KEYSTONE FLAP VERSUS LIMBERG FLAP IN THE MANAGEMENT OF PILONIDAL SINUS: RANDOMISED CONTROL TRIAL

Abstract

Pilonidal sinus (PS) is a chronic inflammatory condition typically affecting the sacrococcygeal region, though it may occur in other body parts. First reported in 1833 and named in 1880, it is most common in young males, particularly those aged 15–30. The disease is often associated with hair insertion, friction, poor hygiene, obesity, and prolonged sitting. Though earlier theories suggested a congenital origin, current evidence supports an acquired pathogenesis. PS commonly presents as painful midline pits, sometimes forming abscesses or sinus tracts. Differential diagnoses include perianal abscesses and hidradenitis suppurativa. Management strategies range from conservative approaches like shaving, phenol injections, and PRP to surgical excision and flap techniques. Among surgical methods, off-midline closure (e.g., Karydakis, Limberg, and Keystone flaps) shows reduced recurrence. The choice of treatment depends on disease complexity, with goals of minimizing morbidity, ensuring faster healing, and maximizing patient satisfaction and return to normal function.AIM OF WORK:This study aims to compare the Keystone Flap (KSF), & the Limberg Flap (LF) approaches, in terms of intra-op time, intra-op bleeding, and early post-op complications like Seroma, Hematoma, Flap Necrosis, Hospital Stay, Wound Dehiscence, Recurrence and Scar Characteristics within a 6 months follow-up period.Secondary outcome includes complete wound‐healing time, duration of the incapacity to work, quality of life and/or patient satisfaction (graded from 1 to 5, with 1 being the least satisfied and 5 being the most satisfied), postoperative pain, wound infection, bleeding or hematoma, skin wound complications, and duration of hospital stay.