Clinical Science Is oval flap reconstruction a good modification for treating pilonidal sinuses? Cafer Polat, M.D.*, Bulent Gungor, M.D., Servet Karagul, M.D., Sercan Buyukakıncak, M.D., Koray Topgul, M.D., Kenan Erzurumlu, M.D. Department of Surgery, Ondokuz Mayis University, School of Medicine, Kutupelit, 55139 Samsun, Turkey Abstract BACKGROUND: Flap techniques are acceptable for the surgical treatment of pilonidal sinuses. This study assessed a new modification of the rhomboid flap technique. METHODS: The study included 133 patients with pilonidal disease who were treated between April 2004 and April 2009. The pilonidal sinus was removed with an oval excision, and an oval head rhomboid flap was prepared to reduce flap necrosis. RESULTS: The mean age of the patients was 27.4  4.6 years (range, 13– 80). The rate of minor postoperative complications was 11.3%. The mean hospital stay was 2.3  .8 days (range, 1– 6). The rate of recurrence was 1.5%. Regarding cosmetic results, 116 (87%) patients were very pleased, 15 (11.2%) were pleased, and 5 (3%) were displeased. The mean follow-up period was 22.5  12.4 months (range, 5–57). CONCLUSIONS: The oval flap reconstruction method is a recommended procedure that produces fewer ischemic flaps with a low rate of recurrence and acceptable cosmesis. © 2011 Elsevier Inc. All rights reserved. KEYWORDS: Pilonidal sinus; Oval excision of pilonidal sinus; Oval flap reconstruction Pilonidal sinus is a common disease, occurring in .7% of the population. It typically affects young males after puberty. 1–4 There is controversy over whether it is congen- ital or acquired although it is generally accepted as being acquired. Suspected etiologic factors include poor hygiene, a hairy sacral area, local trauma, chronic local irritation, a deep natal cleft, and obesity. 5 Pilonidal sinus is one of the most recurrent diseases after surgery. Thus, many surgical techniques have been re- ported, but none of them solves the recurrence problem completely or provides satisfactory postoperative comfort. As recently reported, sinus excision and flap reconstruc- tion is the preferred surgical technique. 6–9 Excision and flap reconstruction are necessary for large tissue defects. How- ever, ischemia and necrosis at the corner of the distal part of the flap negatively affect wound healing and cause cosmetic problems. 10 –12 Another problem with flap reconstruction is recurrence, occurring in the median line in the area nearest the anal region. 13 In this study, we used an oval excision to remove the pilonidal sinus and prepared an oval head rhomboid flap to reduce flap necrosis. We placed the flap exactly in the midline, but with the inferior part near the anus placed slightly laterally, to decrease the risk of recurrence at the inferior corner. Material and Methods The study enrolled 133 patients with pilonidal disease who were treated between April 2004 and April 2009. * Corresponding author. Tel.: +90-362-312-1919; fax: +90-362-457- 6041. E-mail address: caferpolat@omu.edu.tr Manuscript received October 16, 2009; revised manuscript January 10, 2010 0002-9610/$ - see front matter © 2011 Elsevier Inc. All rights reserved. doi:10.1016/j.amjsurg.2010.01.025 The American Journal of Surgery (2011) 201, 192–196