Lateral Advancement Adipo-Fascio-Cutaneous Flap Or Primary Closure In The Treatment Of Uncomplicated Pilonidal Sinus

Background and Objectives: Controversy still exists regarding the best surgical technique for the treatment of pilonidal disease in terms of minimizing disease recurrence and patient satisfaction. The present work was designed to retrospectively analyze the results of pilonidal sinus managed using excision with primary closure and excision with lateral advancement adipo-fascio-cutaneous flap. Materials and methods: Data from 52 consecutive patients who had elective surgery for chronic pilonidal sinus from February 2012 to February 2015 with either excision or primary closure [group 1, n = 21 patients] or excision and flap reconstruction [group 2, n = 31 patients] were retrospectively analyzed. Special emphasis was placed on demographic data, operative time, hospital stay, duration of time off work, postoperative complications (wound infection and wound breakdown), and postoperative recurrence were recorded. Results: The mean follow-up was 20 months. A significant difference was observed between the two groups in terms of postoperative complications, and duration of time off work (in days), and frequency of recurrent disease (P < 0.05) for all comparisons. There were no significant differences among the two groups with respect to age, sex distribution, operative time (min), length of hospital stay (in days)(P>0.05) for all comparisons. Conclusion: The eccentric excision and partial obliteration of the natal cleft using the lateral advancement adipofascio-cutaneous flap ensured reliable earlier wound healing, shorter time off work, with fewer dressings and wound morbidity, lower rate of recurrence, which are the main advantages of this flap technique in comparison to primary closure after excision of uncomplicated pilonidal sinus.