Pilonidal Sinus Flap Surgery

Pilonidal sinus flap surgery is a common procedure, carried out by the best pilonidal sinus surgeons in India to deal with a cyst or abscess near the tailbone. The advanced pilonidal treatment options involve removing the affected tissue and closing the wound using a skin flap, significantly reducing recurrence.

Pilonidal sinus flap surgery is a common procedure, carried out by the best ... Read More

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Dr. Milind Joshi

MBBS, MS - General Surgery

26 Yrs.Exp.

4.9/5

26 Years Experience

Kimaya Clinic, 501B, 5th floor, One Place, SN 61/1/1, 61/1/3, near Salunke Vihar Road, Oxford Village, Wanowrie, Pune, Maharashtra 411040

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Dr. Amol Gosavi

MBBS, MS - General Surgery

26 Yrs.Exp.

4.7/5

26 Years Experience

1st floor, GM House, next to hotel Lerida, Majiwada, Thane, Maharashtra 400601

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Dr. Dhamodhara Kumar C.B

MBBS, DNB-General Surgery

26 Yrs.Exp.

4.5/5

26 Years Experience

PA Sayed Muhammed Memorial Building, Hospital Rd, opp. Head Post Office, Marine Drive, Ernakulam, Kerala 682011

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Dr. Raja H

MBBS, MS, DNB- General Surgery

25 Yrs.Exp.

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What is Pilonidal Sinus Flap Surgery?

Pilonidal sinus flap surgery is a surgical technique opted to effectively treat pilonidal disease, a condition characterised by the presence of a cyst or abscess near the tailbone. The pilonidal disease can be quite painful and if not treated appropriately, it has a tendency to recur. The surgery involves the removal of the affected tissue and subsequently closing the wound with a flap constructed from your skin. This method significantly diminishes the risk of recurrence.

The surgery is performed by experienced surgeons in an operation theatre (OT) on an outpatient department (OPD) basis, which means you can return home post-procedure. Pilonidal sinus flap surgery is remarkably common and is generally considered safe with a high success rate in India.

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Types Of Pilonidal Sinus Flap Surgery

There are various techniques utilised in performing pilonidal sinus flap surgery, each with its unique approach and benefits:

Limberg Flap Surgery: This technique involves creating a diamond-shaped incision to excise the affected area. A skin flap from the nearby buttock is then rotated into position to cover the defect. This method has a low recurrence rate (around 2%) and is especially effective for extensive or recurrent cases of pilonidal disease.
Karydakis Flap: Here, the pilonidal sinus is excised and the wound is closed with a skin flap shifted laterally away from the midline. This technique aims to flatten the natal cleft, lessening moisture build-up and hair growth in the area, thus reducing recurrence.
Z-Plasty: In Z-plasty, triangular flaps are made on either side of the midline after removal of the sinus tract. These flaps are then repositioned to fill the cavity left by the removed tissue. This technique helps in achieving better aesthetic outcomes while also reducing tension on the wound edges.
Fasciocutaneous Flaps: This includes techniques like elliptical rotation flaps and gluteus maximus fasciocutaneous flaps, which use a larger area of skin and tissue beneath to cover the defect. These techniques are beneficial for larger defects and can provide robust coverage with good blood flow.
Elliptical Rotation Flap: Similar to other flap techniques, this method involves excising the sinus and using an elliptical piece of skin to close the wound. It allows for a tension-free closure, which can facilitate faster healing and reduce complications.

Diagnosis Before Pilonidal Sinus Flap Surgery

Before proceeding with pilonidal sinus flap surgery in India, it is crucial to correctly diagnose the condition. The diagnosis is typically made during a clinical examination by looking for characteristic signs and symptoms in the sacrococcygeal region. The best pilonidal sinus surgeons in India may use the following methods:

Symptoms: The patient usually presents with pain, swelling, and discharge from the affected area. The nature of the discharge may be serous, purulent, or bloody, especially if there is an infection.
Physical Examination: The presence of small pits or sinus tracts in the natal cleft is a significant indicator of pilonidal disease. An acute pilonidal abscess may be noted as a swollen, tender mass.
Patient History: Risk factors such as gender (male), age (15 to 45 years old), hirsutism or prolonged sitting, help in assessing the likelihood of pilonidal disease.
Imaging: MRI may be required in complex cases to delineate the extent of the disease and assist with surgical planning.

Procedure For Pilonidal Sinus Flap Surgery

Pilonidal sinus flap surgery is one of the advanced pilonidal treatment options in India that involves several steps:

Preoperative Preparation: Patients are advised on hygiene and may have to undergo hair removal in the affected area before surgery.
Anaesthesia: This procedure can be performed under local or general anaesthesia, depending on the complexity of the case and patient preference.
Surgical Technique: Here, an incision is made to remove the pilonidal sinus and any infected tissue. The type of flap used (e.g., Limberg flap, Karydakis flap) determines how the wound is closed. A skin flap from adjacent areas is prepared and moved to cover the excised area. This reduces tension on the wound edges, promoting better healing.
Closure: The flap is sutured into place, ensuring adequate coverage of the defect while minimising tension across the natal cleft’s midline.
Postoperative Care: Patients are guided on wound care, including keeping the area clean and dry. Follow-up appointments are scheduled to monitor the healing process and detect any signs of recurrence early.

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Who Is The Right Candidate For Pilonidal Sinus Flap Surgery?

The eligibility for pilonidal sinus flap surgery varies from person to person. However, certain factors influence a patient’s suitability for this procedure:

Symptoms: Patients experiencing discomfort, swelling, or discharge from the sacrococcygeal region may be suitable candidates for this surgery.
Physical Examination: The presence of small pits or sinus tracts in the natal cleft indicates pilonidal disease severity confirming the need for surgery.
Patient History: Individuals falling into high-risk categories – males aged 15 to 45 years, or those having hirsutism or prolonged sitting habits – are considered suitable candidates.
Imaging Results: Cases showing complex disease extent through MRI imaging may require surgical intervention.

Benefits Of Pilonidal Sinus Flap Surgery

Pilonidal sinus flap surgery in India is being recognised for its numerous benefits when compared to traditional surgical methods. These benefits include:

Reduced Recurrence Rates: Flap surgery, including the Limberg flap technique, has a lower recurrence rate compared to traditional excision methods.
Quick Healing Time: Use of a flap encourages faster healing due to better wound coverage and decreased tension on the surgical site.
Shorter Hospital Stay: Patients typically spend less time in hospital post-surgery, often around 5-6 days.
Early Return to Daily Activities: Patients can return to work and resume their normal activities sooner than with other methods, often within just 1-3 weeks.
Improved Aesthetic Outcomes: Better cosmetic results can be achieved with flap techniques, as they help minimise scarring in the midline.

How To Prepare For Pilonidal Sinus Flap Surgery?

Once you’ve decided to undergo a pilonidal sinus flap surgery in India, it’s important to prepare thoroughly. Here is what you need to do:

Consultation: Schedule a detailed consultation with a colorectal surgeon to discuss the procedure, risks, and expected outcomes.
Preoperative Instructions: Follow specific guidelines provided by your surgeon. These may include avoiding blood thinners (like aspirin) before surgery, maintaining good hygiene in the affected area and arranging transportation for after the procedure.
Dietary Adjustments: Some surgeons may recommend dietary changes leading up to the surgery to reduce bowel movements on the day of the procedure.

Recovery Tips and Precautions To Follow After Pilonidal Sinus Flap Surgery

Recovery after a pilonidal sinus flap surgery is crucial. Following your surgeon’s instructions carefully can make a big difference in your healing process. Here are some general tips:

Wound Care: Keep the surgical area clean and dry. Follow specific instructions regarding dressing changes and bathing.
Pain Management: Use prescribed pain relief medications as needed and report any severe pain to your healthcare provider.
Activity Restrictions: You should avoid strenuous activities, heavy lifting, or prolonged sitting for several weeks as advised by your surgeon.
Follow-Up Appointments: Make sure to attend all scheduled follow-up visits to monitor healing and address any concerns early.

Complications Associated With Pilonidal Sinus Flap Surgery

Like any surgical procedure, pilonidal sinus flap surgery also carries some risks. It is important to discuss these potential complications with your doctor before the surgery. Potential risks or complications associated with this procedure include:

Infection: There is a risk of infection at the surgical site, as with any surgical procedure.
Flap Complications: Flap necrosis (death of tissue) or poor blood supply to the flap are rare but possible complications.
Seroma or Hematoma Formation: Fluid accumulation or blood collection under the skin can occur post-surgery but usually resolves with proper care.
Recurrence: Even though flap surgeries have lower recurrence rates, there’s still a possibility that pilonidal disease may return.

Frequently Asked Questions

Does pilonidal sinus flap surgery in India have a good success rate?

Pilonidal sinus flap surgery in India, especially when conducted by some of our best pilonidal sinus surgeons, has a high success rate. However, the exact percentage can vary based on several factors such as the surgeon’s expertise, the patient’s overall health, and post-operative care.

What happens if a pilonidal sinus is left untreated?

If left untreated, a pilonidal sinus can lead to complications such as abscess formation and cellulitis. In rare instances, it can also develop into a type of skin cancer called squamous cell carcinoma. Therefore, it’s essential to seek medical help as soon as you notice symptoms.

How long does the pilonidal sinus flap surgery take?

The duration of the procedure may vary depending on the complexity of the condition and the technique used by the surgeon. On average, it can take between one to two hours.

Can a pilonidal sinus recur after surgery?

Yes, there is a risk of recurrence after surgery, but this likelihood is significantly reduced with advanced pilonidal treatment options like flap surgery and proper post-operative care.

Can I resume normal activities immediately after surgery?

Post-surgery recovery time can differ for every individual. Typically, you may need to refrain from strenuous activities for a few weeks following the operation. Your doctor will provide you with specific instructions based on your health condition.

How painful is the recovery from pilonidal sinus flap surgery?

After surgery, you may experience some pain and discomfort in the operated area. This pain can be managed with medications prescribed by your doctor.

Will I have a visible scar after the surgery?

While surgical procedures leave some degree of scarring, flap techniques are designed to minimise visible scarring. Over time, these scars usually fade and become less noticeable.

How does pilonidal sinus flap surgery compare to traditional methods?

Flap surgery for pilonidal sinus is a more advanced treatment option that boasts lower recurrence rates and quicker recovery times compared to traditional methods. It’s crucial to discuss with your doctor about the best treatment plan for your specific condition.

Can I get infected after the surgery?

While every surgical procedure has a risk of infection, taking prescribed antibiotics and following post-operative care instructions diligently can significantly minimise this risk.

Is there any dietary restriction after undergoing pilonidal sinus flap surgery?

After the surgery, your doctor may recommend a diet rich in fibre to ease bowel movements and reduce pressure on the operated area. It’s important to follow this dietary guideline for a smoother recovery.

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Medically Reviewed By

Dr. Milind Joshi

26 Years Experience Overall

Last Updated : April 11, 2025

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