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Erschienen in:
01.01.2015 | Original Article
Primary wound closure with a Limberg flap vs. secondary wound healing after excision of a pilonidal sinus: a multicentre randomised controlled study
Erschienen in: International Journal of Colorectal Disease | Ausgabe 1/2015
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Purpose
Off-midline procedures seem to be the best method of primary wound closure after excision of a pilonidal sinus. Primary wound closure with a Limberg flap was compared to secondary wound healing.
Methods
From January 2006 to July 2012, 102 patients with given informed consent (mean age 28 years, men 81 %) who had excision of a pilonidal sinus in three hospitals in Switzerland were randomised to group L (Limberg flap, n = 51) or to group E (excision only, n = 51). Primary endpoint was duration of incapacity for work. Follow-up was at 3 weeks and at 1 year postoperative (95 % follow-up).
Results
Both groups were comparable with regard to patient characteristics. The median (range) operation time was 60 (30–80) min in group L vs. 30 (10–75) min in group E (p < 0.001). No significant differences were found in postoperative pain and painkiller intake; pain, percentage of patients at work and overall satisfaction at 3 weeks postoperative; and overall duration of incapacity for work and overall satisfaction at 1-year follow-up. The complication rate was 49 % in group L vs. 12 % in group E (p < 0.001). Complications in group L were seroma (6 %), wound dehiscence (45 %), skin necrosis (10 %), hematoma (6 %), infection (4 %) and recurrent disease (13 %). Complications in group E were recurrent disease (6 %) and wound healing disorder (6 %).
Conclusions
After excision of a pilonidal sinus, primary wound closure with a Limberg flap has no advantage over secondary wound healing. The main reason for this conclusion is the relatively high complication rate of primary wound closure with a Limberg flap.