A novel, double Limberg flap repair for recurrent pilonidal sinus disease

Abstract

Pilonidal sinuses are chronic inflammation and/or infection of the intergluteal region. Recurrent disease is common and is a source of significant morbidity for affected patients. We present a case of an eighteen-year-old male with extensive recurrent pilonidal disease. A novel technique of a double Limberg flap repair was used, with the vertical axes of each flap positioned to optimise wound tension. The cranio-caudal length of the disease in the natal cleft would have resulted in a large amount of excised normal tissue laterally if a single Limberg flap was considered. To avoid this, we used two Limberg flaps over the craniocaudal length to minimise the laterally excised tissue. The patient made an uneventful recovery with no recurrence at 3 months follow-up. This technique demonstrates the flexibility of the Limberg flap, and that a double flap may be successfully used in extensive disease.

Keywords: Limberg flap repair; anorectal surgery; pilonidal sinus disease.

Figure 1

Diagram of position and dimensions of the double Limberg flap. Dotted line – midline; solid lines – incisions.

Figure 2

Position and dimensions of scar. Dotted line – midline; solid lines – scar.