Surgical outcomes of Limberg flap reconstruction for pilonidal disease: a five-case series and literature review

Pilonidal disease is a chronic inflammatory condition of the sacrococcygeal region associated with significant morbidity, wound complications and recurrence. Various surgical techniques have been described, with off-midline closure methods demonstrating improved outcomes. The Limberg flap is widely used because it enables wide excision, tension-free off-midline closure, and low reported recurrence rates. We present a case series of five patients with pilonidal disease treated with excision and Limberg flap reconstruction. Clinical presentation, operative management, postoperative complications, and follow-up outcomes were evaluated. All patients achieved complete wound healing. Three patients developed partial wound dehiscence, which healed by secondary intention with conservative management, and one patient developed a postoperative abscess requiring incision and drainage. No recurrence was documented during the available follow-up period, which ranged from 2 to 4 months. These findings support the Limberg flap as a feasible surgical option for pilonidal disease, including recurrent and complicated presentations, with satisfactory wound healing and manageable postoperative complications.