Pilonidal Flap Surgery - Procedure, Benefits and Recovery

Pilonidal disease is a condition characterised by chronic inflammation and infection due to the formation of cysts near the tailbone. The patient may also experience pain and abscess along with the sinus tract that may have chronic drainage. It is generally considered an acquired condition rather than a congenital condition. This condition most commonly occurs in young people. Men (compared to women), obese people, people with rough and thick body hair, people who wear tight clothes, and the person sitting for prolonged periods are at increased risk of developing this condition.lonidal Flap 

  Pilonidal disease is a condition characterised by chronic inflammation and infection due to the formation of cysts near the tailbone. The patient may also experience pain and abscess along with the sinus tract that may have chronic drainage. It is generally considered an acquired condition rather than a congenital condition. This condition most commonly occurs in young people. Men (compared to women), obese people, people with rough and thick body hair, people who wear tight clothes, and the person sitting for prolonged periods are at increased risk of developing this condition.

The Benefits of Pilonidal Flap Surgery are respite from 

1. Pain.
2. Reddening of the skin.
3. Drainage of pus or blood from an opening in the skin.
4. Foul smell from draining pus.

Pilonidal flap surgery is performed in the case of chronic pilonidal cyst, which is not treated with non-invasive treatment options. It is considered in cases where the pilonidal cyst worsens and develops a sinus cavity below the skin. There must be complete removal of cysts and the cavity in such cases

Procedure

There are two types of techniques used for pilonidal flap surgery treatment.

These are the Limberg flap method and  Karydakis flap procedure

Limberg flap method:

1. This method is done in patients who have recurrent pilonidal disease. This method is performed through the following steps:
2. The procedure is performed under spinal anaesthesia so that the patient remains sleepy throughout the procedure.
3. After the anaesthesia, the patient is safely moved to the prone position.
4. The surgeon preoperatively removes the local hairs and retracts the buttocks for better visualisation through adhesive tapes.
5.  The patients may also receive intravenous antibiotics.
6. Prior to starting the surgery, the surgeon marks a rhomboid with a pen.
7. The surgeon then makes the incision to remove the underlying tissues and affected skin. 
8. The surgeon then makes another incision next to the previous incision to free up the buttock tissues and expose the gluteal fascia.
9. The incision  is closed with the help of sutures.
10. The surgeon also provides a vacuum drain before the sutures.

2 .Karydakis flap procedure: 

1. This procedure is also performed under spinal anaesthesia.
2. The area was shaved and prepared with povidone-iodine solution.
3. The surgeon may inject the methylene blue into the sinus orifice to determine the sinus extent. 
4. The surgeon marked an asymmetrical elliptical incision.
5. The elliptical incision is of adequate length to avoid any tension on closure.
6. To make the line of suture vertical and away from the midline, the surgeon makes the lateral edges of the ellipse sloppy. 
7. The surgeon then excises the ellipse to the sacral fascia.
8. The surgeon closes the incision with sutures.
9. What to expect before surgery?
10. Once the doctor recommends the surgery for the pilonidal sinus, he may advise you to undergo a pre-anaesthetic check-up.
11. The doctor may also seek detailed information about the medical history and the medications you are currently taking.
12. The surgeon may provide you with a tentative date for the surgery, subject to the results of a pre-anaesthetic check-up.
13. Once there are no concerns about the results of a pre-anaesthetic check-up, the surgeon or the hospital staff may provide you with the final date of surgery. It can be done through telephonic conversation.
14. The doctor may also provide you with detailed information about the type of anaesthesia used during the surgery and the possible side effects and complications. In pilonidal flap surgery, you may undergo spinal anaesthesia.
15. The doctor may advise you to stop certain medications, such as aspirin or warfarin, that may increase the risk of bleeding. 
16. The doctor may also explain to you the duration of the hospital stay, the time of surgery, or the insurance formalities.
17. You may be advised to stop eating or drinking at least 8-10 hours before surgery. 
18. What to expect on the day of surgery?
19. Once you reach the hospital, you may be asked to complete the formalities. It may include filing the consent form and depositing the surgery charges. It may be done by the relative that accompanies you to the hospital.
20. The staff will inform you about changing your clothes and wearing a hospital gown. You may also be asked to remove the jewellery or dentures. It is important that you should leave the jewellery at home. 
21. The doctor will recheck all the vitals, and a pre-anaesthetic check-up may also perform. 
22. Once the PAC report signals a go-ahead, the staff prepares the surgical site. The hairs surrounding the pilonidal sinus are shaved for better visualisation.
23. The para-medical staff also records the previous meal.
24. If you require taking medicine for any chronic illness, such as diabetes or hypertension, you may take it with one or two sips of water under the supervision of a doctor.
25. You will then be transferred to the operation theatre.

 What to expect during surgery? 

1. The patient is made for relaxing in the operation theatre.
2. The surgery is done under spinal anaesthesia.
3. After the anaesthesia, the patient is safely turned into a prone position (the patient is lying on the abdomen).
4. The nurse inserts an intravenous line through which antibiotics and other medications are injected during surgery or recovery.
5. The surgical site is cleaned with povidone-iodine, and methylene blue is injected into the sinus to determine the extent of the sinus. 
6. The vitals of the patient, such as breathing rate, heart rate, and oxygen saturation, are monitored throughout the surgery. 
7. The surgeon then performs the surgery either through the Limberg flap method or the Karydakis flap procedure.

What to expect after surgery?

1. After the surgery is completed, you may be shifted to the recovery room, where the nurse will monitor your vitals. Once the vitals are stable, you may be shifted to the general ward.
2. You may be asked to lie on your side or front. Avoid lying directly on the wound.
3. One day after the surgery, the surgeon may ask you to move and walk a few times a day.
4. The doctor may prescribe pain medications that will provide relief from pain. You may also be given antibiotics to reduce the risk of infection.
5. You may have a change of dressing in the hospital.
6. You may get discharged from the hospital within 2-3 days after the surgery.

First follow-up appointment

1. Your surgeon will provide you with the complete schedule for follow-up visits during discharge from the hospital. Do not miss any of the follow-up visits.
2. You may be asked to visit the hospitals within two weeks after the surgery for removing the sutures. During the visit, the doctor may evaluate the progress of wound healing and if there are any complications.
3. You need to visit the hospital three months after the removal of sutures. 

o Consult a Doctor?

Like with other surgeries, pilonidal flap surgeries may also have certain complications. 

You should not wait for the follow-up visit date if you are experiencing complications due to surgery. Some of the most common complications with pilonidal lap surgery are:

1. Wound separation
2. Infection
3. Hematoma
4. Flap necrosis
5. Seroma formation