Thereafter, a flat intergluteal incision of approximately 5 cm in length and till the postsacral
fascia in depth was performed.
SCTs are classified into four types according to the anatomical extent of the tumor with type 1 being mostly external and mostly compromising postsacral
area and type IV being internally confined to the presacral area .
Karydakis technique consisted of a vertical eccentric elliptical incision extended down to the postsacral
fascia; complete removal of unhealthy tissue, including a rim of normal tissue around the cyst and sinus tract; mobilization of the medial wound edge by undercutting the adipose tissue at a depth of 1 cm; advancement of flap across the midline to the postsacral
fascia; and suturing of its edges to the lateral wound edges.
In this surgical procedure, the sinus tract was first excised in the prone position, descending as far as the postsacral
fascia with an S-shaped oblique incision facing either right or left (Figure 1).
Surgical Techniques: Karydakis technique after removal of the pilonidal focus with an incision 3cm wider on either (right or left) side of the midline, the subcutaneous tissue under the medial part of the incision was dissected free superficial to the postsacral
fascia enabling it to be mobi-lized and the wound was closed primary by 2-0 polypro-pylene sutures incorporating the presacral fascia.
The sacral vertebra from 21-3 would become a trunk vertebra in 22-2, the first postsacral
vertebra the sacral vertebra, and the last trunk vertebra a rib-bearing trunk vertebra.