Flap repair of complex pilonidal sinus: a single institution experience

Journal Article (Journal Article)

Background: Healing of pilonidal cysts after initial excision remains a vexing problem for surgeons. While simple sinus can be managed with success, recurrence of the cyst after primary excision or sizeable sinus often requires a more complex repair; however, the morbidity and ultimate success of these procedures are unknown. Methods: A retrospective review from 2009 to 2014 of all consecutive patients undergoing surgical intervention for pilonidal cyst disease from a single institution was performed. Management of pilonidal disease after excision with flap coverage was examined. Patient demographics, co-morbidities, procedural data, and post-operative outcomes were analyzed. Results: Twenty-one flap patients were identified. These included 15 V-Y fasciocutaneous repairs, 5 rotational flaps, and 1 Romberg flap closure. Mean BMI was 32, mean defect size was 8 cm, and the patients have had an average of 1.05 attempts prior to the excision and flap repair. The flap group demonstrated 14% recurrence rate, 33% reoperation rate, and 47% dehiscence rate. Mean time to healing was 36.4 days. Conclusions: Flap repairs for complex pilonidal cysts have high rates of recurrence, reoperation, and wound dehiscence. However, flap patients represent a more challenging repair with long operative times, blood loss, and large sinus size. Absence of the perfect approach to managing a complex sinus necessitates a thorough description of the problem and a discussion between the surgeon and the patient about the merits of each approach before a decision is made. Level of Evidence: Level IV, therapeutic study.

Full Text

Duke Authors

Cited Authors

  • Kokosis, G; Barbas, A; Ong, C; Levinson, H; Erdmann, D; Mantyh, CR

Published Date

  • April 1, 2018

Published In

Volume / Issue

  • 41 / 2

Start / End Page

  • 217 - 222

Electronic International Standard Serial Number (EISSN)

  • 1435-0130

International Standard Serial Number (ISSN)

  • 0930-343X

Digital Object Identifier (DOI)

  • 10.1007/s00238-017-1361-4

Citation Source

  • Scopus