Rhomboid (Limberg) Flap Repair for Complex Pilonidal Sinus at Geetanjali Multispeciality Hospital, Wai

Geetanjali Multispeciality Hospital
Dec 29, 2025
2 min read

Pilonidal sinus disease is a chronic inflammatory condition commonly affecting young males, especially those with dense hair in the sacrococcygeal region. Inadequate treatment often leads to high recurrence, prolonged morbidity, and patient dissatisfaction. Flap-based procedures, such as the Rhomboid (Limberg) flap, offer the most reliable long-term results, particularly in complex and multiple sinus disease. Patient Presentation

A 28-year-old young male presented to Geetanjali Multispeciality Hospital, Wai, with:

Multiple discharging sinuses in the sacrococcygeal region
Persistent symptoms for 2 months
Pain, discharge, and difficulty in daily activities

Clinical Examination & Diagnosis

On local examination:

Two sinus openings with surrounding hairy skin in the sacrococcygeal region
One additional opening located lower down in the intergluteal (inter-natal) cleft
Per rectal examination (PR) showed no internal rectal opening

Imaging

Ultrasonography showed communication between the upper two sinuses only
The lower opening showed no connection, resembling a fistulous tract
Based on clinical and radiological findings, a diagnosis of complex pilonidal sinus disease with multiple openings was made.

Treatment Planning & Surgical Rationale

Pilonidal sinus is notorious for recurrence when treated with:

Incision and drainage
Incomplete excision
Simple midline closure

Flap procedures such as:

Rhomboid (Limberg) flap
Karydakis flap
Z-plasty

are known to have very low recurrence rates, especially in complex and recurrent disease.

⚠️ Laser (SiLac) techniques show good outcomes only in simple, single-opening sinuses and are associated with higher recurrence in complex cases.

Considering the multiple openings and complexity, a Rhomboid / Limberg flap repair was planned.

Surgical Procedure

✔ Surgery performed under spinal anesthesia ✔ Complete excision of the upper two pilonidal sinus openings ✔ The lower opening was excised completely, similar to a fistulous tract ✔ Rhomboid (Limberg) flap was raised and transposed to cover the defect ✔ Off-midline closure achieved to prevent recurrence ✔ Closed suction drain placed

Anesthesia: Dr. Ulka Pol

Post-Operative Care & Recovery

Patient discharged on Post-Operative Day (POD) 3 with drain in situ
Strict advice for prone and lateral positioning only till POD 7
No supine position during early healing phase
Drain removed on POD 7
Sitting and supine positioning allowed thereafter
Sutures removed on POD 12

The patient showed excellent wound healing, minimal discomfort, and no complications.

Outcome & Clinical Significance

✔ Good wound healing ✔ Minimal post-operative pain ✔ Very low recurrence risk ✔ Early return to daily activities

Although temporary restriction of supine positioning causes mild inconvenience, flap procedures provide the best long-term results in pilonidal sinus disease.

Why Rhomboid (Limberg) Flap is the Gold Standard

Off-midline closure reduces tension
Flattens the natal cleft
Prevents hair re-entry
Excellent cosmetic and functional outcome
Lowest recurrence in complex pilonidal sinus cases

Advanced Surgical Care at GMH, Wai

Geetanjali Multispeciality Hospital, Wai, offers evidence-based surgical management for pilonidal sinus, including advanced flap reconstructions, ensuring low recurrence and high patient satisfaction, even in rural settings.