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. 2022 Dec 23;14(12):e32880.
doi: 10.7759/cureus.32880. eCollection 2022 Dec.

Primary Closure of Pilonidal Sinus With Slide-Swing Skin Flap Compared With the Secondary Closure: A Single-Blinded Randomized Controlled Trial

Hormoz Mahmoudvand  1 , Sedighe Nadri  2 , Ramin Shekouhi  3 , Maryam Sohooli  3 , Seyed-Ahmad Seyed-Alagheband  1
Affiliations

Primary Closure of Pilonidal Sinus With Slide-Swing Skin Flap Compared With the Secondary Closure: A Single-Blinded Randomized Controlled Trial

Hormoz Mahmoudvand et al. Cureus. .

Abstract

Introduction: There are many surgical approaches for sacrococcygeal pilonidal sinus disease (PSD) therapy, ranging from wide excision repair to less morbid excisions with primary/flap closure. The off-midline flaps, which shift the incision line away from the midline natal cleft, have been associated with lower recurrence rates than the conventional mid-line closure techniques. This single-blinded randomized controlled trial aims to compare the short/long-term efficacy and outcome of the slide-swing flap technique with the conventional secondary wound closure.

Method and materials: This study was a prospective randomized controlled trial conducted on patients with PSD. Patients were assigned into two groups: secondary closure (control) and slide-swing flap (trial). Patients were advised to visit the surgical clinic two times weekly for the two weeks after the operation for at least six months.

Results: In this study, 100 patients were enrolled. They were assigned into two groups of control, and trial. The mean age of all participants was 29.15 ± 8.36 years old (age range: 18-62 years old). The mean operation time was 39.65 ± 12.63 for both groups, with the control group being 29.70 ± 7.71 and the swing flap group 46.90 ± 7.81. Patient visual analog scale (VAS) scores in both groups revealed that the trial group was associated with lower VAS scores compared with patients who underwent secondary closure (p-value = 0.006). Also, the trial group demonstrated a higher rate of healing, better cosmetic outcomes, and quicker recovery time compared with the controls.

Conclusion: Compared with secondary closure, the slide-swing flap was associated with excellent cosmetic outcomes, disease recurrence, and recovery time. Also, the post-operative complications were significantly lower compared with the traditional method.

Keywords: flap technique; limberg flap; pilonidal sinus disease; secondary closure; slide-swing skin flap.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. The CONSORT flowchart of this study.
Figure 2
Figure 2. Incision borders in the slide-swing skin flap.
Figure 3
Figure 3. After sinus removal, the surgical wound edges were mobilized and swing flap was made with subsequent closure.
Figure 4
Figure 4. Surgery site after the slide-swing skin flap technique.
See this image and copyright information in PMC

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