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Abstract
Pilonidal sinus causes discomforts, absence from work, may result in long periods of hospitalization, high recurrence rates with conventional surgical methods. This encouraged surgeons to search for new methods of surgical management.In this study 30 patients had chronic pilonidal sinus, their age ranged from 16 to 48 (mean 28) years, 4 females and 26 males they were randomly divided into three groups, 10 patients in each:• Group (I): 10 patients were subjected to karydakis flap technique.• Group (II): 10 patients were subjected to rhomboid flap technique.• Group (III): 10 patients were subjected to Z – plasty flap technique.The presenting symptoms and signs were:- 1. chronic discharging sinus with single or multiple openings in 18 patients.2. chronic abscess with midline multiple openings in 5 patients.3. Recurrent pilonidal sinus in 7 patients.• The post operative complications were:-1. Haematoma in one patient in each of karydakis flap and rhomboid flap techniques.2. Superficial wound infection in one patient in each of rhomboid flap and Z – plasty flap techniques.3. Wound collection drained with daily dressing and antibiotics in one patient in each of karydakis flap and rhomboid flap techniques and 2 patients in Z – plasty flap technique.4. Wound break down and delayed wound healing in one patient in karydakis flap technique and two patients in each of rhomboid flap and Z – plasty flap techniques.5. Recurrence in one patient in karydakis flap and two patients in each of rhomboid flap and Z – plasty flap techniques.from this study, We found that karydakis flap method resulted in relatively shorter time of operation, shorter hospital stay, rapid healing time, shorter time off work and least recurrence rates compared with rhomboid flap and Z – plasty methods.This led us to strongly recommend the use of karydakis flap method for the management of chronic pilonidal sinus disease.Pilonidal sinus is an acquired disease; causing great disability of the patient.? There is high recurrence rate after traditional surgical procedures such as phenol injection, simple laying open, primary closure after excision and leaving the wound to heal by secondary intention.? Excision and healing by secondary intention took short hospital stay but long time off work, long period of follow up and costly dressing.? The use of skin flaps as karydakis, rhomboid and Z – plasty techniques to cover a sacral defect after wide excision have the advantages of:- - Wide radical excision and closure the defect with a well vascularized fasciocutaneous flap.- Good wound healing in short period.- Least time off work.- Short hospital stay.- Mild disability of the patient- Keeping the scar away from the midline.- Flattening the natal cleft contour there by reducing skin friction and accumulation of hair and depris. - Low recurrence rate.? The Karydakis flap has a lower recurrence rate and least complications because it produces a shallow midline furrow free from scar or suture holes as compared with rhomboid and Z-plasty flaps. It may become the preferred procedure in the treatment of sacrococcygeal pilonidal sinus.