomboid excision and the Limberg/modified Limberg flap were defined with the acetate template and drawn on the gluteal region by using a water resistant multi-purpose pen. The surgeon decided which rhomboid flap size to choose according to the dispersion of the pilonial sinus openings. All pilonidal pits and abscess orifices stayed within the resected area. The size of modified Limberg flap was standardized by the help of the acetate template.
Results: This study included 10 male patients with pilonidal disease between the ages of 20 to 35. The mean disease duration of the patients was 4.2 years. All the patients underwent modified Limberg flap surgery using an acetate template. The follow-up period was three months. We observed surgical site infection only in one patient within seven days, postoperatively.
Conclusions: We suggest that using a standardized template while performing a modified Limberg flap procedure for the treatment of pilonidal disease may help to evaluate and compare the outcomes of this surgical procedure more accurately.
Key words: Flap, Limberg, Modified Limberg, Pilonidal disease, Pilonidal sinus, Surgery
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