Available online 28 August 2022, 100914

Pilonidal sinus disease is a chronic inflammatory condition typically found in the sacrococcygeal region. It is caused by loose hair penetrating natal cleft skin. Treatment of symptomatic disease is surgical. There is a lack of consensus on the ideal surgical technique.

The Karydakis flap involves asymmetric excision of the disease and closing the wound off midline with a lipocutaneous flap to flatten the natal cleft. The procedure has evolved since its description in 1968 and currently entails two layered fat closure, thin flap, displacement of the caudal apex, avoidance of routine drainage and the use of absorbable skin sutures. Its design and execution remain straight forward with a short learning curve.

Out of 1029 type 4 Karydakis flaps reviewed, 16% were complicated by wound dehiscence. Recurrence rate at a mean of 29 months follow-up was 1%.

By achieving a scar which is totally away from the midline, the Karydakis flap achieves a low recurrence rate. Minimizing early superficial dehiscence of the caudal wound remains a surgical challenge. The flap is suitable for all types of pilonidal disease.

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