The aim of this study is to evaluate the effectiveness and feasibility of Limberg and Karydakis flap in complicated and recurrent cases of pilonidal sinus. This study was performed on 54 patients with complicated or recurrent (PSD) who referred to Minya University Hospital from January 2018 to January 2019. Patients were randomly divided into two groups, group A who were subjected to the Limberg flap and group B who were subjected to the Karydakis flap technique. Regarding postoperative complications, the occurrence of wound breakdown in the Karydakis group was 40.7 versus 11.1 in the Limberg group. No recurrence occurred in the Limberg group but recurrence observed in six cases in the Karydakis group. In the Karydakis group, eight patients had infection in comparison to one case in the Limberg group. All these differences were statistically significant. The overall patient satisfaction in the Limberg group was significantly higher than that in the Karydakis group. It is concluded that Limberg flap rotation is clearly preferred in management of recurrent and complicated PNS for safety reasons given its low recurrence and postoperative complication rates.
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