Comparative evaluation of primary repair method with Z-plasty and Limberg flap technique on pilonidal sinus treatment of children

Introduction. Although numerous surgical closure methods have been proposed for the treatment of Pilonidal Sinus Disease (PSD), the ideal treatment method has not yet been identified due to high recurrence rates. The objective of this study is to compare the closure technique that uses traditional post-pilonidal sinus excision Primary Repair (PR) method with closure technique that uses flap-based surgical methods such as Z-plasty (ZP) and Limberg flap (LF) in terms of their role in ensuring healing and their complication and recurrence rates. Materials and Methods. 61 patients (39 male and 22 female) who underwent surgery for PSD using the traditional Primary Repair, flap-based Limberg flap, and Z-plasty flap techniques were included in the study. The median age of the patients was 16.2 years, and the follow-up period was between 3 to 6 months. Results. Throughout the follow-up period, there developed recurrence in two patients and wound dehiscence and wound site infection in 6 patients in the PR group, whereas recurrence was observed in one patient and wound dehiscence in two patients in the LF group. While one patient developed hematoma, and one patient developed seroma in the ZP group, no recurrence or flap necrosis was observed in the ZP group. Discussions. After comparing complication frequency, recurrence rate, and cosmetic evaluation results, it was understood that the results belonging to LF and ZP groups, which represent flap-based surgical methods, were statistically more significant than the PR method group (p<0.05). When comparing flap-based surgical closure methods among themselves, it was seen that the surgical recurrence, complication and cosmetic results of ZP and LF closure methods were statistically more significant in favor of the ZP group (p<0.05). Conclusions. Although it requires technical expertise, it is recommended that sinus excision and flap-based surgical methods and the ZP surgical closure technique be used in surgical PSD treatment in pediatric age groups due to low complication and recurrence rates and better cosmetic results.