There is no universally accepted and used classification of Sacrococcygeal Pilonidal Disease.
This leads to studies being non-generalizable with difficult to compare outcomes driving the tendency towards surgeon specific management.
A survey of pilonidal surgeons was perforemed to determine the necessary components of a classification system.
Pilonidal Disease videos
Bascom in 2002 described his Cleft Lift as a “modification of the successful method of Karydakis and Kitchen".
This relatively straightforward flap results in an off midline scar which is out of the ditch.
In 1955 researchers discovered:
- suction pressure in the subcutaneous tissue of the natal cleft
- due to its scales, hair is always propelled in the direction of the root
- all hairs within a pilonidal sinus are parallel
The Karydakis flap is named after the Greek surgeon George Karydakis.
It is effective ie low risk of recurrence as it eliminates the natal cleft ("crack") and leaves the weakest point (the scar) away from the midline. The pilonidal sinus is also excised.
The typical pilonidal sinus occurs in the natal cleft i.e. sacrococcygeal region.
Other locations where pilonidal sinuses may occur include: penis shaft, axilla, intermammary area, groin, nose, neck, cltoris, suprapubic area, occiput, prepuce, chin, periungual region, breast, face and umbilicus.
The typical pilonidal sinus has three holes in the midline called primary sinuses.
There is usually a single secondary opening off to left. This secondary opening is usually higher than the primary midline pits. But, this is not always the case!
In the early days, doctors thought pilonidal sinus was a dimple in the bum crack present since birth. For this reason, traditionally surgeons would perform a wide excision of the area. An open wound would then take months to heal. In some patients the condition still recurred!