Duformental Flap for Repair of Pilonidal Sinus

The patient was placed prone and the operative field was prepared. The pilonidal sinus and involved tissue were identified and excised completely within a rhomboid incision. A Dufourmentel flap was designed and raised from the right gluteal region, preserving its vascularity. The flap was mobilized and transposed to cover the defect without tension or twisting. Hemostasis was secured, the wound was irrigated, and a drain was placed. The wound was then closed in layers, achieving an off-midline closure with flattening of the natal cleft and a viable, tension-free flap.

Primary pilonidal sinus
Recurrent pilonidsl sinus
Extensive multiple tracts
Large defect after sinus excision

Acute pilonidal abscess

Severe systemic illness

Inability to comply with postoperative wound care

Standard general surgical instrument set.
Scalpel and electrocautery.
Tissue forceps and scissors.
Needle holders.
Suction and irrigation.
Surgical marking pen.
Appropriate retractors.
Absorbable sutures for deep tissue fixation.
Non-absorbable or absorbable sutures for skin closure.
Closed-suction drain when indicated.

Prone position with adequate padding of pressure points.

Buttocks gently separated with adhesive tape to expose the natal cleft.

The operative field is prepared and draped in the standard sterile fashion.

Spinal or general anesthesia may be used depending on the patient and extent of surgery.

Complete history and physical examination.

Assessment of the number and extent of sinus openings and previous operations.

Evaluation for acute infection or abscess.

Routine pre-anesthetic assessment.

Routine laboratory investigations according to patient comorbidities and institutional protocol.

Preoperative hair removal out of the operative field according to local protocol.

Informed consent including recurrence, wound complications, seroma and flap-related complications.

intergluteal cleft.

Sacrococcygeal region.

Midline pilonidal sinus openings.

Lateral sinus openings or extensions.

Sacral fascia.

Gluteus maximus fascia.

Surrounding gluteal skin and subcutaneous tissue

Seroma.

Hematoma.

Surgical-site infection.

Wound dehiscence.

Partial flap necrosis.

Complete flap loss, although uncommon.

Persistent pain or sensory changes.

Delayed wound healing.

Recurrence of pilonidal disease.

Cosmetic dissatisfaction.

No conflicts to disclose

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Theodoropoulos GE, et al. The evaluation of a modified Dufourmentel flap after S-type excision for pilonidal sinus disease. ScientificWorldJournal. 2013;2013:160791. doi:10.1155/2013/160791.

Manterola C, Barroso M, Araya JC, Fonseca L. Pilonidal disease: 25 cases treated by the Dufourmentel technique. Dis Colon Rectum. 1991;34(8):649-652. doi:10.1007/BF02050344.

Hasse FM, Rademacher C, Bingham K, Löhlein D. The Dufourmentel flap-plasty for treatment of chronic pilonidal sinus. Chirurg. 1998;69(6):663-666. doi:10.1007/s001040050472.

Topgül K. Surgical treatment of sacrococcygeal pilonidal sinus with rhomboid flap. J Eur Acad Dermatol Venereol. 2010;24(1):7-12. doi:10.1111/j.1468-3083.2009.03350.x.