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Pilonidal Sinus

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a new surgical technique(modified Karydakis) to be compared with standard Karydakis

Description of a new surgical technique in pilonidal sinüs surgery in order to reduce dead space volume.

A flap extending across the cut (Karydakis) is prepared in medial edge of the wound, 1 cm deep and 2 to 3 cm to be towards the interior. Prepared flap is shifted to the medial and sutured to presacral fascia with vicryl 2/0. To reduce the volume of the dead space formed in the lateral, 5 mm skin is excised along the incision in the flap side. Skin is approximated with sutures in the form of intermittent, using 2/0 poliprolen. No drain used

A new surgical technique

Ali Uzunköy

The purpose of this study is to reduce the volume of dead space by a modification in kardakis flap procedure and consequently, to reduce the use of drains, wound drainage, seroma and hematoma formation, skin degradation and recurrence rates.

The study was a pilot study of 80 patients. Excluding criteria were previous sinüs surgery, active infection, patients who did not accept the procedure and patients under age of 18. After excision of the sinüs volume was measured using a beaker. A flap extending across the cut (Karydakis) was prepared in medial edge of the wound, 1 cm deep and 2 to 3 cm to be towards the interior. Prepared flap was shifted to the medial and sutured to presacral fascia with vicryl 2/0. To reduce the volume of the dead space formed in the lateral, 5 mm skin was excised along the incision in the flap side. Skin was approximated with sutures in the form of intermittent, using 2/0 poliprolen. No drain used. All patients were discharged on postoperative day 1. Sutures were removed 2 weeks later. All patients for at least 6 months were followed for wound drainage, seroma and hematoma formation, separation of skin and and recurrence.

Reduction Dead Space Volume With Karydakis Modification

Effects of Reduction Dead Space Volume With Karydakis Modification

OUTCOME MEASURE:

1. Extracted sinus volume
2. The number of patients with complications

   1. Delayed wound healing
   2. seroma
   3. hematoma formation
   4. wound infection

Harran University

Siverek Devlet Hastanesi

Principal Investigator

Respiratory Tract (Lung and Bronchial) Diseases

Ear, Nose, and Throat Diseases

Paranasal Sinus Diseases

Seroma

Group 1 were treated with the new technique (Asymmetric Primary Closure and Additional Skin Excision).

In this new technique, following total sinus excision, the excision defect was closed with the standard Karydakis method, but an advancement tissue flap was performed using additional skin excision, in order to reduce the dead-space volume.

Group 2 were treated with the standard Karydakis technique.

In this new technique, following total sinus excision, the excision defect was closed with the standard Karydakis method, but an advancement tissue flap was performed using additional skin excision, in order to reduce the dead-space volume.

Asymmetric Primary Closure and Additional Skin Excision Technique

In this new technique, following total sinus excision, the excision defect was closed with the standard Karydakis method

Standard Karydakis technique.

The aim of this study was to reduce the residual dead-space volume with a modification following the standard Karydakis procedure.

All patients were operated in the jack-knife position under spinal anesthesia (SA). The gluteal parts of the patients were stretched in both directions with bandage and intergluteal cleft was opened. Methylen blue was administered from the sinus openings in the gluteal region. Then, total sinus excision was performed, including the entire sinus tracts by passing the skin, subcutaneous tissues up to the presacral fascia.

In patients operated with standard Karydakis procedure, a flap (Karydakis flap) extending along the incision was prepared, with the medial side of the wound to be 1 cm deep and 2-3 cm inward. The prepared flap was shifted to medial and sutured to the presacral fascia with 2/0 vicryl.

In patients who were operated with the Asymmetric Primary Closure with Skin Excision Technique, after the Karydakis flap was formed, 5-10 mm skin was excised along the incision from the side of the flap to reduce the volume of the dead-space laterally.

In both groups, subcutaneous tissue was approximated with 2/0 vicryl. The skin was sutured with mattress technique using 2/0 Prolene. No drains were used in patients from either group.

Patients were followed up for wound leakage, seroma and hematoma formation, skin dehiscence and recurrence.

Asymmetric Primary Closure and Additional Skin Excision Technique.

A Novel Technique in the Treatment of Sacrococcygeal Pilonidal Sinus Disease: Effect of Reduction of Dead-space With Asymmetric Primary Closure and Additional Skin Excision Technique.

The study has been completed. The datas will be shared as an article

wound dehiscence, formation of seroma, hematoma, wound infection

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Reduction Dead Space Volume With Karydakis Modification	NCT02574936	PILONIDAL SINUS	A new surgical ...	18 Years - 49 Years	Siverek Devlet Hastanesi
Asymmetric Primary Closure and Additional Skin Excision Technique.	NCT03424057	Pilonidal Sinus Pilonidal Disea... Surgical Techni...	Asymmetric Prim... Standard Karyda...	18 Years - 65 Years	Siverek Devlet Hastanesi
Asymmetric Primary Closure and Additional Skin Excision Technique.	NCT03424057	Pilonidal Sinus Pilonidal Disea... Surgical Techni...	Asymmetric Prim... Standard Karyda...	18 Years - 65 Years	Siverek Devlet Hastanesi
Reduction Dead Space Volume With Karydakis Modification	NCT02574936	PILONIDAL SINUS	A new surgical ...	18 Years - 49 Years	Siverek Devlet Hastanesi

Spots Global Cancer Trial Database for karydakis modification