title: Karydakis flap for post-proctectomy perineal sinus: A case series and review.
abstract: BACKGROUND
  Persistent perineal sinus (PPS) may occur in up to 38% of patients undergoing proctectomy. The available therapeutic options range from simple but ineffective to relatively successful but complex. The Karydakis procedure is a straightforward day-case operation, commonly performed by general surgeons in the treatment of pilonidal disease, a not dissimilar pathology to PPS. This report is the first in the literature describing the use of Karydakis procedure in patients who developed PPS after proctectomy for Crohn's disease.
  
  
  METHODS
  Two patients, both of whom suffered from Crohn's disease and a PPS, underwent a Karydakis procedure as first-line treatment for PPS. Case 1 had a relatively superficial PPS while Case 2 had a deeper, more complex and longstanding PPS. Both patients had no post-operative complications and were discharged on the same day. They achieved complete healing in eight weeks and eight months respectively. The follow up range was 8-16 months.
  
  
  CONCLUSIONS
  Various techniques, including complex myocutaneous flap reconstruction, have been described in the literature to treat PPS. In contrast to these complex techniques, Karydakis operation is a simple day case procedure that was successful in treating PPS in our patients. While there is robust data regarding low recurrence rates following a Karydakis flap for pilonidal disease, there is no existing data for the indication outlined in this report.
  
  
  CONCLUSIONS
  While it requires further assessment, the Karydakis operation has potential as a simple, safe and effective first-line treatment in selected patients with PPS while not precluding more complex operative options in the future.
authors.affiliation: Department of Colorectal Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow G4 0SF, United Kingdom. Electronic address: stephanieau@gmail.com.
authors.forename: S
authors.initials: S
authors.lastname: Au
authors.affiliation: Department of Colorectal Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow G4 0SF, United Kingdom.
authors.forename: L H
authors.initials: LH
authors.lastname: Moyes
authors.affiliation: Department of Plastic Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow G4 0SF, United Kingdom.
authors.forename: J R C
authors.initials: JR
authors.lastname: Telfer
authors.affiliation: Department of Colorectal Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow G4 0SF, United Kingdom.
authors.forename: J H
authors.initials: JH
authors.lastname: Anderson
keywords: Case series; Crohn’s disease; Karydakis procedure; Perineal sinus; Perineal wound