Modified parasacral flap for pilonidal sinus disease: an easier reproducible option

INTRODUCTION: Pilonidal sinus disease (PSD) is an acquired chronic infection that commonly involves the natal cleft, is difficult to treat and has high recurrence after surgery. The parasacral perforator flap is a useful and effective flap for coverage after excision of disease. However, it requires technical expertise and specialised equipment. We have modified the technique by leaving the base of the flap, the perforator and surrounding tissue and fat intact, making the procedure easier for general or plastic surgeons to perform. METHODS: We included 20 consecutive patients with PSD who underwent surgical reconstruction with this technique between November 2014 and January 2022. RESULTS: All patients were male, with a mean age of 28.35 years. Average flap size was 5 × 11.75cm. In all cases, perforators were found at the 12 o'clock and 1 o'clock positions. All the flaps survived entirely. There were minor complications in two patients, which were managed conservatively. Mean follow-up was 8.65 months. None of the patients had recurrence at final follow-up. CONCLUSIONS: In patients with PSD, our modification of the parasacral perforator flap is useful for reconstruction. The procedure is easy to perform and does not require specialised equipment or microvascular and perforator dissection expertise.