Lecturer
Department of Shalya Tantra
Kala Ashram Ayurved Medical College and Hospital
Gogunda, District Udaipur (Rajasthan)

LIMBERG’S FLAP/RHOMBOID FLAP RECONSTRUCTION PROCEDURE FOR SACRO-COCCYGEAL PILONIDAL SINUS-  A SINGLE CASE STUDY PUBLISHED IN INTERNATIONAL AYURVEDIC MEDICAL JOURNAL(IAMJ); ISSN:-23205091; IMPACT FACTOR:5.344; April 2020 (Volume VIII, Issue 4)

ABSTRACT:

Pilonidal sinus disease is infective origin and occurs in sacral region between the buttocks. It is epithelium lined tract, situated short distance behind the anus, containing hairs and unhealthy diseased granulation tissue. It is due to penetration of hairs through the skin into subcutaneous tissue. It forms unhealthy granulation tissue in the deeper plane. It is common in 20-30 years of age. It is common in males and mostly affects hairy men. Aacharya Sushruta has described a minimally invasive Para-surgical procedure Kshar-Sutra procedure for Nadivrana. Sushruta has also advocated Chedan Karma (Excision of PNS tract with lay open). This procedure is good, safe, less expensive, very less or no recurrence rate, less discomfort but prolonged recovery time and changing Kshar Sutra in every seven day. The most used surgical techniques for this disease excision and primary closure, Excision with healing by secondary intention (Lay opening of tract), Drainage with or without excision, Marsupialization. However, the recurrence rate or developing an infection of the wound after the operation is high. To prevent the recurrence rate and Chronicity various other techniques are brought into action. They are Karydaki’s flap, Bascom procedure and other procedures like Z plasty, V-Y fascio-cutaneous advancement flap, Crossed Triangular Flap, Rhomboid flap of Limberg’s. Limberg’s flap reconstruction procedure is a feasible procedure for the patients of Pilonidal sinus. This technique is performed in recurrent and complex PNS disease. Limberg flap reconstruction surgery has low recurrence rate and low complication rate and fast recovery. This is case study of 25 years old male patient complain of intermittent pain with swelling in Sacro-coccygeal region- 7 month and Blood stain pus discharge from lesion in Sacro-coccygeal area–4 month. Patient not given any previous history of surgical intervention. This patient was operated by Limberg’s flap /Rhomboid flap reconstructive procedure. Patient wound was healed primarily with minimal scarring and less postoperative pain, no flap necrosis, no seroma formation with any recurrence till the six months.