Elliptical Midline Excision With Rectangular Flap Shows Low Complications in Pilonidal Sinus Study

Surgeons at a single tertiary referral center have reported encouraging results with a combined technique for pilonidal sinus disease, a common condition that develops in the cleft between the buttocks and can cause pain, drainage and repeated infections. In a retrospective analysis of 102 patients treated between February 2019 and February 2024, elliptical midline excision followed by tension-free rectangular advancement flap reconstruction produced a mean wound healing time of 9.1 ± 2.3 days and a mean return to normal daily activities of 11.6 ± 3.2 days.

The study, published in BMC Surgery, evaluated the clinical outcomes, effectiveness and safety of the procedure. The cohort consisted of 95 males, or 93.1% of the group, and 7 females, or 6.9%, with a mean age of 28.1 ± 5.8 years.

Complications were uncommon. The overall complication rate was 7.8%, corresponding to 8 of 102 patients, with a 95% confidence interval of 3.4% to 14.9%. The one-year recurrence rate was 4.9%, or 5 of 102 patients, with a 95% confidence interval of 1.6% to 11.1%. Notably, the researchers reported no flap necrosis and no major complication requiring reoperation, a key safety concern for any flap-based reconstruction.

The technique itself is straightforward in concept. Surgeons remove the diseased tissue through an elliptical incision centered on the midline, then reconstruct the defect by advancing a rectangular flap of nearby tissue into the wound without tension.

Diagnosis in the study was confirmed clinically and by routine preoperative ultrasonography, a step the authors used to verify the extent of disease before surgery. Patients were excluded if they had an acute abscess requiring drainage, uncontrolled comorbidities, or incomplete one-year follow-up. Those exclusions mean the reported results apply to a selected group of patients rather than to everyone presenting with the condition.

The retrospective design carries inherent limitations. Because the analysis looked back at records from a single center, there was no comparison group against which the technique could be measured, and the findings depend on the quality and completeness of the documented follow-up. The authors themselves emphasized that their conclusions should be confirmed by prospective comparative studies with longer follow-up.

Within those constraints, the numbers describe a favorable short-term picture. A mean healing time of just over nine days and a return to daily activities in under two weeks suggest a rapid recovery profile, while the absence of flap necrosis addresses one of the more serious potential drawbacks of flap reconstruction.

The reported combination of low complication and recurrence rates with quick recovery positions the elliptical excision and rectangular advancement flap approach as a candidate for more rigorous evaluation.

For now, the evidence comes from one center’s experience with a carefully defined patient group. The authors’ own conclusion is measured: the technique appears safe and effective in their cohort, providing low complication and recurrence rates together with rapid postoperative recovery, but prospective comparative studies with longer follow-up are needed before broader claims can be made.

Subject of Research: Surgical outcomes of elliptical midline excision with rectangular advancement flap reconstruction for pilonidal sinus disease

Article Title: Effectiveness and safety of elliptical midline excision and rectangular flap reconstruction in the treatment of pilonidal sinus disease: a retrospective study

Article References: Güreş, N., Fırat, M., & Uludağ, S. S. (2026). Effectiveness and safety of elliptical midline excision and rectangular flap reconstruction in the treatment of pilonidal sinus disease: a retrospective study. BMC Surgery. https://doi.org/10.1186/s12893-026-04286-0

Image Credits: AI Generated

DOI: 10.1186/s12893-026-04286-0

Keywords: pilonidal sinus disease, elliptical midline excision, rectangular advancement flap, retrospective study, wound healing, surgical complications, recurrence rate, tertiary referral center, postoperative recovery, BMC Surgery, Effectiveness, safety