KARYDAKIS TECHNIQUE FOR PILONIDAL CYST CORRECTION: ADVANTAGES OF A FLAP WITH AN INCISION OUTSIDE THE MIDLINE

Case Presentation Male, 19 years old. Three years ago, he developed a painful sacral swelling with intermittent episodes of inflammation, treated with oral antibiotics and warm compresses. There were three openings along the midline. An ultrasound of the soft tissues showed a superficial, hypoechoic, and regular cystic image of 3.0 cm in the longest axis. Surgical intervention was indicated, involving resection and closure of the defect using the Karydakis technique. This technique aims to displace the midline suture, without tension, flattening the gluteal fold depression and reducing mechanical stress during the postoperative period. The patient was positioned prone under local anesthesia, with the pilonidal cyst identified and demarcated. An extensive incision was made to include the main sinus and the two secondary ones, left of the midline. A circumferential dissection was performed, reaching the presacral fascia, followed by cyst excision. The subcutaneous deep flap was created up to the contralateral gluteal fold, followed by dissection of the superficial flap, below the dermis in the same direction and extent. The flap was advanced from right to left, with U-shaped separated sutures using Vicryl 3-0. The wound was moved away from the midline, and a Portovac drain was placed. The dermis was then closed with the same suture material, finishing with nylon 4-0 epidermal sutures, followed by an occlusive and compressive dressing. The patient progressed well, was discharged on the first day, and the drain was removed on the tenth day without wound dehiscence. Follow-up after 3 months showed no signs of recurrence.

Discussion The pilonidal cyst is an infectious condition that is twice as common in young males. It can be acute, with abscesses, or chronic, with intermittent discharge from sinus tracts. The nests are located in a deeper cavity with hair presence. Treatment is usually surgical in symptomatic cases, but there is no consensus regarding the best technique. The main objectives are to stop the suppuration, resolve the cyst, reduce morbidity, and decrease the risk of recurrence. The wound complication rate is low, around 8%, and recurrence is less than 2%. Moreover, compared to an open wound, this technique has the advantages of lower morbidity, fewer lost workdays, and fewer medical visits for dressing changes; compared to midline primary closure, it results in less recurrence and fewer wound complications.

Conclusion The Karydakis technique proved to be safe and effective for correcting the pilonidal cyst, promoting primary closure with low local morbidity and allowing for early return to activities.

 

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Artikel online veröffentlicht:
25. April 2025