Bilateral subcutaneous fatty flaps (BSF) for the treatment of recurrent pilonidal sinuses are a Novel technique superior to Z-plastics (ZP)

Abstract

Abstract Background: Pilonidal disease has numerous management techniques available to surgeons worldwide. Because of the variety of clinical manifestations, several methods of intervention are needed; as a result, we hope for careful selection of the best technique for the patient's severity and recurrence. Aim: To prevent possible recurrence after bilateral subcutaneous fatty flap(BSF), a novel method for treating pilonidal sinus illness and Z-Plasty(ZP) with fasciocutaneous flap. Patients and methods: All prospective patients having recurrent pilonidal sinus and operated on at our institute, Surgical Department from Jan. 2022 to Dec. 2023. In total, 50 cases have sacrococcygeal disease ( SCD), and 25 patients in Group A had bilateral subcutaneous fatty flap surgery. In contrast, the 25 patients in Group B were treated by Z-Plasty(ZP) with fasciocutaneous flap surgery. We assessed the length of the procedure, the level of postoperative pain, the length of the hospital stay, the postoperative complications, and the likelihood of recurrence. Results: The wound size was in the bilateral Subcutaneous fatty flap (BSF) 28.11 ± 8.48 mm relative to the (ZP) 23.84 ± 8.44 mm). Also, the complete healing was comparatively prolonged in the BSF (13days) relative to the ZP group (30 days). The surgery duration differs significantly (P < 0.001) between the groups; it was lower in the BSF group (29.15 ± 7.69 mins) than in the ZP (23.03 ± 6.06 mins). In the BSF group, the hospitalization was four days. Still, ZP group (11days), The time for work recovery or activity was shorter in the BSF (11 days) relative to the ZP group (36 days). BSF had more reasonable satisfaction than the ZP group, duration of wound healing in BSF being 11 days but in ZP 30 days. Additionally, the duration of pain in the group was ZP (38 days but in the BSF group (11 days). Return to work in BSF 11 days and in ZP 36 days; The median satisfaction scores attained 8 (28.1%) in BSF and 9 (37%) in the ZP (P = 0.046). The median VAS scores attained 37.8% BSF and 44% for ZP (P = 0.934). The highest VAS score was equal to group B, which was 6. Conclusion: when treating pilonidal sinus disease, the bilateral subcutaneous fatty flap is superior to the ZP flap.