ACTA SCIENTIFIC MEDICAL SCIENCES (ISSN: 2582-0931) Volume 4 Issue 7 July 2020 Karydakis Flap Reconstruction for Pilonidal Disease Aybala Yildiz 1 , Alp Yildiz 1 *, Veysel Baris Turhan 2 , Engin Kucukdiler 3 and Erkan Karacan 3 1 Department of General Surgery, Yenimahalle Training and Research Hospital, Yildirim Beyazıt University, Ankara, Turkey 2 Department of General Surgery, Kecioren Training and Research Hospital, Ankara, Turkey 3 Department of General Surgery, Aydin State Hospital, Aydin, Turkey *Corresponding Author: Alp Yildiz, Department of General Surgery, Yenimahalle Training and Research Hospital, Yildirim Beyazıt University, Ankara, Turkey. Research Protocol Received: May 08, 2020 Published: June 22, 2020 © All rights are reserved by Alp Yildiz., et al. Abstract Keywords: Pilonidal Disease; Karydakis Flap; Complications Introduction The reported incidence rate of pilonidal disease is 25 per 100,000 people. Initially, the pathogenesis was considered to be congenital. Today, however, the theory that it is acquired is more widely accepted. Work by Georgios Karydakis who highlighted 3 main factors contributing to pilonidal disease had a pivotal role in this paradigm shift. As the primary treatment still surgery, we present our karydakis flap experience in this study. Fourty-four patients has enrolled for this study. All patients has diagnosed pilonidal sinus disease and treated by the same surgical team with Karydakis flap reconstruction. The most common post-operative complication was fluid collection. 2 patients developed fluid collection under the flap site which reduce spontaneously. No hemorrhagia has occurred. 1 patient developed wound infection. No hematoma, bleeding occurred and no need for secondary powder application. No flap necrosis occurred, also wound dehiscence and early recurrence were not found. When low recurrence rates, patient comfort and cosmetic results are evaluated together, Karydakis technique emerges a method that is preferred by physicians and patients. The reported incidence rate of pilonidal disease (PD) is 25 per 100,000 people. Initially, the pathogenesis was considered to be congenital [1,2]. Today, however, the theory that it is acquired is more widely accepted. Work by Georgios Karydakis [1,3,4] who highlighted 3 main factors contributing to pilonidal disease (loose hair, an external force that facilitates insertion of hair into the skin and an underlying vulnerability of natal cleft skin), had a pivotal role in this paradigm shift. The first 2 factors are related to per- sonal hygiene and lifestyle and their modulation can influence the initiation, development and recurrence of pilonidal disease [1-5]. Armstrong and Barcia [5] reported that improved hygiene, an ac- tive lifestyle and hair control in the natal cleft area decreased the need for surgical procedures and resulted in faster return to work. However, the third factor can be modified only surgically [1-5]. In this paper we present our experience of karydakis flap reconstruc- tion on pilonidal sinus disease management. Patients and Methods Fourty-four patients included this study. All patients has di- agnosed pilonidal sinus disease and treated by the same surgical team with Karydakis flap reconstruction. All patients underwent routine investigation before surgery. On premedication wide spec- trum antibiotics has used 30 minutes before surgery. All procedures performed under spinal anaesthesia in prone jack knife position. Methylene blue used to help visualisation of the sinus tracts. An elliptodi incision was made to excise the pilonidal sinus. The sharp ends of the ellipse has incised 3 cm away from the midline. The complex then excised full thickness to end of the sacral fascia with a straight edge on the side of flap mobilisation and a smooth edge on the other side. For bleeding control electrocautery (The Valleylab TM , Covidien, USA) and hemostatic powder (Aris- ta TM , Bard, USA/Oxicel Powder, Betatech Med, Istanbul, Turkey) -by applying and holding 2 minutes- used for flap side. If hemor- rhagia from flap side continues secondary application of powder then electrocauterisation planned. This is followed by mobilisation of the flap across the midline. 1-0 polyglactin sutures was used to put together the sacral fascia in the midline to the V junction of the flap. A hemovac drain was placed. A second layer of polyglactin su- tures used to secure the flap. Skin closed using 2-0 nylon mattress Citation: Alp Yildiz., et al. “Karydakis Flap Reconstruction for Pilonidal Disease". Acta Scientific Medical Sciences 4.7 (2020): 44-46.