Karydakis flap procedure for pilonidal sinus

The technique is demonstrated on a chronic recurrent pilonidal sinus.

First, define the resection margins. The dotted lines correspond to the highest point of the buttock in question. The ovoid incision should be located eccentric to the midline and cover the entire system of tracts. The central axis of the incision should be about 2cm lateral to the midline.

Incise the tissue to be removed. Since the chronic infection always predestines this operation to bleeding, we prefer the electrocautery. 

Excise the inflamed tissue together with all the fistula tracts. On the far side of the midline bevel the incision, while bringing it straight down close to the midline. Leave a thin layer of fat on the sacral fascia.