In 1973, the Greek military physician G. Karydakis introduced a new surgical technique for the treatment of pilonidal cysts and tailbone fistulas, which is still performed under his name today. In developing his surgical technique, he referred to the research results of Patey and Scarff in the 1940s (see Z-plastic) that the pilonidal disease was by no means exclusively congenital, but rather predominantly due to hair that grows into the bottom fold and leads to a foreign object irritation under the skin, as a result of which inflammatory reactions can develop.
Karydakis´ technique is based on the idea of making the butt fold flatter through wound closure after cutting out the fistula system through the wound closure. This is to reduce the tendency of the hair to grow into the skin, thus minimizing the risk of renewed fistula formation. Another important aspect of the Karydakis´ technique is that the wound closure or skin suture is located to the side next to the bottom fold. This is intended to prevent the dreaded wound healing disorders that can be triggered, for example, by the midline suture.
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| Karydakis Technique |
In the Karydakis technique, the soft tissues are cut out asymmetrically and ovally, taking along the fistulas. The soft tissue defect is then covered by a tissue flap that is mobilized near the butt fold. After the procedure, the skin sutures lie next to the bottom fold, which is flatter than before the procedure.
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Karydakis published his experiences with the surgical technique named after him, which he performed on approximately 1700 patients, in 1973 in a renowned scientific journal. Wound healing disorders occurred in 8.5 % and recurrences (renewed fistula formation) in only 1.3 % of patients. Karydakis´ study, however, had one flaw: it could only examine 40 % of the patients so that there was a certain number of unreported cases of wound healing disorders and fistula recurrences. His follow-up work from 1992 is also not very credible: He claims to have observed a recurrence rate of < 1 % in 5876 operated patients, allegedly observed all (!) patients, whereby the follow-up period was 2 to 20 years.
Here you can see the performance of the surgery on a video. Warning, original surgical footage!
Nevertheless, the Karydakis technique has been adopted by many surgeons, correspondingly many field reports have been published. Particularly noteworthy is the 1996 study by Kitchen, which reported a credible rate of wound healing disorder of 9% and recurrent fistulas of 4% in 141 patients operated on after Karydakis. Over the last 15 to 20 years, recurrent fistulas between 0 and 6 % and a rate of wound healing disorders of 8 to 23 % after Karydakis surgery have been reported throughout.
In comparison with the Karydakis technique and other plastic procedures, e.g. Limberg plastic surgery, there are no significant differences in wound healing disorders and renewed fistula formation. The recurrence rate after Karydakis plastic surgery is low at 0 to 6% and wound closure allows a quick return to everyday life. If the restoration of a tailbone fistula is planned with a plastic procedure, the Karydakis sculpture can certainly be considered.
Literature sources:
Karydakis GE (1973) New approach to the problem of pilonidal sinus. Lancet 2:1414–1415
Karydakis GE (1992) Easy and successful treatment of pilonidal sinus after explanation of its causative process. Aust N Z J Surg 62:385–389
Lord PH, Millar DM (1965) Pilonidal sinus: a simple treatment. Br J Surg 52:298–300
Patey DH, Scarff RW (1946) Pathology of postanal pilonidal sinus; its bearing on treatment. Lancet 2:484–486
Kitchen PR (1996) Pilonidal sinus: experience with the Karydakis flap. Br J Surg 83:1452–1455
Akinci OF, Coskun A et al (2006) Surgical treatment of complicated pilonidal disease: limited separate elliptical excision with primary closure. Colorectal Dis 8:704–709
Bessa SS (2007) Results of the lateral advancing flap operation (modified Karydakis procedure) for the management of pilonidal sinus disease. Dis Colon Rectum 50:1935–1940
Bessa SS (2013) Comparison of short-term results between the modified Karydakis flap and the modified Limberg flap in the management of pilonidal sinus disease: a randomized controlled study. Dis Colon Rectum 56:491–498
Moran DC, Kavanagh DO et al (2011) Excision and primary closure using the Karydakis flap for the treatment of pilonidal disease: outcomes from a single institution. World J Surg 35:1803–1808
Morden P, Drongowski RA et al (2005) Comparison of Karydakis versus midline excision for treatmentof pilonidal sinus disease. Pediatr Surg Int 21:793–796
Sözen S, Emir S et al (2011) Are postoperative drains necessary with the Karydakis flap for treatment of pilonidal sinus? (Can fibrin glue be replaced to drains?) A prospective randomized trial. Ir J Med Sci 180:479–482
Arslan K, Said Kokcam S et al (2014) Which flap method should be preferred for the treatment of pilonidal sinus? A prospective randomized study. Tech Coloproctol 18:29–37
Aslam MN, Shoaib S et al (2009) Use of Limberg flap for pilonidal sinus-a viable option. J Ayub Med Coll Abbottabad 21:31–33
Ersoy E, Devay AO et al (2009) Comparison of the short term results after Limberg and Karydakis procedures for pilonidal disease: randomized prospective analysis of 100 patients. Colorectal Dis 11:705–710
