Sacrococcygeal Pilonidal Disease Research Articles

A proposed staging system for chronic symptomatic pilonidal sinus disease and results in patients treated with stage-based approach.

BackgroundAlthough there are many therapeutic options to manage patients with sacrococcygeal pilonidal sinus disease, there remains controversy over a gold standard method for treating such patients. Most studies regarding sacrococcygeal pilonidal sinus, collected patients in a single pool, and single modality was performed to all patients so far. Staging according to the progressive nature of disease and comparisons of stage-based treatment approaches are yet to be conducted. This study aimed to define a staging system and to evaluate outcomes with the use of stage-based treatment approach.MethodsThe collected data of patients who underwent surgery for the treatment of pilonidal sinus disease prior to June 2011 were analyzed. Following this analysis, a staging system was defined based on morphological extent of disease (stage I to stage IV for primary disease, and stage R for recurrent disease). Specific surgical technique was used for each stage. Between June 2011 and December 2014, 367 patients were operated based on proposed staging system and treatment algorithm. Demographics, perioperative data, short-term and long-term outcomes were evaluated according to the disease stage.ResultsFor all patients, the median length of hospital stay was 1 (range, 0–4) day. Primary healing without any wound complications was achieved in 320 (87.2 %) patients. The median time to functional recovery was 10 (range, 2–35) days and for wound healing was 12 (range, 10–55) days. Disease recurrence was identified in six (1.6 %) patients within the median follow-up period of 29 (range, 5–47) months. The outcomes of each stage were evaluated separately.ConclusionsWe believe that the proposed staging system and stage-based treatment approach, which need further validation, will have an efficacy in the treatment of chronic pilonidal sinus disease and will contribute to the development of more appropriate individualized management approaches. Moreover, the use of this staging system will likely facilitate sharing and comparing more specific clinical data from future studies.Trial registrationNCT02712970 (ClinicalTrials.gov/09.03.2016)

Bilateral gluteal advancement flap for treatment of recurrent sacrococcygeal pilonidal disease: A prospective cohort study

BackgroundThere is controversy about the best surgical approach for recurrent pilonidal disease (PND) up till now. This study aims to evaluate the efficacy of bilateral gluteal fascio-myo-cutaneous advancement flap (BGFMCF) in treatment of recurrent PND. Patient and methodsForty patients (35 males, 5 females) with recurrent PND were admitted and treated with BGFMCF. Variables assessed were incidence of recurrence, postoperative complications, patients' satisfaction and quality of life. ResultsPatients had a mean age of 25 ± 6.8 years and a mean body mass index of 28.4 ± 2.7. Mean operative time was 87 ± 13 min and mean length of hospital stay was 3 ± 0.7 days. Mean period of follow-up was 15.8 ± 4.9 months. Recurrence was detected in 2 (5%) patients and minor complications occurred in 6 (15%) patients. Thirty eight (95%) patients were satisfied by the procedure at the end of follow-up period. ConclusionBGFMCF is an effective procedure for treatment of recurrent sacrococcygeal PND with low recurrence rate and acceptable morbidity.

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.

A modified surgical approach to sacrococcygeal pilonidal disease: our experience

Background: Pilonidal disease is a fairly common condition encountered in clinical practice with recurrent follicular infection being the causative factor. Inspite of many surgical options available, controversy still exists for the best procedure. Pilonidal disease has been treated for a long time with the conventional open excision technique. Limberg procedure is a safe and reliable technique in the treatment of sacrococcygeal pilonidal disease, with low complications and recurrence rates if performed according to appropriate surgical principles. Epilation is a very useful adjunct to the surgery for Pilonidal disease to prevent recurrence, which is almost a rule.Methods: In our study we recruited 27 patients of pilonidal disease who underwent modified Limberg flap procedure and were followed up for two years post-surgery. All the patients were subjected to epilation in preoperative period and post operatively for 6 months.Results: During our study period (2011-2016) 27 patients were enrolled with a median age of 25 years and were followed up 2 years post-surgery. 22 patients were males while 5 were females, 13 were recurrent cases with previous history of one or more surgeries, 11 cases had a sinus without any surgical intervention in the past and 3 had an abscess. There was no recurrence noted for a follow up period of 2 years and there was no flap failure as well.Conclusions: Modified Limberg flap with epilation for pilonidal disease is safe and easy to perform with minimal morbidity, early recovery and no recurrence.

Limberg flap reconstruction following rhomboid excision of the sacrococcygeal pilonidal sinus

Background: Pilonidal sinus disease has been treated with various techniques. There is still no consensus about treatment. However, a long list of surgical techniques available reflects the inability to find an ideal procedure for the treatment. The rhomboid flap of limberg is a transposition flap that has been advocated for treatment of this condition. The objective of this study was to evaluate the limberg flap reconstruction for pilonidal sinus in terms of complications, hospitalization time, days to return to work and recurrence in Indian rural setup. Methods: Patients with simple, complex and recurrent pilonidal sinus were included in the study. Patients presenting with acute abscess were excluded. Patients were followed for a period of three year to report the recurrence. Results: Total 26 patients, with pilonidal sinus disease were treated with rhomboid excision and limberg transposition flaps. All sinus tracts were resected en bloc, and the limberg flap was prepared from the gluteal region and transposed to fill the defect. There were 22 males (80%) and 4 females (20%) with a mean age in males 28.6 years and in females 21.6 years. The mean duration of symptoms was 10.4 months. Mean operative time was about 70.57 minutes. Full primary healing was obtained in 20 patients, 6 patients presented with post-operative complications. Minor infection occurred in 4 patients. 3 patients had minimal necrosis of flap edge and partial gaping of flap. 2 patients developed seroma. But all these complications required no additional treatment except secondary suturing in one patient. The average hospital stay was 4 days. Most patients returned to work within 3.23 weeks. Follow up period was 3 year and no recurrence reported. Conclusions: Limberg flap following rhomboid excision of the sinus area is worth to be considered as the surgical treatment of choice for sacrococcygeal pilonidal sinus disease.

Pilonidal sinus disease - Etiological factors, pathogenesis and clinical features

‘Pilonidal sinus’ disease, which is most commonly seen in reproductive populations, such as young adults - mostly in males who are in their twenties - is actually a controversial disease in that there is no consensus on its many facets. It is sometimes seen as an infected abscess draining from an opening or a lesion extending to the perineum. It may also present as a draining fistula opening to skin. In terms of etiological factors, various theories (main theories being congenital and acquired) have been established since it was first described, no universal understanding achieved. A long and significant post-operative care period with different lengths of recovery depending on the type of operation are quite prevalent with regards to recurrence and complication status. In order to prevent recurrence and improve the quality of life, etiological and predisposing factors as well as clinical features of sacrococcygeal pilonidal disease should be well known, a detailed differential diagnosis should be made, and a suitable and timely intervention should be performed. It was aimed here to explain the etiological factors, pathogenesis and clinical features of the disease that may present with various clinical symptoms.

A comparison of surgical outcome of fasciocutaneous V–Y advancement flap and Limberg transposition flap for recurrent sacrococcygeal pilonidal sinus disease

The aim of this study was to compare the surgical outcome of fasciocutaneous V-Y advancement flap and limberg transposition flap used to treat recurrent sacrococcygeal PSD. A total of 58 patients with recurrent pilonidal sinus who underwent surgery were evaluated retrospectively between January 2008 to December 2013. Fasciocutaneous V-Y advancement flap was performed in 25 patients (Group VYF), and limberg transposition flap repair was performed in 33 patients (Group LTF). Patient demographics, operative and postoperative outcomes were recorded then retrospectively analyzed. The mean age (p=0.69), sex ratio (p=0.48), and concomitant diseases (p=0.98) were not statistically different when compared the VYF with LTF groups. Mean operative time was 55±19 min for the LTF group and 75±25 min for the VYF group (p=0.01). When length of hospital stay were compared, there was a significant difference between the groups (p=0.01). Return to work was carryed out after a mean of 23±1.1 days in VYF group and 16.7±1.2 days in LTF group, which is significantly different (p<0.0004). Between the groups, there was no significantly different regarding surgical complication and recurrent rate. Only one recurrence (4%) was found in VYF group. Limberg transposition flap may be use in recurrent cases of PSD, because of the lower recurrence rate and less hospital stay time, early return to work. Most important advantage of fasciocutaneous V-Y advancement flap is the ability to close larger defects in recurrent cases.

Local administration of gentamicin collagen sponge in surgical excision of sacrococcygeal pilonidal sinus disease: a systematic review and meta-analysis of the literature.

Surgical site infections occur in up to 24% of patients after surgical excision of sacrococcygeal pilonidal sinus disease with primary wound closure. Local administration of antibiotics by a gentamicin collagen sponge could reduce this infection rate. The objective of this systematic review and meta-analysis was to evaluate the effect of a gentamicin collagen sponge on outcome after surgical excision in patients with sacrococcygeal pilonidal sinus disease. A structured literature search was performed in the PubMed, Embase, The Cochrane Library, and Scopus databases. Studies comparing surgical excision of sacrococcygeal pilonidal sinus disease with versus without a gentamicin collagen sponge were included. Outcome measures were surgical site infection, wound healing, and recurrence. The search strategy yielded six studies with a total of 669 patients. Three randomized controlled trials, comparing excision of pilonidal sinus disease and primary wound closure with versus without gentamicin collagen sponge, were eligible for inclusion in the meta-analysis (319 patients), demonstrating a trend towards reduced surgical site infections after administration of gentamicin collagen sponge [absolute risk reduction 20%, 95%-confidence interval (CI) 1-41%, p=0.06]. The wound healing (absolute risk reduction 22%, 95% CI 32-77%, p=0.42) and recurrence rate (absolute risk reduction 8%, 95% CI 7-22%, p=0.30) were not significantly different between both groups. Administration of a gentamicin collagen sponge after surgical excision of sacrococcygeal pilonidal sinus disease showed no significant influence on wound healing and recurrence rate, but a trend towards a reduced incidence of surgical site infections. Therefore, additional larger well-designed randomized controlled trials are required.

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.

Pilonidal Sinus Disease with Especial Reference to Limberg Flap

Abstract This article lays an emphasis on “Pilonidal Sinus disease” along with the historical background, materials, and methods used. The term ‘Pilonidal’ was coined by Hodge in 1880. The disease commonly affects middle-aged working population and most often arises in the hair follicles of the natal cleft of the sacrococcygeal area. This disease affects males thrice as much as females because of their hirsute nature. Pilonidal sinus is associated with obesity, sedentary occupation, and local irritation or trauma. The management of pilonidal disease is complex and a big burden on hospital and community resource because of the recurrent nature of the disease. Various surgical methods have been practiced to treat sacrococcygeal pilonidal sinus disease. Each method is associated with different postoperative complications, morbidity, and recurrence rates for each of the procedures. The most simple approach for pilonidal disease is simple incision. It is effective for simple, superficial, small, and mostly midline tracts. Excision is a simple technique used for chronic and recurrent pilonidal sinuses. Rhomboid Limberg flap reconstruction plastic surgery procedure was done after proper preoperative assessment and preparation in all cases.

Surgical Treatment of Expansive Sacrococcygeal Pilonidal Sinus with the Spider Procedure

Many techniques have been described to treat sacrococcygeal pilonidal sinus disease in its chronic and acute forms. Appear to be the main problems associated with the closing techniques during the surgical treatment of this disease. The aim of this study, in patients with expansive sacrococcygeal pilonidal sinus (ESPS) was to analyse results of with triangular excision and the spider flap procedure. From Nov 2012 through Nov 2013, single centre a totaly 46 male patients were performed the with triangular excision and spider flap procedure for surgical treatment of ESPS. Patient datas were analysed retrospective. Patients with sepsis underwent surgery after treatment with the appropriate antibiotic. In the literature, we didn’t find a study made with the procedure for pilonidal sinus surgical treatment. We described a new effective repair method using the spider procedure for the excision of the pilonidal cyst. Within the scope of the study, a total of 46 male patients mean aged 26.5 (21-38) were treated with this technique. One of our patients (2.2%) developed recurrence. No flap rotation failures flap necrosis, incisional line maceration, delayed wound healing, or further complications were observed in an average of 8 month (6-11 months) follow-up period. Minimum postoperative morbidity and pain, short hospital stay and reduced time off work, satisfying esthetic outcome, and low recurrence rate make the proposed spider flap procedure an advantageous method for the treatment of ESPS.

Comparative Study between Modified Limberg Flap Transposition and Karydakis Flap Reconstruction in Patients with Primary Sacrococcygeal Pilonidal Disease

Comparative Study between Modified Limberg Flap Transposition and Karydakis Flap Reconstruction in Patients with Primary Sacrococcygeal Pilonidal Disease

Karydakis flap versus excision-only technique in pilonidal disease

BackgroundKarydakis flap (K-flap) and excision with healing by secondary intention (EHSI) are currently accepted methods for surgical management of sacrococcygeal pilonidal disease. This clinical trial study aimed to compare early and late outcomes of these two surgical techniques. Materials and methodsIn this controlled, prospective, randomized clinical trial, patients diagnosed with sacrococcygeal pilonidal disease were randomly allocated to two groups. Patients in the first group underwent Karydakis procedure, whereas EHSI was the surgical management in the second group. The two techniques were compared based on their overall time of wound healing, return to work, rate of complications, and recurrence. ResultsA total of 321 patients including 161 in the K-flap group and 160 in the EHSI group were included in the study. The median follow-up duration was 49 mo. The mean time of wound healing (16.44 versus 80.01 d, P < 0.001), return to work (14.44 versus 24.19, P < 0.001), rate of wound complications (18.7% versus 31.2%, P = 0.006), and recurrence (1.2% versus 7.5%, P = 0.005) were all significantly lower in the K-flap group. The mean operation time was significantly shorter in the EHSI group (15.87 versus 55.17 min, P < 0.001). The K-flap group showed significantly higher pain on their first postoperative day and significantly less pain after 1 wk (P < 0.001). ConclusionsAlthough both techniques are safe, the K-flap is associated with significantly lower rates of complications and recurrence and significantly shorter time of wound healing and return to work.

Comparison of modified limberg flap and modified elliptical rotation flap for pilonidal sinus surgery: A retrospective cohort study

BackgroundAlthough various surgical procedures have been described for pilonidal sinus disease, the best surgical technique is still controversial. Aim of this study was to compare the short term results of modified limberg flap (MLF) and modified elliptical rotation flap (MERF) for pilonidal sinus disease in terms of postoperative complications, recurrence and patient satisfaction. Materials and methodTwo hundred and thirty six patients (43 female, 193 male) who were operated on for sacrococcygeal pilonidal sinus disease between January 2010 to December 2013 were retrospectively analyzed. 115 patients underwent Modified limberg flap (MLF) procedure and 121 patients underwent modified elliptical rotation flap (MERF) procedure. The median follow-up period was 22 months (range, 4–34). Complication and recurrence rate were the mean end points of the study. ResultsSurgical area related complications were lower in MERF group than in MLF group, but the difference was not statistically significant. Patients in the modified elliptical rotation flap group had shorter operation time, better cosmetic results and earlier return to normal social life than modified limberg flap group. There were no recurrences in MERF group but one recurrence in MLF group. ConclusionModified limberg flap reconstruction is still one of the most commonly performed procedures for pilonidal sinus disease because of its low complication and recurrence rate and higher postoperative quality of life. This study shows that modified elliptical rotation flap technique is at least effective as modified limberg flap reconstruction. Further prospective clinical trials are needed to show the effectiveness of this technique on long term.

Does Sacrococcygeal Angle Play a Role on Pilonidal Sinus Etiology?

The predisposing factors for the development of sacrococcygeal pilonidal disease (SPD) still remain undetermined. Here, we investigate the sacrococcygeal angle as a possible predisposing factor for the development of disease. Consecutive male patients admitted to our clinic with the diagnosis of SPD were included. Sex, age and BMI matched healthy controls without SPD were enrolled to the study. The predefined sacrococcygeal angles of patients and controls were measured on lateral pelvic radiographs by a single experienced radiologist. Thirty patients were included in each group. Sacrococcygeal angles of patients and control group were measured as 37.3±14.5 and 36.81±10.23 in patients and controls, respectively. The difference with respect to sacrococcygeal angle was not statistically significant between two groups. Sacrococcygeal angle which is the main skeletal determinant of intergluteal sulcus is not a predisposing factor for the development of sacrococcygeal pilonidal disease.

Rhomboid excision with modified Limberg flap in the treatment of sacrococcygeal pilonidal disease

Background: Optimal treatment for sacrococcygeal pilonidal disease has not been determined because of high complications and recurrence rate. We conducted this study to evaluate the effectiveness of rhomboid excision with modified Limberg flap in the treatment of sacrococcygeal pilonidal disease. Patients and Methods: Twenty one patients with pilonidal sinus of both primary and recurrent presentations were operated from July 2011-July 2012. Following rhomboid excision of the pilonidal sinus a modified Limberg flap was performed and used to cover the defect under spinal anesthesia. Cases were followed up for median of 4 months post operatively. Results: Of the 21 cases, 16 (76%) had no post operative complications, either during their stay in the hospital (3-9 days) or during the follow up period (4 months). Five cases presented with different complications. One patient had recurrence, two had complications of both wound infection and wound dehiscence and underwent second operation under local anaesthesia. Conclusion: Rhomboid excision with modified Limberg flap is a promising surgical technique proved to be safe and effective in the treatment of both primary and recurrent pilonidal sinuses with less post-operative complications, short hospital stay and low recurrence rate.

Disease that should be remembered: Sacrococcygeal pilonidal sinus disease and short history.

Pilonidal sinus disease has led to heated debates since it was first described in the medical literature. Although a consensus has been built on its etiology and pathogenesis, the same course has not progressed for treatment modality. This review is a short article about the process of pilonidal sinus disease from past to present. Some important points were mentioned between the years 1833, which is accepted as the milestone for the awareness of the disease, in which it was first reported until the year of 1880, in which it was given its name. Although its name has been the same for about two centuries, some other names such as "Jeep Disease" have also been used depending on the population affected by the disease. At present, it is indisputable that the disease is acquired. Large series were presented about the treatment in the last two decades. Some surgical methods were even named after the ones who first described them and they have many supporters. However, since the treatment modalities have some advantages and disadvantages and they do not have marked superiority over others, debates still continue. We hope that pilonidal sinus disease will not lose its significance and be underrated in parallel with the developments in technology and specialization in medicine.

How to repair the surgical defect after excision of sacrococcygeal pilonidal sinus: a dilemma

Although there are various therapeutic modalities to manage patients suffering from sacrococcygeal pilonidal sinus disease, there remains controversy over a standard method to treat such patients. In this study the postoperative outcomes after three different surgical methods of wound repair in patients with sacrococcygeal pilonidal sinus were compared. Patients were divided randomly into three different groups. All of the patients underwent a wide excision of their pilonidal sinus; the subsequent surgical wound was left open in the first group (lay open group) whereas it was repaired with a simple primary closure and a rhomboid flap in the second and third groups. Variables including length of hospitalisation, time for wound healing, time off work, recurrence and surgical complications were evaluated. A total of 60 patients with an average age of 27.61 years were studied, including 47 (78.3%) men and 13 (21.7%) women. Postoperative hospitalisation time was significantly shorter in patients who were treated using the simple primary closure method than those with the rhomboid flaps. However, there were no differences in terms of postoperative hospitalisation time between the lay open and simple primary groups or the lay open and rhomboid groups. The period of absence from work was significantly shorter in patients who were managed by a simple primary closure or rhomboid flap technique comparing to those whose wound was left open (p<0.05). Complete wound healing had a significantly shorter course in the rhomboid flap and the simple primary closure techniques compared to those within the lay open group. In terms of complications, postoperative infection and haemorrhage were more common in the lay open group than in the other two. Recurrence was about 5% in patients who were treated with the lay open method in an 18-month follow-up period; however, no recurrence was observed in the other two groups. Considering the earlier wound healing period, less days absent from work, lower complication levels and recurrence rates, the simple primary closure or rhomboid flap techniques appear to be better options to treat the subsequent wound after a wide excision of pilonidal sinus when compared to the lay open method. The simple primary closure method causes no cosmetic disfiguration and the most promising option among the three techniques assessed. The authors have declared that no conflict of interest exists.

A Comparative Study between Karydakis Flap Reconstruction and Double Z-Plasty in Patients with Sacrococcygeal Pilonidal Disease

The most difficult problems that follow surgery for pilonidal disease are persistent unhealed midline wound and recurrence. Various innovations were proposed to deal with these problems. The adipocutaneous flap of Karydakis was devised to shift the natal cleft, while Z-plasty involves fasciocutaneous flap. The present prospective randomized trial was conducted on 50 cases of symptomatic or recurrent pilonidal sinuses divided randomly into two equal groups undergoing Karydakis procedure and Z-plasty. The duration of hospitalization for Karydakis procedure was found significantly lesser than that for double Z-plasty (P < 0.001). Similar observations are obtained for duration of wound healing (P < 0.001), work off period (P < 0.001), and the duration of presence of significant pain postoperatively (P < 0.001). The overall complications were more in double Z-plasty. Recurrence developed in 32% of the cases in double Z-plasty group comparable to no recurrence seen in Karydakis procedure. Thus, Karydakis flap was found superior to double Z-plasty having less seroma formation, no local hematoma, and no flap necrosis. Statistically, this comparison was highly significant (P < 0.001). Karydakis flap has some added advantages over double Z-plasty technique like keeping scar away from the midline and flattening of the natal cleft, thus reducing local recurrence rates.

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.