Tandem Rhomboid Flap Repair: A New Technique in Treatment of Extensive Pilonidal Disease of the Natal Cleft

Background: Pilonidal disease is a controversial benign condition that often causes nuisance and disability in young adults. Sacrococcigeal region, intergluteal natal cleft, interdigital cleft in barbers and the other hair bearing areas like axilla are found to be involved. Different authors have described different techniques of management of pilonidal disease.Methods: During September 2010 to August 2018 total 24 patients were presented with pilonidal disease and were treated using various surgical interventions. This retrospective study is done to study demographics and clinical spectrum, clinical course, outcome of different surgical interventions done and complications associated with various techniques.Results: Out of 24 patients 18 (75%) were males whereas 6 patients (25%) were females. The age range was 23 to 44 years. Sacrococcigeal region is the most commonly affected region in this series. In this series average duration of presence of pilonidal disease before presentation was 89 days ranging from 4 days to 168 days. One of 24 patients was treated with medical management and rest 23 patient required surgical intervention. Complete excision with rhomboid flap was the most common way of treating pilonidal disease and was used in 10 (41.6%) cases.Conclusions: Pilonidal disease is benign condition seen in young adults associated with morbidity without any mortality. Sinus is the commonest mode of presentation and sacrococcigeal region is the commonest site affected by this disease. Rhomboid flap has a promising result in terms of less post-operative recovery time and post-operative complications.

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A Comparative Study on flap necrosis following Karydakis Flap Reconstruction and Z-Plasty in Patients with Sacrococcygeal Pilonidal Disease – Our experience

Surgical Update: International Journal of Surgery and Orthopedics ◽

10.17511/ijoso.2021.i04.02 ◽

2021 ◽

Vol 7 (4) ◽

pp. 85-90

Author(s):

Dr. MJ Prabu ◽

◽

Dr. R Niranjan Kumar ◽

Dr. SP Gayathre ◽

Dr. R Kannan M.S. ◽

...

Keyword(s):

Hospital Stay ◽

Pilonidal Disease ◽

Pilonidal Sinus Disease ◽

Flap Necrosis ◽

Recurrence Rates ◽

Natal Cleft ◽

Median Hospital Stay ◽

Stay Suture ◽

Flap Procedure ◽

Flap Repair

Aim: The purpose of this study was to evaluate patients with sacrococcygeal pilonidal sinus disease(SPSD) who underwent the Karydakis procedure and Z plasty at our centre concerning theperioperative findings, late postoperative results and recurrence. Patients and Methods: A total of30 patients presenting with SPSD at our centre underwent Karydakis flap repair and Z plasty fromMay 2019 to June 2021. These patients were then followed up and evaluated concerning operativetime, drain use, hospital stay, suture removal, complications, and recurrence. The adipocutaneousflap of Karydakis was devised to shift the natal cleft, while Z-plasty involves a fasciocutaneous flap.Results: The mean operative time was 60 min with a median hospital stay of 4 days. Drains wereremoved at a median of 5 days and sutures at a median of 15 days. The duration of hospitalisationfor the Karydakis procedure was found significantly lesser than that for Z-plasty Patients who werefollowed up for a median of 12 months. The overall complications were more in Z-plasty. Flapnecrosis developed in 30 % of the cases in the Z-plasty group, comparable to no recurrence seen inthe Karydakis procedure. Conclusion: Karydakis flap was found superior to Z-plasty, having lessseroma formation, no flap necrosis and no local hematoma Karydakis flap procedure is a relativelysimple procedure for SPSD and has advantages over Z-plasty technique like keeping scar away fromthe midline and flattening of the natal cleft, thus reducing local recurrence rates.

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