Management of Pilonidal Sinus Disease with Oblique Excision and Bilateral Gluteus Maximus Fascia Advancing Flap: Result of 278 Patients

PURPOSE: Excision followed by natal cleft depth reduction should be performed, with no leftover midline scar tissue, to prevent recurrence of pilonidal sinus, which is the main problem in the treatment of this disease. We investigated the potential advantages of this advancing flap technique, which we developed. METHOD: An S-type incision together with a bilateral gluteus maximus fascia advancing flap was applied on 278 (89 percent) patients, who did not have extensive gluteal involvement, of the 312 patients who had pilonidal sinus disease, between January 1997 and January 2007. No drainage was performed on any patient. RESULTS: All patients were discharged within 24 hours. Total complication rate was 7.2 percent and recurrence rate was 0.7 percent. The mean time off from work was 12 +/- 2 days (range, 10 to 22). The mean follow-up period was 66 +/- 32 months (range, 12 to 120). CONCLUSION: We suggest that this surgical procedure may successfully be applied to a large majority of the patients. It does not lead to unnecessary excision of healthy tissue because of its significantly simpler nature compared with the full-layer flap technique and its S-type incision, it does not create a midline scar tissue, and it is able to flatten the gluteal sulcus.