Limberg Flap Cover for Sacrococcygeal Pilonidal Sinus: Experience from a Rural Tertiary Care Hospital in North Kashmir, India

Abstract

Background: Pilonidal sinus disease is a common condition affecting the sacrococcygeal region, particularly in young adults. Surgical excision with flap coverage, especially the Limberg flap, has been recognized for its efficacy in reducing recurrence and complications. This study presents a prospective case series evaluating the outcomes of the Limberg flap technique in 100 patients at GMC Baramulla over a period of five years. Methods: This prospective study was conducted from March 2020 to March 2025 at the Department of General Surgery, GMC Baramulla. A total of 100 patients diagnosed with pilonidal sinus disease underwent surgical excision followed by Limberg flap reconstruction. All patients were evaluated preoperatively with routine baseline investigations including CBC, RFT, LFT, serum electrolytes, ECG, chest X-ray, and coagulation profile. MRI of the sacrococcygeal region was performed selectively in patients with multiple sinus openings to assess the extent and complexity of disease. Intraoperative and postoperative data were collected, including complications, duration of hospital stay, wound healing time, and recurrence. Results: Out of 100 patients, 7 patients developed surgical site infections (SSI), which were successfully managed with antibiotic therapy and abscess drainage. 6 patients develop seroma, managed by aspiration and antibiotics & pressure dressings. Two patients develop flap necrosis managed by regular dressings, another two patients experienced recurrence, both of which were treated conservatively. Another 2 patients develop wound dehiscence (Distal end) managed by Secondary suturing. The overall complication rate was low, and the Limberg flap proved effective in ensuring tension-free closure and rapid wound healing. Most patients returned to normal activity within 2–3 weeks. Conclusion: The Limberg flap is a reliable and effective technique for managing pilonidal sinus disease, even in complex and recurrent cases. The flap offers low morbidity, minimal recurrence, and excellent cosmetic and functional outcomes. Preoperative MRI can be reserved for patients with multiple openings or complex disease patterns. The study supports the use of the Limberg flap as the procedure of choice in selected patients with pilonidal sinus disease.