The Incomplete V-Y Flap: A Useful Design Modification of the Conventional V-Y Flap Exampled With a Case Series of Pilonidal Sinus Excision Defects.

Abstract: Pilonidal disease is relatively common and can be particularly comorbid for patients, especially in circumstances of chronic abscess or sinus formation. Excision of such disease can require flap reconstruction, one of the most common types being V-Y advancement flap. We present a modification of the V-Y flap that leaves incompletely incised distal edges that theoretically will help to avoid flap tip necrosis while allowing sufficient tissue mobility. Five male patients underwent 7 operations to excise their pilonidal disease with reconstruction using the incomplete V-Y technique modification over a 4-year period. Two patients had further operations due to development of additional disease adjacent to the prior operating site. There were no incidents of wound dehiscence or flap tip necrosis. No admission was required for postoperative complications, and no revisional surgery was necessary. Subjectively, there were no issues raised by patients regarding scar appearance. This V-Y flap modification appears to be safe and reliable in terms of complication rate and flap tip preservation following pilonidal disease excision surgery. In addition, it does not compromise the ability to perform sufficient soft tissue cover in such cases.