Complications - Karydakis Flap

Perforation of the flap during mobilization

• This can occur especially during preparation near the anus and usually has serious consequences: Non-healing wounds in the area of the perforation.

Wound Infection/Wound Healing Disorder

• Infected Seroma: After the Karydakis procedure, a subcutaneous seroma inevitably forms, which should not be opened or punctured. However, it can become infected, indicated by very severe (!) pain, fever, and chills. The flap then becomes very swollen, tense, and red. In this case, the wound should be opened at the upper pole over 1-1.5 cm and the opening kept open with a drainage for 5-7 days. After that, the drainage can simply be removed. Antibiotics are not required. The treatment is outpatient. Larger wound openings or, for example, VAC treatment should be urgently avoided.
• Dehiscence: Smaller dehiscences over 1-2 cm are common and can be ignored, as they close spontaneously. Large dehiscences leading to medialization of the flap edge should be revised. During the revision, all subcutaneous fat tissue should be debrided and the flap reclosed. No planned secondary healing after revision!

Postoperative Bleeding/Hematoma

• Immediate evacuation of the hematoma. Active bleeding is almost never found. Then primary wound closure.

Recurrence

• Wound dehiscences that have led to medialization of the flap edge can lead to chronic wound healing disorders that need to be revised. The revision is complicated because the findings are almost always near the anus. However, the principles are the same as with the primary Karydakis.
• A "true" recurrence, i.e., the appearance of new pits in the midline, is rare and can also be treated minimally invasively.

Cosmetically Disturbing Changes in the Buttock Region

• Patients are often dissatisfied with the cosmetic result. However, most are relieved to be rid of the disease.