Pilonidal sinus: Karydakis procedure

GA
Prone
Buttocks strapped apart
Buttocks shaved fully
Methylene Blue inserted to outline track
IV antibiotics (cephazolin & metronidazole)
Aim is to lateralise the natal cleft
see photos for margins
Undercut the flap: 2cm wide, 1cm deep, the whole length of the wound
Use 2 layers of 0 vicryl to secure the flap with deep sutures. Follow the curvature of the sacrum. Sacral bites are closer together. Lower sutures are 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 then do second layer (undersurface of flap to halfway up other side
Avoid any suture hole or drain hole near midline
Padded dressing
Aim is well lateralised wound 2cm to left or right
Beware the difficult lower end where failures occur if wound reaches the midline
Undercut edge of flap if tending to invert

Post op
2 days RIB
Then drain out and home
Sutures out 10 days
Shave twice weekly one month only