Karydakis Flap Procedure Research Articles

Comparison of Limberg Flaps and Karydakis Flaps in The Treatment of Pilonidal Sinus Disease: A Single Physician Experience

Objective: Pilonidal sinus disease (PSD) is a chronic inflammatory disease that impacts quality of life. Many conservative and surgical approaches for treating PSD have been described, but the best surgical method is still up for debate. Our aim is to see whether there is a difference between Limberg flap (LF) and Karydakis flap (KF) procedures in patients with (PSD).Methods: The study was designed retrospectively. Our research includes a comparison of two patient groups who had PSD surgery performed by a single physician between March 2016 and October 2020. The patients who underwent LF proceure were determined as Group 1, and the patients who underwent KF as Group 2 and the clinical and practical differences between these two techniques were analyzed.Results: The mean age, duration of surgery and hospitalization were shorter in Group 2 (p=0.019, p=0.0001, p=0.0001, respectively). There was no significant difference between the two groups in terms of the remaining variables.Conclusion: There was no significant difference between LF and KF procedures in terms of quality of life, recurrence and complications. However, the fact that KF procedure can be completed in a shorter time and patients can be discharged earlier makes this group one step ahead.

The Cleft Lift procedure for pilonidal disease renamed as a rotation and advancement flap procedure (RAF): Insights and technical tips for a successful outcome

IntroductionThe Cleft Lift procedure originally named by Bascom is a derivative of the Karydakis flap procedure for pilonidal sinus disease. The terminology and variations of the name have long confused surgeons and have limited its wide adoption. TechniqueThis technical paper deconstructs the confusing terminology, suggests simple steps for success, and proposes a more descriptive name for the asymmetric flap procedure which has the lowest reported recurrences for all surgical options for pilonidal disease. ResultsThe author has successfully performed the Cleft Lift procedure for pilonidal disease since 2000. In the last consecutive 757 patients treated over 12 years, only 6 patients have required a second operation. This cohort included 287 patients referred with recurrent disease or open wounds from prior pilonidal surgery. A new naming scheme is proposed that more accurately describes the operation. The proposed name is the pilonidal RAF procedure for rotation (around the anus) and advancement (across the natal cleft midline) flap . ConclusionsThe pilonidal RAF procedure is highly successful in treating pilonidal sinus disease with a very low need for additional surgery even in complex recurrent disease.

Surgical outcome between Karydakis flap and Limberg flab in pilonidal sinus: A comparative study

Introduction: Pilonidal sinus disease (PSD) is a chronic inflammation and infection of the sacrococcygeal area with swelling, discomfort and seropurulent discharge among the ain symptoms. Studies show the disease to be an acquired condition. Among the treatments offered are excision and secondary intention healing, marsupialization, excision and primary closure, and different kinds of excision followed by flap repair, commonly being Karydakis flap and Limberg flap. The surgical outcomes of both the types of flaps is compared in this study.Aim and Objectives: To assess the surgical outcome between Karydakis flap and Limberg flap in pilonidal sinus.Materials and Methods: It was an observational study conducted at department of surgery, in patients with pilonidal sinus between the age of 15 to 65 yrs. A total of 30 patients were included after obtaining the informed consent, with group A as 15 patients undergoing Karydakis flap procedure and group B as 15 patients undergoing Limberg flap procedure.Results: The mean age of patients was found to be 33.10±11.57yrs of age, male preponderance (80.0%) was seen. Male to female ratio was 4:1. Mean operative time was 45.1±3.0 and 57.7±3.7mins for Karydakis flap and Limberg flap method respectively. Significant lower blood loss was seen among the Karydakis flap method. Lower duration of hospital stay was seen among the Karydakis flap group (4.9±1.2days), Limberg flap group (5.2±0.7days). Overall, 6 patients presented with recurrence who underwent the Karydakis flap method.Conclusion: Comparative results seen between both Karydakis flap and Limberg flap however, Karydakis flap procedure showed shorter operative time, lower blood loss. Patient’s with Limberg’s flap had lesser early post operative complications, early pain-free toileting and nil recurrence and was recommended to other patients. Hence, Limberg flap is still a better option to the patients as compared to Karydakis flap procedure.

A Comparative Study on flap necrosis following Karydakis Flap Reconstruction and Z-Plasty in Patients with Sacrococcygeal Pilonidal Disease – Our experience

Aim: The purpose of this study was to evaluate patients with sacrococcygeal pilonidal sinus disease(SPSD) who underwent the Karydakis procedure and Z plasty at our centre concerning theperioperative findings, late postoperative results and recurrence. Patients and Methods: A total of30 patients presenting with SPSD at our centre underwent Karydakis flap repair and Z plasty fromMay 2019 to June 2021. These patients were then followed up and evaluated concerning operativetime, drain use, hospital stay, suture removal, complications, and recurrence. The adipocutaneousflap of Karydakis was devised to shift the natal cleft, while Z-plasty involves a fasciocutaneous flap.Results: The mean operative time was 60 min with a median hospital stay of 4 days. Drains wereremoved at a median of 5 days and sutures at a median of 15 days. The duration of hospitalisationfor the Karydakis procedure was found significantly lesser than that for Z-plasty Patients who werefollowed up for a median of 12 months. The overall complications were more in Z-plasty. Flapnecrosis developed in 30 % of the cases in the Z-plasty group, comparable to no recurrence seen inthe Karydakis procedure. Conclusion: Karydakis flap was found superior to Z-plasty, having lessseroma formation, no flap necrosis and no local hematoma Karydakis flap procedure is a relativelysimple procedure for SPSD and has advantages over Z-plasty technique like keeping scar away fromthe midline and flattening of the natal cleft, thus reducing local recurrence rates.

Evaluation of Different Methods of Treatment of Pilonidal Sinus; a Randomized Controlled Trial

Background: Sacrococcygeal Pilonidal disease is an infection of the skin and subcutaneous tissue at or near the upper part of the natal cleft of the buttocks. This results from chronic infection of hair follicles and subsequent formation of a subcutaneous abscess. Hair then enters the abscess cavity and provokes a foreign body tissue reaction with chronic suppuration and discharge. The aim of this study was the selection of best method of treatment of pilonidal sinus. Patients and methods: This randomized controlled trials was conducted on 56 patients with the diagnosis of pilonidal sinus disease were admitted to the Department of General Surgery, Zagazig University Hospitals from March 2020 to September 2020. The patients were allocated randomly into four groups, each included 14 patients; Group (1): was Conservative method with medical treatment and drainage if needed. Group (2): were operated by Open technique. Group (3): were operated by Limberg flap technique. Group (4): were operated by Karydakis technique. All patients were subjected to history taking, complete clinical examination, preoperative Laboratory investigations. Results: Recurrence was significantly associated with open and conservative groups while there was only one case in Limberg Group and no case in Karydakis Group. Conclusion: The Karydakis flap procedure should be chosen instead of the Limberg flap for treating uncomplicated Sacrococcygeal pilonidal disease because of its shorter operative time, earlier return to work, faster healing time and significantly higher patient satisfaction.

Comparison of Crystallized Phenol Application and the Karydakis Flap Technique in the Treatment of Sacrococcygeally Localized Pilonidal Sinus Disease.

ObjectiveTo evaluate crystallized phenol application and the Karydakis flap procedure in terms of treatment success, postoperative complications, and recurrence in the treatment of pilonidal sinus disease (PSD).Materials and methodsThe study included patients who underwent the Karydakis flap procedure and crystallized phenol application with the diagnosis of PSD in our clinic between June 2016 and January 2019. Age, gender, preoperative body mass index (BMI), sinus number, number of crystallized phenol administrations, postoperative length of hospital stay, postoperative complications, and recurrence rates were compared between the Karydakis and crystallized phenol groups.ResultsOf the 88 patients included in the study, 29 (32.95%) were female, and 59 (67.05%) were male. The median age was 30 (27-33) years, and BMI was 29 (26-32) kg/m2. The median sinus number was 3 (2-3). There was no difference between the two groups in terms of age, BMI, sinus number, follow-up duration, gender, recurrence, wound infection, hematoma, wound dehiscence, and preoperative complaints (p > 0.05). A higher rate of drain requirement and more extended hospital stay were observed in the Karydakis group than in the crystallized phenol group, and the difference was statistically significant (p < 0.01 and p < 0.01, respectively).ConclusionThe crucial advantages of crystallized phenol treatment in PSD are high wound healing rates, outpatient applicability, and no requirement of operating room conditions. Crystallized phenol application also has similar post-application complication rates to the Karydakis flap procedure. The results of our study support that crystallized phenol application is a less invasive alternative treatment method that can be applied before surgical treatment in selected patients.

Karydakis Flap: A preferred procedure for Sacrococcygeal Pilonidal Sinus Disease (SPNSD).

Objectives: To evaluate patients with SPNSD who underwent Karydakis Flap procedure with reference to operative time, drain removal time, hospital stay, complications and recurrence rate. Study Design: Prospective study. Setting: Surgical Department of Allied Hospital, Faisalabad. Period: September 2009 to January 2018. Material &amp; Methods: A total of 117 patients underwent Karydakis Flap procedure. Data was collected according to the above said parameters .Patients were followed up for 12 months. Results: The operative time was 35.5 minutes. Average Hospital stay was 2 days. Drain removed at median of 8 days.17 patients (14%) developed seroma. Wound Infection occurred in 5 patients (4%). Wound burst opened in 1 patient (0.8%).No recurrence was noted (0%) in any patient during a follow up of 1 year. Conclusion: Karydakis Flap procedure is a relatively simple and easy technique with minimal chances of recurrence.

Pilonidal sinus disease: Karydakis flap procedure in our patients.

Despite the available guidelines, opinions of many surgeons are quite ambiguous when it comes to the therapy of pilonidal sinus disease. The treatment can be afrustrating problem both for the surgeon and the patient because it is associated with wound complications and high recurrence rate. The objective of this study was to analyze the results of patients with pilonidal sinus disease undergoing the Karydakis flap procedure. Atotal of 27 patients treated for primary and recurrent pilonidal disease using the Karydakis flap procedure at our department between October 23, 2018 and November 22, 2019 were analyzed prospectively. We evaluated postoperative wound healing, complications and recurrence of the disease in ashort-term follow-up period. Disease recurrence was defined as prolonged healing or as anew disease requiring repeated surgery. In December 2019 all 27 patients came for afollow-up visit. The result was afully lateralized wound without any signs of anew disease in all patients. In May 2020 afollow-up visit by phone was performed. The median follow-up was 12 months. The healing process was free of any serious complications in 25 patients. Seroma formation cases were managed by puncture in the outpatient setting. According to the available evidence and guidelines, off-midline procedures - the Karydakis flap, Bascom cleft lift, and Limberg flap procedures - are associated with lower recurrence rates and better wound healing. An important goal is to achieve complete wound lateralization and to change the configuration of the gluteal cleft by reshaping it, which results in anicely flattened gluteal crease.

Comparison of Limberg Flap and Karydakis Flap Surgery for the Treatment of Patients With Pilonidal Sinus Disease: A Single-Blinded Parallel Randomized Study.

Purpose Pilonidal sinus disease is a common condition, which mostly affects young men. While various surgical techniques have been introduced for treating intergluteal pilonidal disease (IPD), controversies still exist regarding the best surgical approach. The purpose of this study was to compare the efficiency and the short-term outcomes of Limberg flap and Karydakis flap surgeries for the treatments of patients with IPD.Methods A total of 80 patients with IPD who had underwent either Karydakis flap (KF group: n = 37) or Limberg flap (LF group: n = 27) surgery between January 2015 and January 2016 at Imam Khomeini Hospital of Sari in the North of Iran were recruited for inclusion in this randomized, single-blind study.Results Compared to the KF group, the LF group showed faster complete wound healing, longer duration of surgery and hospital stay, larger wound size, and shorter period of incapacity for work. The overall patient satisfaction in the LF group was significantly higher than that in the KF group. The visual analogue scale score of pain was lower in the LF group than in the KF group. Also, the overall frequency of postoperative complications was higher in the KF group than in the LF group. Recurrence was reported in one patient from the KF group.Conclusion Given the lower rate of postoperative complications and greater cosmetic satisfaction of patients, the Limberg flap procedure should be selected, instead of the Karydakis flap procedure, as the standard technique for treating patients with IPD.

Methylene Blue Provides an Efficient Resection for the Treatment of Pilonidal Sinus Disease

Aim: The Methylene Blue (MB) is commonly used dye for Sacrococcygeal Pilonidal Sinus Disease (SPSD). The aim of this randomized prospective trial was to determine the benefits and effectiveness of (MB) for (SPSD) by comparing the results of Karydakis flap procedure. Patients and Methods: Between January 2016 and April 2017, a total of 100 patients with sacrococcygeal pilonidal sinus disease were randomly assigned to two equal groups which underwent Karydakis flap procedure with or without MB usage. Patients age, gender, BMI, duration of the disease and number of the orifices, excised specimen height, width, area, circumference, depth, volume,postoperative complications and duration of hospital stay were recorded. Results: Characteristics of the patients were similar in both groups. In the MB used group all the parameters except the depth of the excised specimens found as statistically significant (p<0.01). Conclusion: Our results s

Comparison of results of minimal invasive surgery for pilonidal sinus with karydakis procedure: less is more

Aim: Controversy still remains regarding the best surgical technique to use for the treatment of pilonidal disease to minimize disease recurrence and patient discomfort. Minimal surgical procedures can be performed on an outpatient basis. In this study, the early results of our minimally invasive operative approach cases are compared with Karydakis flap reconstruction results. Material and methods: From January 11, 2012 to January 23, 2013, 312 patients were diagnosed with pilonidal sinus and treated in our clinic. Eighty-two of these patients (35 treated by a minimally invasive procedure (group I), 47 by the Karydakis flap procedure [Group II]) were included in the study. Data were collected by reviewing the patients’ records and by conducting telephone interviews. Results: The follow-up time of each case for Group I was 35 months and the average follow-up time was 32.5 months for Group II (interval, 24-40 months). Group I patients returned to work in 1 day; however, 40 patients (85.1%) in Group II returned in 20 days and 7 (14.9%) returned to work in 30 days. In group I, 32 patients (94%) were satisfied and 2 patients (5.7%) were not satisfied. In Group II, 32 patients (68.1%) were satisfied with the results of the surgical procedure and 15 patients (31.9%) were not satisfied. Our recurrence rates for group I and II were 5.7% and 6.4% for the first year, respectively. Conclusion: This indicated that the minimally invasive operative procedure can be performed with a low recurrence rate on a one day outpatient basis.

A Comparison of the Results of the Karydakis Flap Procedure and Primary Closure in the Treatment of Pilonidal Sinus Disease Over the Short and Long Term: A Randomized Clinical Study

In the current prospective study, we compared the results of the Karydakis flap procedure (KFP) and primary closure (PC). This study compared the short and long-term results of the KFP and PC techniques. The sample of this study was a total of 352 patients (302 male: 85.7%; median age: 24 years) who underwent reconstruction after pilonidal sinus excision in our clinic. The reconstruction was performed using the KFP (group 1, n = 176, 50%) or PC (group 2, n = 176, 50%). The following data on the patients was obtained; sex, age, body mass index (BMI), duration of operation and hospital stay, length of time patient could walk without pain, length of time patients could sit on toilet without pain, complications (e.g., infection, recurrence). No significant difference was found between groups 1 and 2 with respect to sex, age, BMI, and duration of operation. Moreover, length of time patients could walk and sit on toilet without pain was similar in both groups. On the other hand, the rate of recurrence was significantly lower in group 1 (n = 4, 2%) compared with group 2 (n = 20, 11%, P &amp;lt; 0.001). KFP is preferable to PC since it is easier to learn and perform and has lower complication and recurrence rates.

Risk factors for complications and recurrence after the Karydakis flap

BackgroundThis study describes risk factors leading to the development of various postoperative complications and recurrence after the Karydakis procedure. Materials and methodsIn this prospective analytic cohort study, 179 patients with sacrococcygeal pilonidal disease underwent Karydakis procedure. Characteristics of the pilonidal disease and excised ellipse were measured as possible risk factors. Postoperative complications and recurrence were recorded as outcomes. ResultsMultivariate analysis showed that the distance between the last caudal pit and anal verge and length of excised part are independent factors predicting limited superficial skin disruption and infection, respectively. Delayed wound healing was associated with the distance between the last caudal pit and anal verge and history of previous pilonidal surgery. The length of excised part was the only predictor of future recurrence. ConclusionsPatients with no history of previous pilonidal surgery, a short length of extracted part, and long distance of caudal pit from anal verge are best candidates for the Karydakis flap procedure.

Comparative study between the Karydakis technique and the Limberg flap in pilonidal sinus

Objective A comparative study was carried out between the Karydakis technique and the Limberg flap in the management of sacrococcygeal pilonidal disease. Background Pilonidal sinus is a sinus tract that commonly contains hairs under the skin between the buttocks a short distance above the anus, but can occur elsewhere in the body. The best surgical technique for sacrococcygeal pilonidal disease is still controversial. The aim of this randomized prospective trial was to compare the results of both the Karydakis technique and the Limberg flap. Patients and methods This study included 13 patients with sacrococcygeal pilonidal sinus disease who were assigned randomly. Fifteen patients were subjected to the Karydakis technique and 15 patients received the Limberg flap. Results Our study showed that the time to removal of stitch in the Karydakis group was 12.26 ± 1.66, whereas in the Limberg group, it was 13.66 ± 1.29 (longer in group that received the Limberg flap; P = 0.016). The percentage of complete healing in the Karydakis group was 80%, whereas that in the Limberg group was 66.7% (no significant difference; P ≥ 0.05). Postoperative wound breakdown in the Karydakis group was 13.3%, whereas that in the Limberg group was 26.7% (no significant difference; P ≥ 0.05). Recurrence was 6.7% in the Karydakis group, whereas it was 6.7% in the Limberg group (no significant difference; P ≥ 0.05). The time to return to work was 21.73 ± 6.49 in the Karydakis group, whereas in the Limberg group, it was 28.66 ± 7.50 (longer in the Limberg flap group; P = 0.012), and the duration of surgery in the Karydakis group was 37.73 ± 12.98, whereas that in the Limberg group was 61.60 ± 11.11 (longer in the Limberg flap group; P ≤ 0.001). Conclusion The Karydakis flap procedure had many advantages over the Limberg flap for the treatment of uncomplicated pilonidal sinus because of its lower postoperative complication rate, time to removal of stitches, time to return to work, and duration of surgery. However, there was no difference between the two surgical procedures in terms of prevention of recurrence.

Klassische Rautenplastik nach Limberg zur Behandlung einer sakrokokzygealen Pilonidalsinuserkrankung – Erklärung der OP-Technik

Sacrococcygeal pilonidal sinus disease is frequently encountered in surgical practice. Besides excision only, the current pilonidal sinus guideline of the Association of the Scientific Medical Societies in Germany (AWMF-S3) also recommends plastic surgical procedures such as the cleft-lift operation described by Bascom, the Karydakis flap procedure and, due to the low recurrence rates, the Limberg flap procedure, for the treatment of this disease. In our case we show the surgical procedure performed on a 23-year-old male patient, who was previously treated for an acute abscess-forming sacrococcygeal pilonidal sinus. Our video shows the fasciocutaneous rhombic flap procedure described by Limberg step by step. The Limberg flap procedure is a simple operation for the treatment of sacrococcygeal pilonidal sinus disease.

Karydakis procedure for sacrococcygeal pilonidal sinus disease: Our experience.

Aim:The purpose of this study was to evaluate patients with sacrococcygeal pilonidal sinus disease (SPSD) who underwent Karydakis procedure at our centre with reference to the perioperative findings, early and late postoperative results and recurrence.Materials and Methods:A total of 103 patients presenting with SPSD at our centre underwent Karydakis flap repair from January 2001 to December 2010. These patients were then followed-up and evaluated with respect to operative time, drain use, hospital stay, suture removal, complications, and recurrence.Results:The mean operative time was 74.9 min with a median hospital stay of 5 days. Drains were removed at a median of 7 days and sutures at a median of 15 days. Twenty-one patients presented with serous collection in the wound. Six patients had wound infection. Patients were followed-up for a median of 29 months. No recurrences were noted in any of the cases.Conclusion:Karydakis flap procedure is a relatively simple procedure for SPSD with reproducible low recurrence rates.

Karydakis Flap for Recurrent Pilonidal Disease

Patients undergoing surgery for recurrent pilonidal disease are at high risk of developing re-recurrence. The present retrospective analysis was performed to compare long-term results in patients with recurrent disease undergoing midline excision surgery compared to patients undergoing the Karydakis flap procedure. Only patients with previous excision surgery apart from simple abscess incision were included. Disease recurrence was defined as the need for repeat surgery. A total of 124 patients underwent surgery for recurrent pilonidal disease. Group 1 consisted of 37 patients (25 excision + midline closure, 12 excision + lay-open). Group 2 consisted of 87 patients (Karydakis flap). There were no statistically significant differences between the groups with regard to patient's age, duration of disease, body mass index, or sex. The average number of previous surgeries was significantly higher in group 1 patients (2.1 vs. 1.8, p = 0.019). The overall 1-year recurrence rate was 43 % in group 1 and 3 % in group 2 (p < 0.0001). The wound dehiscence rate after the Karydakis flap procedure was as high as 43 % between years 2005 and 2009, but it fell to 10 % thereafter (p = 0.02). Karydakis flap procedure is superior to midline excision surgery in patients presenting with recurrent pilonidal disease.

Karydakis Flap Procedure in Patients with Sacrococcygeal Pilonidal Sinus Disease: Experience of a Single Centre in Istanbul

Background. The aim of this retrospective study was to evaluate the results of patients with sacrococcygeal pilonidal sinus who underwent surgery using the Karydakis technique. Methods. Two hundred fifty-seven patients with sacrococcygeal pilonidal sinus disease were treated by the Karydakis flap procedure between December 2003 and June 2011. Patients were evaluated with respect to age, gender, preoperative symptoms, duration of preoperative symptoms, history of pilonidal sinus surgery, early postoperative complications, recurrence rates, and cosmetic satisfaction. Results. There were 223 (86.8%) male and 34 (13.2%) female patients. The mean age of the patients was 27.15 ± 7.69 years. The most frequent symptom was seropurulent discharge (57.58%). Postoperative morbidity was noted in 24 patients (9.3%). The mean hospital length of stay was 3.34 ± 1.42 days. The cosmetic satisfaction rate was 91.06%. Recurrences were noted in 6 patients (2.3%). Conclusion. The Karydakis flap procedure is a safe treatment alternative for the surgical treatment of sacrococcygeal pilonidal sinus disease owing to the associated low complication rate, short hospital length of stay, rapid healing, and a high patient satisfaction rate.

Short and long-term results of the Karydakis flap versus the Limberg flap for treating pilonidal sinus disease: a prospective randomized study

Background Pilonidal sinus is a common disease that mostly affects young people. Although various surgical techniques have been described for treating sacrococcygeal pilonidal disease (SPD), controversy still exists as to the best surgical technique. The purpose of this study was to compare the efficiency and short-term and long-term results of the Karydakis flap with that of the Limberg flap for treating SPD. Methods In this prospective randomized study, 269 patients with SPD were recruited to undergo either the Karydakis flap (n = 135) or the Limberg flap (n = 134) procedure between September 2004 and September 2008. Results The mean operative time for the Karydakis group (42.32 ± 8.64 minutes) was shorter than that for the Limberg group (50.14 ± 6.96 minutes) ( P = .01). The complication rate for the Karydakis group (n = 15 [11.1%]) was lower than that for the Limberg group (n = 28 [20.8%]) ( P = .029). The visual analogue scale score for postoperative pain at the operation site on the 30th day was lower in the Karydakis group than in the Limberg group (2.22 ± 1.01 vs 3.23 ± 1.14, P = .01). The visual analogue scale score for satisfaction with the cosmetic appearance of the scars in the Karydakis group was 7.08 ± 1.75, whereas it was 3.16 ± 1.40 in the Limberg group at the 3rd month ( P = .01). Length of hospital stay was significantly shorter in the Karydakis group than in the Limberg group (3.40 ± .94 vs 3.8 ± 1.19 days, P = .03). Only 4 patients in the Karydakis group developed recurrence (3%), whereas 9 patients (6.9%) did so in the Limberg group ( P = .151). Conclusions The Karydakis flap procedure should be chosen instead of the Limberg flap for treating uncomplicated SPD because of its lower postoperative complication rate, lower pain scores, shorter operation time and length of hospital stay, and good cosmetic satisfaction. However, no differences existed between the 2 surgical procedures in terms of recurrence prevention.

Tek Doz Profilaktik Antibiyotik Elektif Pilonidal Sinüs Cerrahisinde Yeterli Olmayabilir: Erken Sonlandırılan Bir Çalışma

Objective: The surgical infection rate is not low in some series of elective pilonidal sinus surgery despite single dose antibiotic prophylaxis. This study was designed to compare wound infection rate after a single dose and a 5-day intravenous course of cefazolin plus metranidazole administration in patients who were operated employing Karydakis flap for pilonidal sinus. Material and Methods: A total of 50 patients were involved in this prospective randomised clinical study. Karydakis flap procedure was used and a vacuum drain was left in situ in all cases. The patients were divided into two groups: Group 1 had either a single dose of 500 mg metranidazole plus 500 mg cefazolin sodium IV for prophylaxis and Group 2 were subjected to same preoperative drugs IV followed by their oral administration for five days (Sefazol 500 mg tablet plus Flagyl 500 mg tablet, twice a day). The surgical site infection rate, total drainage volume and drain removal time were recorded. Results: The study was truncated because of occurence of an unacceptable infection rate, thus, 30 patients were able to continue on the study. Five surgical site infections were observed in 14 patients in Group 1 (35.71%) whereas only one infection was recorded in 16 patients in Group 2 (6.25%). Although the target patient number was not reached, the statistical difference was already achieved (p= 0.04). The mean total drainage volume was greater in Group 1 than in Group 2 (91.42 v.s. 72.12 ml; p= 0.073). However, the mean drain removal times were similar. Conclusion: The wound infection rate is high in elective pilonidal sinus surgery. Single dose prophylactic antibiotic combination may not be sufficient to avoid wound infection in pilonidal sinus surgery in which Karydakis flap technique is used.