Karydakis Flap

Prone positioning with elevated pelvis. Shaving of the surgical area and V-shaped taping apart of the buttocks at the level of the anus with 5 cm wide Leukoplast strips.

Note: If the Leukoplast strips tear during this maneuver, do not reapply them, but use fresh adhesive strips because the old ones no longer adhere well and often come loose during the operation.

Next, disinfect with Octenisept. Alternatively, Chlorhexidine can also be used.

Note: A surgical towel/Moltex should be placed between the legs because moisture can cause skin burns in the genital area.

Then let the disinfectant dry, otherwise the drape will not adhere well enough.

In the midline, there are two fistula openings or unhealed wounds from previous surgeries, located in the scar. First, an axis is drawn parallel to the anal cleft. The marking on the side that will later be rotated includes the fistulas/chronic wounds/scar tissue, but not healthy skin. At the level of the maximum transverse diameter of the planned excision, the distance to the left and right of the axis should be approximately equal.

Note: In previously operated patients—as is the case in most instances of Karydakis flap—the upper pole of the excision is not on the excision axis but medial. This modification of the Karydakis technique avoids crossing between the scar from the previous operation and the new wound. Such crossings often lead to wound healing disturbances.