Pilonidal Flap Surgery: Procedure, Benefits, and Recovery

Pilonidal sinus flap surgery is used to treat a chronic pilonidal sinus (a small cyst or abscess that forms near the tailbone at the top of the buttocks). The procedure involves excising the infected cyst and sinus tracts and then covering the surgical site with a flap of healthy skin and tissue. This flap helps close the wound and reduces the chances of recurrence.

Pilonidal flap surgery is needed for individuals with complex or recurrent pilonidal sinus disease. The procedure is performed when less invasive treatments like injections or drainage fail to treat the condition. It is recommended in cases where the pilonidal cyst worsens, forming a sinus cavity beneath the skin.

Symptoms and conditions that may indicate a need for surgery include: 

1. Chronic pain and discomfort 

2. Recurrent infections 

3. Multiple sinus tracts 

4. Persistent drainage 

5. Painful mass or abscess

Pilonidal treatment with flap reconstruction offers several benefits compared to open surgery. According to a study by Doll et al., 2022, the recurrence rate of the disease was 11.7% for primary open treatment and only 5.8% for the Limberg flap technique. Other advantages of the procedure are as follows: 

1. Quick healing time 

2. Shorter hospital stay 

3. Early return to daily life  

4. Low recurrence rate

Patients consult with a colorectal surgeon to prepare for their pilonidal flap surgery. The specialist provides detailed instructions to be followed before and on the day of the procedure. These include:

Before Pilonidal Flap Surgery 

During the initial consultation for pilonidal sinus surgery, patients should address all their questions and doubts. They will need to follow their surgeon’s specific guidelines to ensure a successful procedure and smooth recovery: 

On the Day of Pilonidal Flap Surgery 

Patients should arrive at the hospital well before their scheduled time on the day of the pilonidal flap surgery. This allows time to complete any remaining administrative tasks. They will then be prepped for the procedure, which includes the following steps:

The Limberg flap and Karydakis lap methods are two common techniques used in pilonidal flap surgery to treat chronic pilonidal disease. The Limberg flap may take 29 to 54 minutes, whereas Karydakis may take 22 to 48 minutes. Both procedures are performed under spinal or general anaesthesia and involve the following steps: 

Limberg Flap Method

It is performed for people with extensive or recurrent pilonidal disease. It is performed as described below: 

1. The surgeon makes a rhomboid-shaped incision around the pilonidal sinus to remove the infected cyst and the underlying tissue. 

2. Another incision is made to dissect healthy tissue from the buttock and create a rhomboid-shaped flap.

3. One side of the flap is swung into position and sutured into place. It covers the wound entirely and leaves the wound slightly off the midline.

4. Drainage tubes are placed to prevent fluid accumulation.

Karydakis Flap Method

It reduces the risk of recurrence. The steps involved are mentioned below: 

1. An elliptical incision (asymmetrical to one side, away from the midline) is made around the pilonidal cyst to remove the infected cysts and any sinus tracts. 

2. A flap is created from healthy tissue on the lateral side of the excised area.

3. The flap is moved across the midline to cover the wound entirely and is sutured in place.

4. Drains may be placed to facilitate drainage of fluids. 

Note: The treatment approach is selected based on the patient’s condition and the surgeon’s opinion. 

Proper post-operative care is essential after pilonidal sinus flap surgery to ensure healing and prevent complications. Patients should follow their surgeon’s instructions in the hospital and home for a smooth recovery.

In Hospital Recovery 

Patients can return home on the same day of the procedure. However, if there are any complications, they may need to stay in the hospital for 2-3 days. During this time, they can expect the following: 

1. Patients are moved to a recovery area where the nursing staff monitors the effect of anaesthesia and checks their vital signs. 

2. Antibiotics and pain relievers are administered to reduce the risk of infections and manage post-operative discomfort, respectively. 

3. The surgical area is checked for excessive bleeding or drainage, and the wound is appropriately dressed.

4. Individuals are asked to lie on their front or side and not directly on the wound. 

5. They are encouraged to move gently to promote blood circulation and prevent blood clots.

At-home Recovery 

The pilonidal sinus flap surgery recovery time is usually two to three weeks. After this period, patients can return to work. During this time, it is important to follow these guidelines at home: 

1. Take prescribed pain medications as directed to alleviate discomfort.

2. Follow the surgeon’s instructions for cleaning the wound and changing dressings to prevent infection.

3. Shower regularly to keep the area clean, but avoid soaking in a bathtub or swimming. Dry the treatment area with a hairdryer in a cool setting. 

4. Do not put pressure on the treated site for three weeks. 

First Follow-up Appointment 

The first follow-up visit is scheduled two weeks after the surgery. During this appointment, the surgeon removes the sutures and examines the surgical site to ensure the wound is healing properly. 

The next visits will be scheduled at three and six months after discharge from the hospital. 

According to a study by Zou et al., 2022, there is no significant difference between complications for the Limberg and Karydakis methods. One of the early complications of the procedures is wound splitting, which occurs in about 16-17.4% of cases. Other risks of the procedure are as follows: 

1. Infection 

2. Flap necrosis (death of body tissue)

3. Seroma or haematoma formation (fluid or blood accumulation under the flap)

4. Aesthetic dissatisfaction 

5. Recurrence 

When to call a doctor?

After pilonidal sinus flap surgery, patients should monitor their recovery closely. They must contact their doctor immediately if they experience any of the following symptoms:

1. A fever above 101 F 

2. Severe pain 

3. Increased redness, swelling, and warmth around the wound

4. Drainage of pus from the incision 

Delaying pilonidal sinus flap surgery can lead to several complications that may worsen the condition over time. Mentioned below are some of the primary risks associated with postponing treatment:

1. As the condition progresses, patients may experience worsening pain, swelling, and discomfort, which can significantly affect daily activities.

2. The infected pilonidal sinus may continue to progress, increasing the risk of abscess formation and recurrent infections.

3. Without treatment, it can increase the risk of squamous cell carcinoma (a type of skin cancer).

The pilonidal sinus surgery cost in India varies significantly from one individual to another. It generally starts from ₹ 30,000 and reaches a maximum of ₹ 70,000. The average price is ₹ 45,000. 

Note: The prices mentioned above are approximate. Patients should talk to HexaHealth experts for current and accurate expenses.  

Factors that affect the expenditure of the procedure include: 

1. Surgical Technique: The type of flap method (Limberg or Karydakis) and the complexity of the surgery can impact the cost. More specialised techniques may be costlier.

2. Surgeon’s Fees: Specialists with significant experience may charge higher fees, affecting the total price.

3. Hospital Charges: Private healthcare facilities are more expensive than government centres due to better amenities and services. 

4. Geographic Location: Expenses vary significantly by region due to differences in living costs and healthcare infrastructure. Prices are higher in metropolitan cities than in small towns. 

5. Preoperative and Post-operative Care: The cost of pre-surgery consultations, diagnostic tests, and follow-up appointments can also affect the final bill.

Pilonidal sinus flap surgery offers an effective solution for patients struggling with chronic or recurrent pilonidal sinus disease. The procedure removes the infected tissue and uses a healthy flap to ensure better wound coverage and faster healing. This approach minimises recurrence risk while providing long-term relief.

HexaHealth is here to guide you through every step of the process, from diagnosis and preparation to post-operative care. We help ensure a smoother pilonidal sinus flap surgery recovery time by connecting you with expert surgeons. With our network of specialists, you will receive personalised care for effective treatment. Contact us TODAY! 

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