Pilonidal sinus: Karyadakis

IV abx Keflin/Flagyl
Length 2.5-3x width
1.5-2cm off midline
3-4cm wide ellipse
Dont be tempted to take less laterally
(except at upper end)
Take more from lower end laterally to avoid a dog ear
(lower end where wound reaches midline is where failures occur)
Undercut flap (2cm wide, 1cm deep, full length of wound)
2 layers interrupted absorbable sutures
follow the curvature of the sacrum (sacral bites are closer together,, lower sutures almost horizontal)
Hold all sutures before tying and cutting
Suture base of flap to midline - assistant advances base across as knot tied
Insert 10Fr suction drain and then tie second layer
Second layer: undersurface of flap to halfway up other side
Avoid suture of drain hole in the midline
Undercut edge if flap tending to invert
LA
Padded dressing

Post op
2 days RIB
Then drain out and home
Sutures out 10days
to work 2-3/52
shave twice weekly one month only