Ann Surg Treat Res.  2018 Feb;94(2):88-93. 10.4174/astr.2018.94.2.88.

Evaluation of intradermal absorbable and mattress sutures to close pilonidal sinus wounds with Limberg flap: a prospective randomized comparative study

• Çetin K
• Sikar HE
• KocaoÄŸlu
• KündeÅŸ M
• Karahan M
• KaptanoÄŸlu L

• KMID: 2402851
• DOI: http://doi.org/10.4174/astr.2018.94.2.88

Abstract

PURPOSE
We aimed to compare skin closure techniques, standard (intermittent mattress) and continuous subcuticular sutures, following Limberg flap procedure.
METHODS
From July 2013 to July 2015, 92 patients with sacrococcygeal pilonidal disease were prospectively randomized into 2 groups consisting of 46 patients for both. Patients underwent sinus excision and closure with Limberg flap; continuous subcuticular suture was used in subcuticular group (SG) and intermittent mattress sutures were used in mattress group (MG) for skin closure. Characteristics of patients, features of pilonidal disease, macerations, infections, wound dehiscence, flap necrosis, operation time, time of drain removal, wound complications, early recurrences, and time till return to work were compared between the 2 groups.
RESULTS
There was no statistical difference between groups per sex, age, body mass index, smoking, number of sinuses, depth of intergluteal sulcus, distance of incision to anus, volume of extracted tissue, number of hair follicles per cm2, recurrence, operation, and mean follow-up time. Two patients showed signs of wound complications (4.4%) in SG, whereas 8 cases (17.4%) showed signs in MG (P < 0.05). One patient in SG had surgical site infection and required antibiotics (2.2%), where as there were 6 cases treated in MG (13.0%) (P < 0.05). Removal of drain tube, and time till return to work rates are lower for SG than MG (P < 0.05).
CONCLUSION
In conclusion, surgical procedures which include Limberg flap method and subcuticular closure may reduce infection and maceration rates. Future studies are needed to achieve greater detailed evaluation.

Keyword

Pilonidal sinus; Sutures; Surgical flaps

MeSH Terms

Anal Canal
Anti-Bacterial Agents
Body Mass Index
Follow-Up Studies
Hair Follicle
Humans
Methods
Necrosis
Pilonidal Sinus*
Prospective Studies*
Recurrence
Return to Work
Skin
Smoke
Smoking
Surgical Flaps
Surgical Wound Infection
Sutures*
Wound Infection
Wounds and Injuries*
Anti-Bacterial Agents
Smoke

Figure

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  Fig. 1 Maceration due to mattress sutures.

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  Fig. 2 (A) Landmarks for Limberg flap. (B) Excision of sinus. (C) Approximation of fascia and subcutaneous tissue. (D) Closed wound with Limberg flap.

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