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Background: There are controversies about the etiology and management of recurrent pilonidal sinus. The numbers of techniques are testament in treating pilonidal sinus (PNS) and no single procedure is superior in all aspects. Aim of the study: The aim of this study was to compare two operative procedures (modified Limberg flap versus Z plasty flap) in management of recurrent pilonidal sinus, regarding their complications including recurrences of the disease, morbidity, hospital stay, day off work and postoperative complications. Patients and methods: This is comparative prospective study between modified Limberg flap and Z plasty flap in treatment of recurrent pilonidal sinus. 30 patients were divided into 2 groups: Group (1) treated with modified Limberg flap and group (2) treated with Z plasty, and we followed up the patients in both groups for postoperative complications, hospital stay, day off work, recurrences, patients satisfactions. Results: Operative time, hospital stay duration, complete wound healing was longer in group (2) Z plasty group. Mobilization was early in MLF group than Z plasty group (1 day versus 2 days). Time to return to work, it was 14 (12 - 16) days in MLF groups and 18 (15 - 22) in Z plasty group (p Conclusion: Both of modified Limberg flap and Z-plasty technique are used to cause flattening of the natal cleft, thus reducing local recurrence rates. So, we recommend use of flap technique for recurrent pilonidal sinus patients; modified Limberg transposition flap is better than Z plasty flap, because of the less hospital stay time, early return to work, and cosmetically more accepted as it has less postoperative complications. Also Z plasty flap has a major limitation as it is difficult to apply if there is a wide defect in the horizontal axis.

A Modified Limberg Flap versus Z Plasty Flap Technique in Management of Recurrent Pilonidal Disease: A Comparative Prospective Study