Objectives: To evaluate outcome of bilateral myocutaneous gluteus maximus advancement flap for treatment of complicated and recurrent pilonidal sinus disease (PSD).
Patients & Methods: The study included 55 male patients with chronic PSD with mean age of 21.3±2.3 years and mean duration of disease of 3.1±1.6 years, 23 patients had complicated primary and 32 had recurrent PSD after surgical treatment. Hairiness (≥3 Ferriman-Gallwey (FG) score) was detected in 49 patients (89.1%). All patients underwent bilateral gluteus maximus myocutaneous advancement flap for closure of the excisional defect. Collected data included duration of surgery, amount of bleeding, need for blood transfusion and number of used units. Duration of wound drainage and frequency of development of wound seroma and surgical wound infection, durations of wound healing, postoperative (PO) hospital stay and follow-up were determined. Recurrence was defined as development of pain, pit and discharge.
Results: All patients had uneventful intraoperative course with mean operative time was 69.5±13.1 minutes and mean intraoperative blood loss of 263.3±140.9 ml; 8 patients (14.5%) required blood transfusion. Thirty-one patients (56.4%) were managed as one-day surgery with a mean PO hospital stay of 1.6±0.7 days. Mean duration of wound drainage was 8.4±1 days and wound healing of 10.7±1.6 days. Five patients (9.1%) developed PO wound-related complications and 2 patients had recurrent complaint throughout a mean follow-up period of 12.9±4.3 months; one had pain at wound site that responded to conservative treatment and the other had a pit at the previously recurrent pilonidal sinus area but no discharge and was considered as blind pit, for a total success rate of 97.3%.
Conclusion: Bilateral myocutaneous gluteus maximus advancement flap is feasible and safe reconstruction modality after excision of pilonidal sinus with minimal postoperative morbidities and low acceptable recurrence rate and can be managed as one-day procedure so minimized hospital stay and spared its resources. It is advocated as a surgical modality for pilonidal sinus disease even in cases had multiple recurrences.