Surgical Removal


Chronic or recurrent pilonidal disease requires pilonidal cyst removal. Pilonidal cystectomy is available at PTCNJ.

When a patient has had multiple abscesses, or has developed a chronically draining sinus tract, surgical removal of the entire pilonidal cyst complex, or “pilonidal cystectomy,” is indicated. This procedure is generally performed in an ambulatory care setting under some form of anesthesia. Following cyst excision, the resulting wound is closed in multiple layers, often over a small drain.

Historically, the pilonidal cystectomy was wrought with wound breakdown and prolonged healing times. Fortunately, several advanced closure techniques have been developed, and far greater success rates are now seen.

In the Karydakis flap, further modified into the “cleft-lift procedure,” an elliptical incision is created that incorporates the entirety of the diseased cleft, but is strategically offset several centimeters from the midline. On the side of the incision that is closer to the midline, a subcutaneous flap is mobilized that will ultimately be transferred across the midline for closure. The closure that results is one with a raised, shallow cleft. This technique is associated with superior wound healing results.


In the modified Limberg flap, a rhomboid incision is created that incorporates the entirety of the diseased cleft. On the gluteal region, adjacent to the excision, a rhomboid-shaped soft tissue flap is incised, mobilized, and rotated to fill in the defect without tension. The closure that results enjoys a robust blood supply. Moreover, it is oriented parallel to the lines of maximal tension. This technique is also associated with excellent wound healing results.


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