Combined Horizontal Split Gluteus Maximus Muscle and Fasciocutaneous Limberg Flaps for Reconstruction of Recurrent Sacrococcygeal Pilonidal Sinus

Abstract

Pilonidal sinus is a chronic recurrent medical disease. The exact etiology of the disease is still unknown, but the most accepted theory is an acquired condition characterized by infected sinus in the natal cleft area containing a lifeless hair tuft. Multiple techniques were prescribed for its treatment; however, the ideal method is not yet defined.

Methods: The study population includes 58 male patients who underwent excision of their recurrent pilonidal sinus, and the resulting defects were reconstructed using combined horizontal split gluteus maximus flaps and rhomboid flaps. Outcomes were revised from patient case files and followed up in our outpatient clinic and via questionnaires.

Results: The mean hospital stay was 3 days. The mean time to return to work was 16 days. Partial wound dehiscences occurred in 2 patients. Distal end flap necrosis occurred in 1 patient. There were no flap losses, no recurrences, no infections, no loss of function, and no seromas during a mean follow-up period of 24 months. All patients were satisfied with the results.

Conclusions: This technique has an operative time and hospital stays comparable to those of other techniques. It has minimal and acceptable complication rates and no recurrences. We can conclude that this procedure of combined split gluteus maximus muscle flap and rhomboid flap provides an excellent, effective, easy, and feasible method of choice for reconstructing defects of recurrent pilonidal sinus disease.

Fig. 1.

A, Perforators are detected and marked, and 2 rhomboid flaps are outlined with dotted lines, which mark the underlying muscle flaps. B, Injection of methylene blue into the sinus tracks. C, Intraoperative view after preparation of 2 rhomboids and 2 horizontally split gluteus muscle flaps. D, The partial split muscle flaps turned over 180 degrees and transposed into the defect. E, Postoperative view after 1 year, stable wound without recurrence.

Fig. 2.

A, Preoperative design of the rhomboid flap and the rhombus design of excised area, including all sinuses. Marking of perforator sites was identified by Doppler. Split muscle flap marked with dotted lines. B, Postoperative view after few months. C, Late postoperative view (16 months).