Outcome of treatment of primary and recurrent pilonidal sinuses with the Limberg flap

Background: Surgical treatment of pilonidal sinus disease has a significant morbidity and recurrence rate. The rhomboid flap of Limberg is a transposition flap that has been advocated for treatment of this condition. We present our experience with the Limberg technique for both primary and recurrent pilonidal sinuses. Patients and Methods: In a three-year period, 25 patients with chronic pilonidal sinus disease were treated with this method. Twelve patients had recurrent disease and were previously treated with other types of surgery. The sinuses were excised in a rhomboid fashion and the defect closed using a transposition flap designed to obliterate the midline cleft. Patients were treated with prophylactic antibiotics and the wound drained with a vacuum drain. Results: Median post-operative hospital stay was four days. There were four (16%) wound complications. The mean follow-up period was 20 months. There was a single recurrence (4%) of a pilonidal sinus, which required further surgical excision. Conclusions: Despite the risk of wound complications, this method is particularly useful for complex sinuses with extended tracts where radical excision leaves a large defect. It is also suitable for cases where simpler operations have failed and carries a low risk for recurrence.