No clear benefit was shown for open healing over surgical closure. A clear benefit was shown in favour of off-midline rather than midline wound closure. When closure of pilonidal sinuses is the desired surgical option, off-midline closure should be the standard management.
Open excision with secondary healing versus rhomboid excision with Limberg transposition flap in the management of sacrococcygeal pilonidal disease.
To compare the outcome of Open excision and secondary healing with rhomboid excision and Limberg flap in the management of sacrococcygeal pilonidal sinus disease (SPD).
                A prospective, analytical, comparative study using randomized controlled trial (RCT) was conducted at Liaquat University Hospital (Jamshoro) & Fatima Hospital-Baqai Medical University (Karachi), from June 2004 to July 2007. In total 49 patients, who either underwent open excision and secondary healing (group A: 25 patients) or rhomboid excision and Limberg flap (group B: 24 patients), were enrolled in the study. Duration of operation, postoperative pain, duration of hospital stay, postoperative complications, and time to recurrence were noted. The inclusion criteria were all patients with primary or recurrent SPD. The exclusion criteria were: cases with incomplete data and those lost to follow-up.
                Duration of operation was longer in group B patients (p = 0.004) but pain perception was markedly reduced in this group (p = 0.003). Total hospitalization period was shorter in patients in group B (p = 0.002) and so was the time for complete healing of the wound (p = 0.002). The recurrence rate was also significantly lower in patients who underwent Limberg rotation flap (p = 0.005).
                Limberg flap is advantageous over simple excision and secondary healing in the management of SPD.