Unilateral Asymmetrical Z-Plasty Including Presacral Fascia for Reconstruction of Sacrococcygeal Pilonidal Defect: Clinical Evaluation

Abdeen, Mostafa S

doi:10.21608/ejprs.2025.405193

Unilateral Asymmetrical Z-Plasty Including Presacral Fascia for Reconstruction of Sacrococcygeal Pilonidal Defect: Clinical Evaluation

Document Type : Original Article

Author

Mostafa S Abdeen

Plastic Surgery Unit, Faculty of Medicine, Benha University

10.21608/ejprs.2025.405193

Abstract

Background: Pilonidal disease frequently occurs in adults
and is characterized by a significant rate of recurrence, leading
to discomfort for the affected cases.
Aim of the Work: This work aims to evaluate the results
of ellipse excision of sacrococcygeal pilonidal sinus and
reconstruction of the defect with a unilateral unequal Z-plasty
at the upper third part defect.
Patients and Methods: The study involved 50 patients who
were diagnosed with sacrococcygeal pilonidal sinus. They underwent
an ellipse excision of the sacrococcygeal pilonidal sinus,
followed by the reconstruction of the excised area using a
unilateral unequal Z-plasty at the upper third of the defect. A
follow-up period of 6 months was observed. Data on surgical
outcomes, any complications, rate of recurrence, and patient’s
satisfaction levels were recorded and analyzed.
Results: The study included 50 participants, comprising
45 men and 5 women, with a median age of 23.7 years (ranging
from 18 to 37 years). Healing of the wound occurred within the
first two weeks for both primary and subsequent occurrences,
with an average healing time of 14 days (ranging from 10 to 30
days). Two patients (4%) experienced postoperative infections,
which were treated with wound dressing, appropriate antibiotics,
and extended drainage. The length of hospital stay varied
from 1 to 2 days, and the average duration before patients
could return to work was 12 days (ranging from 10 to 17 days).
After an average follow-up period of 6 months, recurrences
were observed in three cases (6%).
Conclusion: Unilateral unequal Z-plasty provides a simple
healthy and well-vascularized flap that fits and fills the defect
following pilonidal sinus excision.

Keywords

Main Subjects

Reconstructive surgery

References

Armstrong J.H. and Barcia P.J.: Pilonidal sinus disease: The
conservative approach. Arch. Surg., 129: 914–9, 1994.
2- Surrell J.A.: Pilonidal disease. Surg. Clin. North Am., 74:
1309– 15, 1994.
3- Mohammad A.: Karydakis flap operation for chronic pilonidal
sinus. Pak J. Surg., 23: 65–69, 2007.
4- Bascom J.U.: Pilonidal sinus. Curr. Pract Surg., 6: 175–80,
1994.
5- Duchateau J., De Mol J., Bostoen H. and Allegaert W.:
Pilonidal sinus. Excision marsupilization-phenolization?
Acta Chir Belg, 85: 325–8, 1985.
6- Andrew A. and Purnendu Dutta: Cryosurgery for pilonidal
disease. The American Jour. of Surgery, 133: 249-254,
1977.
7- Sondena K., Andrsen E. and Soreid J.A.: Morbidity and
short-term results in a randomized trial of open compared
with closed treatment of chronic pilonidal sinus. Eur. J.
Surg., 158: 351–5, 1992.
8- Mahdy T., Gartner W.B., Hagerman G.F., Goldberg S.M.
and Fine C.O. III: Surgical treatment of pilonidal disease:
Primary closure or flap reconstruction after excisions. Dis.
Colon. Rectum., 51: 1816-1822, 2008.
9- Hussein G. Elgohary and Ehab M. Oraby: Pilonidal sinus:
Minimal excision and primary closure under local anesthesia
The Egypt. Jour. of Surg., 34: 287–292, 2015.
10- Spivak H., Brooks V.L., Nusbaum M. and Friedman I.:
Treatment of chronic pilonidal disease. Dis. Colon. Rect.,
39: 1136–9, 1996.
11- Khiara H.S. and Brown J.H.: Excision and primary closure
of pilonidal sinus. Ann. R. Coll. Sur. Eng., 77: 242-4,
1995.
12- Obeid S.A.: A new technique for treatment of pilonidal
sinus. Dis. Colon. Rectum., 31: 879–85, 1988.
13- Bascom J.A.: Pilonidal dis.: Origin from follicles of hair
and result of follicle removal as treatment. Surg., May 87
(5): 567-72. PMID: 7368107, 1980.
14- Tochi A., Mazoni G., Bononi M., et al.: Outcome of chronic
pilonidal disease treatment after ambulatory midline excision
and primary suture. Am. J. Surg., 196: 28-33, 2008.
15- Allen M.T.G.: Pilonidal Sinus: Finding the right track for
treatment; British Journal of Surg., 77: 123-32, 1990.
16- Al-Hassan H.K.L., Francis I.M. and Neglen P.: Primary
closure or secondary granulation after excision of pilonidal
sinus? Acta. Chir. Scand, 156:695–9, 1990.
17- Rosen W. and Davidson J.S.: Gluteus maximus musculocutaneous
flap for the treatment of recalcitrant pilonidal
disease. Ann. Plast. Surg., 37: 293–7, 1996.
18- Karydakis G.E.: Easy and successful treatment of pilonidal
sinus after explanation of its causative process. Aust. N Z
J. Surg., 62: 385–9, 1992.
Egypt, J. Plast. Reconstr. Surg., January 2025 19
19- Kitchen P.R.B.: Pilonidal sinus: Experience with the Karydakis
flap. Br. J. Surg., 83: 1452–5, 1996.
20- Schoeler T., Wechselberger G., Oto A. and Papp C.: Definite
surgical treatment of complicated recurrent pilonidal
disease with a modified fasciocutaneous V-Y advancement
flap. Surg., 121: 258–63, 1997.
21- Mansoory A. and Dickson D.: Z-plasty for treatment of
disease of the pilonidal sinus. Surg. Gynecol. Obstet., 155:
409–11, 1982.
22- Tschudi J. and Ris H.B.: Die Morbidität des Z-plastic in
der behandlung des pilonidal sinus. Chirurg, 59: 486–90,
1988.
23- Roth R.F. and Moorman W.L.: Treatment of pilonidal sinus
and cyst by conservative excision and W-plasty closure.
Plast. Reconstr. Surg., 60: 412–5, 1977.
24- Kapan M., Kapan S., Pekmezci S. and Durgun V.: Sacrococcygeal
pilonidal sinus disease with Limberg flap repair.
Tech. Coloproctol., 6: 27–32, 2002.
25- Milito G., Cortese F. and Casciani C.U.: Rhomboid flap
procedure for pilonidal sinus: Results from 67 cases. Int.
J. Colorectal Dis., 13: 113–5, 1998.
26- Azab AS, Kamal M.S., Saad R.A., Abou al Atta K.A. and
Ali N.A.: Radical cure of pilonidal sinus by a transposition
rhomboid flap. Br. J. Surg., 71: 154–5, 1984.
27- Abdou M.A. Darwish and Hassanin A.: Reconstruction
following excision of sacrococcygeal pilonidal sinus with
a perforator-based fasciocutaneous Limberg flap. JPRAS,
63: 1176–1180, 2010.
28- Hull T.L. and Wu J.: Pilonidal disease. Surg. Clin. N. Am.,
82: 1169-86, 2002.
29- Can M.F., Sevinc M.M., Hancerliogullari O., Yilmaz M.
and Gokhan Yagci G.: Multicenter prospective randomized
trial comparing modified Limberg flap transposition
and Karydakis flap reconstruction in patients with
sacrococcygeal pilonidal disease. The American Jour. of
Surgery, Volume 200, Issue 3, September, Pages 318-327:
22, 2010.
30- Ersoy E., Devay A.O., Dganay B., Ozdogan M. and Gundodgu
R.H.: Comparison of the short-term results after
Limberg and Karydakis procedures for pilonidal diseases:
Randomized prospective analysis of 100 patients.
Colorectal Disease, Volume 11, Issue 7, Pages 705-710,
September, 2009.
31- Unalp H. R., Derici H., Kamer E., Nazlı O. and Onal M.A.:
Lower recurrence rate for Limberg vs V-Y flap for pilonidal
sinus. Dis. Colon. Rectum., 50: 1436-44, 2007.
32- Gurer A., Gomceli I., Ozdogan M., et al.: Is routine cavity
drainage necessary in Karydakis flap operation? A prospective,
randomized trial. Dis. Colon. Rectum., 48: 1797-
9, 2005.
34- Daphan C., Tekelioglu H. and Sayilgan C.: Limberg flap
repair for pilonidal sinus disease. Dis. Colon. Rectum., 47:
233-7, 2004.
35- Topgül K., Ozdemir E., Kilic K., Gokbatir H. and Ferahkose
Z.: Long term results of Limberg flap procedure
for treatment of pilonidal sinus. Dis. Colon. Rectum., 46:
1545-8, 2003.
36- Petersen S., Aumann G., Kramer A., Doll D., Sailer M. and
Hellmich G.: Short term results of Karydakis flap for pilonidal
sinus disease. Tech. Coloproctol., 11: 235-40, 2007.
37- Mentes B.B., Leventoglu S., Cihan A., et al.: Modified
Limberg transposition flap for sacrococcygeal pilonidal
sinus. Surg. Today, 34: 419-23, 2004.
38- Akinci O.F., Bozer M., Uzunkoy A., et al.: Incidence and
aetiological factors in pilonidal sinus among Turkish soldiers.
Eur. J. Surg., 165: 339-42, 1999.
39- Morden P., Grongowski R.A., Geiger J.D., Hirschi R.B.
and Teitelbaum D.H.: Comparison of Karydakis versus
midline excision for treatment of pilonidal sinus disease.
Pediatr. Surg. Int., 21: 793-6, 2005.
40- Goligher J.C.: Pilonidal sinus. In: Goligher J.C., Duthie
H.L., Nixon H.M., editors.: Surgery of the anus, rectum, and
colon. 5th ed. London: Bailliere-Tindall, p. 221–36, 1984.
41- Petersen S., Koch R., Stelzner S., Wendlandt T.P. and Ludwig
K.: Primary closure techniques in chronic pilonidal sinus:
A survey of the results of different surgical approaches.
Dis. Colon. Rectum., 45: 1458–67, 2002.
42- Aldemir M., Kara I.H., Erten G. and Tacyildiz I.: Effectiveness
of collagenase in the treatment of sacrococcygeal
pilonidal sinus disease. Surg. Today, 33: 106–9, 2003.
43- Solla J.A. and Rothenberger D.A.: Chronic pilonidal disease.
An assessment of 150 cases. Dis. Colon. Rectum.,
33: 758–61, 1990.
44- Silva J.H.: Pilonidal cyst: Cause and treatment. Dis. Colon.
Rectum., 43: 1146–56, 2000.
45- Khatri V.P., Espinosa M.H. and Amin A.K.: Management
of recurrent pilonidal sinus by simple V-Y fasciocutaneous
flap. Dis. Colon. Rectum., 37: 1232–5, 1994.