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!