Modified Limberg Flap versus Modified Elliptical Rotational Flap for Recurrent Pilonidal Sinus Disease

Abstract

Background: Over the past few decades in the management of sacrococcygeal pilonidal sinus disease, surgeons have increasingly come to appreciate the importance not only of flattening the natal cleft but also of achieving an off-midline closure of the resultant defect in order to minimize wound-related complications and recurrence.

Purpose: This study aims to compare modified Limberg flap (MLF) and modified elliptical rotational flap (MERF) for recurrent pilonidal sinus

Material and Methods: This cross-sectional study was carried out in the Department of General Surgery at October 6 University Hospital between January 2023 and January 2025, and included 50 patients with recurrent pilonidal sinus disease. Patients were randomly divided into two groups: Group A (25 patients treated with a modified Limberg flap, MLF) and Group B (25 patients treated with a modified elliptical rotational flap, MERF). Inclusion criteria were both genders with recurrent disease within two years and no more than one recurrence, while exclusion criteria included primary disease, contraindications to surgery, or prior flap surgery. Standard preoperative assessment and prophylactic antibiotics were applied, and all surgeries were performed by senior surgeons using standardized techniques with closed suction drainage. Postoperative outcomes, including operative time, healing, complications, recurrence, return to work, and patient satisfaction, were recorded during a 24-month follow-up.

Results: Fifty patients with recurrent pilonidal sinus were studied, most of whom were male (84%) and had previously undergone open surgery (60%). Compared with the modified Limberg flap (MLF), the modified elliptical rotational flap (MERF) required longer operative time but showed faster healing, earlier return to work, and significantly higher patient satisfaction and cosmetic scores. Recurrence was lower in the MERF group (4% vs. 12%), though not statistically significant. Postoperative complications, including numbness, tightness, infection, seroma, and wound dehiscence, were comparable between groups with no significant differences.

Conclusion: MLF remains a reliable technique with shorter operative time, MERF demonstrated superior outcomes in terms of healing, return to work, cosmetic satisfaction, and possibly recurrence. The longer operative time of MERF is offset by its functional and aesthetic benefits, making it a favorable choice in recurrent PSD where tissue planes are distorted and recurrence risk is high. Both techniques were safe, with comparable rates of complications. The differences observed between our study and previous literature emphasize the complexity of recurrent PSD, where operative challenges, patient compliance, and postoperative care critically influence outcomes.