Excision and primary closure using the Karydakis flap for the treatment of pilonidal disease: outcomes from a single institution.

BACKGROUND: Chronic pilonidal disease is a debilitating condition that typically affects young adults. There is a wide variety of available therapeutic strategies reflecting the inconsistent outcomes attributed to the various operative approaches. The majority involve excision of the sinus tract followed by either primary closure or healing by secondary intention. A variety of closure approaches exist. There remains uncertainty as to which is more effective. The aim of the current study was to determine subjective and objective outcomes following excision and Karydakis flap closure in a unit where this technique is the standard of care in the management of chronic pilonidal disease.
METHODS: This study involving consecutive patients with chronic pilonidal disease was conducted over a 4-year period. A tailored patient satisfaction questionnaire was given to each patient. Postoperative primary and secondary outcomes were evaluated. The mean follow-up time was 30 months.
RESULTS: One hundred six consecutive patients (33 female, 73 male) underwent excision and primary closure using the Karydakis flap. Ninety-two completed questionnaires were returned (87% response rate). Patients consulted their general practitioner 2.8 times (mean) and 46% received empirical oral antimicrobial therapy prior to referral for a surgical opinion. The mean time lost to work/school following the Karydakis flap repair was 13 days (range 3-33). Successful treatment was achieved in 96.3% of cases and 92% of patients were satisfied with their operative result.
CONCLUSION: Excision and primary closure with Karydakis flap is an effective treatment for chronic pilonidal disease. It is associated with low morbidity, early return to premorbid functioning, and a high degree of patient satisfaction (92%).