Dufourmentel Rhomboid Flap versus the Karydakis and Bascom Flap Reconstruction Following Wide Excision of Pilonidal Sinus Disease

Abstract

Abstract Background: Primary closure of the defect following radical excision of pilonidal sinus disease often has high complication rates. Objectives: This study aims to compare the outcomes of the Karydakis and Bascom off-midline flap closure techniques with the more recently described Dufourmentel rhomboid flap technique. Design: Retrospective cohort study. Setting: Patients who underwent elective pilonidal sinus excision with flap reconstruction at a tertiary referral center from January 2019 to January 2023. Patients and Methods: De-identified data of patients who underwent elective pilonidal sinus excision with flap reconstruction at a tertiary referral center from January 2019 to January 2023 were analyzed. Patients who underwent pilonidal sinus surgery without flap reconstruction were not included in the analysis. Institutional ethical committee review was waived for this study. Main Outcome Measures: Wound healing time, postoperative complications, disease recurrence, operative duration, and length of hospital stay. Sample Size: Forty-four patients. Results: Over a 4-year duration, 44 patients had elective pilonidal sinus surgery, of whom 44 (36 men, eight women) underwent flap reconstruction of the defect. Mean age and body mass index was 25.6 years and 26.6 kg/m2, respectively. The overall mean complete wound healing time was 10.8 weeks, with the Dufourmentel group having the quickest healing time compared to the Karydakis and Bascom groups (6.1 weeks versus 10.8 weeks versus 13.9 weeks, respectively; P = 0.206) At a mean follow-up duration of 8 months, 18 (40.1%) patients developed postoperative wound complications. Overall wound complication rate was lowest in the Dufourmentel group (9.1% versus 52.9% versus 56.3%, respectively; P = 0.030). This was largely contributed by the reduced wound dehiscence rate (9.1% versus 35.3% versus 56.3%, respectively; P = 0.043). The rates of wound infection, sinus recurrence, and reoperation were low and statistically comparable across all three groups. Conclusion: Our findings suggest the superiority of the Dufourmentel flap reconstruction technique compared to the Karydakis and Bascom closure techniques following elective pilonidal sinus excision. Limitations: Retrospective study with a small sample size and short follow-up duration. Conflict of Interest: The authors have no conflict of interest to declare.