✦ PILONIDAL SINUS · OFF-MIDLINE FLAP

Limberg Flap Reconstruction

Q: Is the Limberg flap suitable for first-time pilonidal sinus surgery?

Yes — the Limberg flap is suitable for both first-time and recurrent operations, especially for complex multi-tract disease or deep natal cleft anatomy.

Q: How is recovery after Limberg flap surgery?

Sutures removed at 10–14 days. Return to desk work in 2–3 weeks. Strenuous physical activity restricted for 4–6 weeks.

Q: What if the Limberg flap fails or partially breaks down?

Minor wound edge separation is managed by dressings and heals secondarily. If recurrence occurs, repeat flap surgery or EPSiT can be considered.

Rhomboid excision with rotational flap — gold standard for recurrent or complex pilonidal sinus with under 5% recurrence.

60–120 Min TREATMENT DURATION

2–3 Days CARE SETTING

Reconstructive APPROACH

2–3 Weeks RECOVERY TIMELINE

What is Limberg Flap Reconstruction?

The Limberg flap (rhomboid flap) excises the entire pilonidal sinus complex and covers the defect with a rotational skin flap from the adjacent buttock. By moving the scar off-midline and flattening the natal cleft depth, the Limberg flap eliminates the anatomical cause of recurrence — achieving under 5% recurrence versus 15–20% with simple midline excision. Dr. Tagore Mohan Grandhi performs Limberg flap reconstruction for recurrent or complex pilonidal sinus disease. Post-operative laser hair removal is performed at 6 weeks to provide additional long-term protection against recurrence.

Suitable for patients with recurrent pilonidal sinus after previous surgery, complex multi-tract disease, deeply natal-cleft anatomy, or any pilonidal sinus where the recurrence risk with primary closure is unacceptably high.

How the Procedure Works

Rhomboid Excision Design

Pilonidal sinus area marked as a rhomboid. Flap designed from buttock skin with adequate vascular base.

Rhomboid Excision

Entire pilonidal sinus complex excised within the rhomboid to presacral fascia. Complete haemostasis.

Flap Elevation

Rhomboid skin and subcutaneous flap elevated from the adjacent buttock to fill the excision defect.

Off-Midline Inset

Flap inset off-midline — scar placed away from the cleft depth and secured with sutures over a drain.

Suture Removal

Sutures removed at 10–14 days. Post-operative laser hair removal at 6 weeks. Return to desk work in 2–3 weeks.

Outcomes

60–120 MinTREATMENT DURATION

2–3 DaysCARE SETTING

ReconstructiveAPPROACH

2–3 WeeksRECOVERY TIMELINE

Who Needs This Treatment?

→Under 5% recurrence — dramatically lower than 15–20% with simple midline excision
→Flattens natal cleft depth — eliminates the anatomical cause of recurrence
→Off-midline scar placement away from mechanical stress of the cleft
→Excellent cosmetic result — vascularised, tension-free flap closure

The Limberg flap is the most effective surgical option for pilonidal sinus — under 5% recurrence by eliminating the natal cleft depth that drives the problem. For recurrent or complex disease, it gives patients a definitive solution.

— Dr. Tagore Mohan Grandhi, Senior Consultant Gastrointestinal Surgeon, Lux Hospitals, Hyderabad

Common Questions

Frequently Asked Questions

Is the Limberg flap suitable for first-time pilonidal sinus surgery?+

How is recovery after Limberg flap surgery?+

What if the Limberg flap fails or partially breaks down?+

Not sure which treatment is right for you?

Book a consultation with Dr. Tagore Grandhi and get a personalised treatment plan.

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