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[av_heading tag='h1′ padding='10' heading='Coccygeal fistula treatment: Flapplasty' color='custom-color-heading' style='blockquote modern-quote' custom_font='#008dcf' size=" subheading_active='subheading_below' subheading_size='20' custom_class=" admin_preview_bg=" av-desktop-hide=" av-medium-hide=" av-small-hide=" av-mini-hide=" av-medium-font-size-title=" av-small-font-size-title=" av-mini-font-size-title=" av-medium-font-size=" av-small-font-size=" av-mini-font-size="]
Removing coccygeal fistulas surgically
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In the past, the standard treatment for coccygeal fistulas was surgery, known as flap surgery. Today, treatment options such as pit picking are preferred because they are minimally invasive and involve less surrounding tissue. In our practice, we now only perform flapplasty in a modified form if there has been a larger defect of the midline due to previous operations.
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The classic method of treating a coccygeal fistula is still surgery. The fistula tissue is cut out in a spindle shape. A simple suture closure is rarely successful because of the shearing forces that act in the buttock fold. If the wound is not to heal openly, a flapplasty must be used. This uses the body's own healthy tissue to close the wound. With this technique, wound healing can be accelerated considerably. It also reduces the risk of recurrence.

The disadvantage of this technique is that a larger incision is necessary to have enough tissue available for wound closure. If there is a wound healing disorder, the wound must still heal openly in many cases and healthy tissue has been unnecessarily affected.
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Flap plastic according to Dr. Hofer

If a larger defect of the midline has occurred due to repeated previous operations of the coccyx fistula, we use a version of the flap plastic developed further by Dr. Hofer. The first step is to remove the scar and the reoccurrence of the fistula. The wound is then sutured to the side of the midline as this technique has been shown to have the best chance of healing. Blood and lymph vessels are spared as much as possible when the tissue for wound closure is removed from the subcutis. This can also prevent bruising and accumulation of lymph fluid under the wound.

With this incision, the scar can be moved further to the side in the critical zone at the lower edge:
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Here you can see the extent of the tissue to be removed during the Karydakis surgery for coccygeal fistula.
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The skin-subcutaneous flap is mobilised on the superficial body fascia. My technique does not go down to the bone!
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The skin-subcutaneous flap is sutured in without tension, the midline defect is repaired. The flattening of the gluteal fold and the lateral suture line are clearly visible, both factors that prevent recurrence of the pilonidal sinus.
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The course of treatment

The operation is usually performed under general anesthesia, local anesthesia is also possible in individual cases. Physical rest is then necessary for two to three weeks, during this time you should not sit for long and do no sports. The skin threads are pulled after twelve days. The deep threads dissolve by themselves.

After this operation, the patients come to our Proctological Practice in Munich for a weekly check-up. Minor wound healing disorders are common, but they can be controlled well by appropriate care of the wound edges, removal of sutures and special wound dressings.

We will be happy to advise you on all questions regarding the treatment of a coccygeal fistula using flap surgery. Come and see us - we are happy to be there for you.
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