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This highlights containing video demonstrates the surgical technique of a Dufourmentel flap for the treatment of pilonidal sinus disease. The procedure involves excision of the pilonidal sinus tract and involved tissue, followed by reconstruction using a rhomboid-based Dufourmentel advancement flap. The flap is designed and mobilized to achieve tension-free wound closure while shifting the final scar away from the natal cleft.
The video highlights the key steps of flap design, excision of the diseased tissue, flap elevation and mobilization, meticulous hemostasis, and tension-free flap fixation. This technique provides effective wound coverage and aims to reduce midline tension and the risk of recurrent pilonidal disease.
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
Lieto E, Castellano P, Pinto M, Zamboli A, Pignatelli C, Galizia G. Dufourmentel rhomboid flap in the radical treatment of primary and recurrent sacrococcygeal pilonidal disease. Dis Colon Rectum. 2010;53(7):1061-1068. doi:10.1007/DCR.0b013e3181defd25.
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.
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