Modified limberg flap technique in the treatment of. Primary closure or rhomboid excision and limberg flap for. International journal of case reports and images 2012. This flap became internationally known and was subsequently referred to as the limberg flap. Another incision is made in the skin to free up tissue from the buttock next to it.
The dufourmentel modification of the limberg flap advances in. Modified limberg flap technique in the treatment of pilonidal. In the operation, a diamondshaped incision cut is made to remove the affected skin and underlying tissue. We describe a simple system for marking up a patient for a limberg flap for pilonidal disease treatment. Excision and reconstruction with the limberg flap was performed in its classic form.
Sep 01, 2015 the flap necrosis after limberg flap is rare, and it varies from 0 to 3. Limbergs flap technique for pilonidal sinus disease. In this study, we report our clinical results with the mlf technique, performed on 94 patients. With this technique of flattening the natal cleft, a tensionfree. Donor areas were closed following the hemovac zimmer biomet drain. The limberg flap technique has several drawbacks including undesirable cosmetic. Rhomboid excision with limberg flap a novel treatment for pilonidal sinus 689 p j m h s vol. Modified limberg flap technique in the treatment of pilonidal sinus. Comparison of limberg flap and oval flap techniques in sacrococcygeal pilonidal sinus disease surgery. In this study, a design of four neighboring local limberg flaps to cover a moderate to large defect without using a skin graft is introduced. The limitations of the limberg, dufourmentel, and webster flaps are analyzed. The limberg flap was then rotated transposed from the gluteal fascia to the area excised. Comparison of limberg flap and oval flap techniques in.
The technique involves only the use of a ruler and produces a consistent marking for the flap. Becker advised this flap as very helpful technique for na. The aim of the present study is to compare the modified limberg flap versus the z plasty flap technique in the treatment of. This video gives in depth information about the limberg flap, the dufourmentel flap and the webster 30 degree angle flap. Akin et al classic and modified limberg flap 759 structed flap, incorporating the gluteal fascia, and the statistical analysis anatomic bands between the rectum and dermis of the the statistical software package spss statistical lower midline sulcus were fully mobilized on the. The limberg flap has proven useful to cover skin defects on face and other body parts after resection of different types of skin lesions. Revisiting the limberg flap for central midface reconstruction in. Comparison of limberg flap and tensionfree primary closure. Limberg flap reconstruction for sacrococcygeal pilonidal sinus. The rhomboid limberg flap is a transposition flap that, like the bilobed flap and the zplasty, depends on the pliability of the adjacent skin, which can be determined by pinching various areas between the thumb and forefinger 2. The rhomboid flap of limberg is a transposition flap that has been advocated for treatment of this condition. For a long time, this option for plastic surgical coverage was used mainly in facial and plastic surgery.
The great advantage of using local flaps on the face is the similarity of color and texture of the tissues to the location of the defect to be repaired. Rhomboid limberg flap, single or multiple, can be applied widely with extreme safety and good cosmetic results. Outline the preparation and technique required for rhombic flap reconstruction. One or two suction drains were placed beneath the flap as the situation figure 1. Alexander limberg created the limberg flap in 1946 to repair rhomboid defects. Rhomboid flap is a very versatile and robust flap, easy to master and practice, that can be tailored to suit the surgeons needs. Tension free flap transposition was obtained in all cases. Versatility of limberg flap in head and neck region. Original article open excision with secondary healing versus. Earlier, the open surgery technique was used for the treatment of pilonidal sinus. Post limberg or rhomboid flap status of wound after reconstruction and mobility of joint is shown.
Comparison of limberg flap and tensionfree primary. This surgical technique showed promising results with regards to less postoperative complications, short hospital stay and low. We analyzed the outcome of the tension free primary closure tf 1ry in comparison with the modified limberg flap mlf technique. For tension free primary closure after excision of the sinus tract with an elliptical incision, the skin and subcutaneous tissue were released 23 cm away from the incision line. In 8 patients with unilateral total and contralateral partial defects, a unilateral limberg flap was sutured to the opposing side so that scrotal tissue could be released. A limberg flap operation is a procedure for people who have either extensive or recurrent pilonidal disease. The flap must then be replaced alternative means of skin cover found.
Nov 30, 2014 while comparing both procedures one study found it to be 2. Rhomboid flap was first described by alexander limberg in 1946 as a transposition flap with a random blood supply and it was modified by dufourmentel in 1962 10 11. Walid and kaled 2012 compared open excision with secondary healing versus modified limberg flap and showed. Results the development rates of postoperative hematoma, wound separation, wound infection, and seroma were 2. The procedure is carried out under a general anaesthetic, where you will be fully asleep. Rhomboid excision and reconstruction by limberg flap described in 1990 by azab is associated.
This versatile skin flap combines the principles of rotation and advancement. Dufourmentel rhomboid flap for sacrococcygeal pilonidal. Subcutaneous pedicle limberg flap for facial reconstruction. Final view of limberg s flap 21 discussion in this study, all the patients were less than 40 years of age except one. Arslan k, said kokcam s, koksal h, turan e, atay a, dogru o tech coloproctol. Assessment of outcomes after limberg flap reconstruction for. Rhomboid flap excision demonstrated a trend towards less disease recurrence p 0. Having a limberg flap operation patient information. The aim of this retrospective study was to assess the effectiveness of the modified limberg flap technique for psd.
Limberg flap showed less convalescence and wound infection, while the. Modified limberg transposition flap in the treatment of. Final view of limberg s flap 21 discussion in this study, all. Modified limberg versus lateral advancement flaps in the surgical. A diamond rhomboid shaped piece of skin and underlying fat is removed and a plastic surgical type of procedure is used to mobilise a similarly shaped piece of skin from the. Undergoing pilonidal sinus surgery and perforatorbased flap. Pdf comparison of the classic limberg flap and modified.
Mar 03, 2021 in 8 patients with unilateral total and contralateral partial defects, a unilateral limberg flap was sutured to the opposing side so that scrotal tissue could be released. The limberg flap for pilonidal sinus was designed by limberg in 1946. Mar 14, 2021 rhomboid flap design with pictures how to design a rhomboid flap is a common clinical scenario in exams and surgical training. Limberg flap versus karydakis flap for treating pilonidal. May 23, 2016 a single limberg flap is used frequently on the face while for closure of small to medium defects. Nov 01, 2014 the deep layers of the limberg flap, the subcutaneous layer, and the skin were closed with 20 vicryl, 40 vicryl and 30 polypropylene, respectively fig. To evaluate the advantage of using a limberg flap to reconstruct facial defects. D, e four possible limberg flaps are drawn for each rhomboid defect. Limberg flap procedure for sacrococcygeal pilonidal sinus. Limberg flap this is a much more extensive procedure for people who either have extensive pilonidal disease or who have disease affecting both sides of the buttocks. Tensionfree primary closure compared with modified limberg flap. Conclusion the current published literature supports the use of the rhomboid flap excision and the limberg flap. Flap techniques including the limberg flap have become more popular in recent years. Subcutaneous tissue was sutured using polyglactin 910 20 suture and skin by silk 30 suture figure 1.
Comparision of the limberg flap with the vy flap technique. In 1984, azab 3 first adopted this transpositional flap for the treatment of pilonidal sinus disease. The investigators are introducing this treatment for recurrences of this illness in our clinic and want to analyse the feasibility, the results, the complications and the patients opinion. Apr 22, 2015 n295 karydakis flap limberg seroma formation 19. All the surgical procedures have their pros and cons. The use of multiple rhomboidal transposition flaps to close rhomboidal surgical defects is illustrated. Rhomboid excision and limberg flap for managing pilonidal sinus. A modified limberg flap was used to reduce the problems of skin maceration and recurrence associated with the conventional limberg flap technique. Eyedropshaped, modified limberg transposition flap in the.
Mar 22, 2021 limberg flap method for pilonidal sinus. The purpose of the surgery is to ensure resection of disease cancer, pilonidal and closure of the defect under minimal tension. C, d modi fied rhomboid excision and the limberg flap mlf m. Comparison of limberg flap and tensionfree primary closure during pilonidal sinus surgery. Limberg flap versus primary closure in the treatment of. Wplasty, limberg flap, rotation flap, gluteus maximus musculocutaneous flap, sacral adipofascial turnover flap, v y fasciocutaneous advancement flap and skin flap of the cleft lift procedure 2 3 9 11 12. The aim of the study was to compare the shortterm results of modified limberg flap transposition, a widely used technique in pilonidal sinus surgical treatment. Limberg flap in the treatment of pilonidal disease. Review of rhomboid flaps and their modern modifications. Abstract to present the use of limberg flap in the central midface. Rhomboid excision with limberg flap a novel treatment for. Any defect which can be as a parallelogram the long side of which is twice as long as the short side, angles of which are 6o, may be closed with 2 limberg flaps.
Original article, report by turkish journal of surgery. However, overall early postoperative complications occurred in the limberg flap group at a rate of 24. May 06, 2008 the investigators think, that the treatment of pilonidal sinus with excision and covering of the defect with a limberg flap is a very good treatment option. Primary closure or rhomboid excision and limberg flap for the. Comparison of modified limberg flap and karydakis flap. The current evidence is inconclusive as to which is the optimal technique. Comparison of the classic limberg flap and modified limberg flap in the treatment of pilonidal sinus disease.
Limberg flap technique is an effective procedure for pilonidal sinus disease associated with. In conclusion, i would propose that the rhomboid limberg flap, single or multiple, can be applied with extreme. In the context of our study on the limberg flap plasty with a homogenous group of 12 male patients, we measured the depth of the rima ani after the excision and we also. Akin m, gokbayir h, kilic k, topgul k, ozdemir e, ferahkose z.
Claude dufourmental modified limberg rhombic flap design in 1962, describing closure of defects with a. The medical records of 176 patients in whom the limberg flap lf or vy flap techniques were applied for reconstruction after the excision were evaluated retrospectively. Versatility of the limberg flap in reconstructions after. The patients were assigned consecutively by the closedenvelope technique to one of two groups. Pilonidal sinus disease with especial reference to limberg flap. Flap design in facial reconstruction is particularly del. The innovative design of the limberg flap allows for tension free closure of the. Modified limberg transposition flap in the treatment of pilonidal. Operative time was shorter by 7 minutes in the karydakis group than in the limberg group mean difference 7. The dufourmentel flap has a safer blood supply than the limberg flap because its base is wider 12. There are many types of flap, from simple to complex sometimes lasers are used to try and reduce the amount of hair around the sinus or wound whatever technique is used, it is important to minimise tension on any wound, flatten the natal cleft and avoid a midline scar. These patients were followed up postoperatively for a mean duration of 1 year. The bases of the triangles in flaps 2, 3, 5, and 8 do not follow the lme.
The subcutaneous tissue was closed twofold with 20 polyglactin sutures. Assessment of outcomes after limberg flap reconstruction. Pilonidal sinus disease with especial reference to limberg. Out of all the available procedures for surgery, the doctors considered the limberg flap procedure to be the most effective. The rhomboid flap of limberg is a transposition flap that has been advocated for treatment o f this condition. Limberg flap reconstruction for pilonidal sinus disease. To prepare the flap must determine the number of layers must be replaced, and the area of skin that will cover the defect. The limberg flap reconstruction and the karydakis flap reconstruction are the 2 most used offmidline closure techniques in pilonidal sinus surgery. The rate of development of seroma after limberg flap is 014. Pdf on oct 15, 2017, dr atul sharma published limberg flap repair. A the limberg rhombic design is based on designing a rhombus around the defect with angles of 60.
The procedure, rhomboid excision and limberg flap have less incidence of recurrence, less morbidity, less duration of hospital stay and good patient compatibility made the procedures popular and acceptable with minimal cosmetic disfigure. It is believed that this design is the geometric limit of multiple limberg flaps that can entirely cover a single large rhombic. May 01, 2015 ates et al compared limberg flap and karydakis flap operations in their 269case prospective randomized study in terms of cosmetics using vas score. In our hands it has been used in over 120 cases with no failures of rotation or flap necrosis. A modified limberg flap versus z plasty flap technique in. Controversy still exists regarding the best surgical technique. Undergoing pilonidal sinus surgery and perforatorbased.
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