Kaplan Mehmet, Ozcan Onder, Bilgic Ethem, Kaplan Elif Tugce, Kaplan Tugba, Kaplan Fatma Cigdem
Department of General Surgery, Bahcesehir University (BAU) School of Medicine, İstanbul, Turkey.
Department of General Surgery, Sitki Kocman University School of Medicine, Mugla, Turkey.
Am J Surg. 2017 Nov;214(5):811-819. doi: 10.1016/j.amjsurg.2017.02.008. Epub 2017 Mar 9.
The Limberg flap (LF) procedure is widely performed for the treatment of sacrococcygeal pilonidal sinus (SPS); however, recurrences continues to be observed. The aim of this study was to assess the relationship between LF designs and the risk of SPS recurrence.
Sixty-one cases with recurrent disease (study group) and 194 controls, with a minimum of 5 recurrence-free years following surgery (control group), were included in the study. LF reconstructions performed in each group were classified as off-midline closure (OMC) and non-OMC types. Subsequently, the 2 groups were analyzed.
After adjustment for all variables, non-OMC types showed the most prominent correlation with recurrence, followed by interrupted suturing type, family history of SPS, smoking, prolonged healing time, and younger age. The best cut-off value for the critical distance from the midline was found to be 11 mm (with 72% sensitivity and 95% specificity for recurrence).
We recommend OMC modifications, with the flap tailored to create a safe margin of at least 2 cm between the flap borders and the midline.
Limberg皮瓣（LF）手术广泛用于治疗骶尾部藏毛窦（SPS）；然而，复发情况仍时有发生。本研究旨在评估LF设计与SPS复发风险之间的关系。
本研究纳入了61例复发病例（研究组）和194例对照，对照组术后至少有5年无复发（对照组）。每组进行的LF重建分为中线外闭合（OMC）和非OMC类型。随后，对两组进行分析。
在对所有变量进行调整后，非OMC类型与复发的相关性最为显著，其次是间断缝合类型、SPS家族史、吸烟、愈合时间延长和年龄较小。从中线起的临界距离的最佳截断值为11毫米（对复发的敏感性为72%，特异性为95%）。
我们建议对OMC进行改良，根据皮瓣进行调整，使皮瓣边界与中线之间形成至少2厘米的安全边缘。
