Coccyx fistula treatment: flap plastic surgery

Surgical removal of coccyx fistulas

In the past, coccyx fistulas were usually treated with an operation called flap plastic surgery. Today, treatment options such as pit-picking are preferred because they are minimally invasive and have less impact on surrounding tissue. In our practice, we perform flap plastic surgery in modified form only if a major defect of the midline has occurred during previous operations.

Flap Plastic Proctological Practice Munich

The classic method of treating a coccyx fistula is still surgery. The fistula tissue is cut out in the shape of a spindle. A simple seam closure is rarely successful due to the shear forces acting in the fold. If the wound is not to heal openly, a flap plastic must be used. The body's own healthy tissue is used to close the wound. With this technique, wound healing can be considerably accelerated. It also reduces the risk of recurrence.

The disadvantage of this technique is that a larger incision is necessary in order to have sufficient tissue available for wound closure. If a wound healing disorder occurs, the wound must still heal openly in many cases and healthy tissue has been unnecessarily affected.

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 shifted further to the side in the critical zone at the lower edge of the scar:

Flap Plastic Treatment Proctological Practice Munich

Here you can see the extent of the tissue to be removed during the Karydakis operation of the coccyx fistula.

Flap plastic surgery treat proctological practice Munich

The skin subcutaneous lobe is mobilized on the superficial body fascia. My technique doesn't go down to the bone!

Treatment of flap plastic surgery Proctologische Praxis München

The subcutaneous subcutaneous flaps are sutured without tension, the defect of the midline is repaired. The flattening of the gluteal fold and the lateral suture line are clearly visible, both factors preventing a recurrence of the pilonidal sinus.

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 relating to the treatment of a coccyx fistula using flap plastic. Come to us - we are there for you.