Figure 4.

Excision of the disease and primary closure is one surgical option. In an effort to improve upon this technique, Karydakis modified the procedure. The midline sinus is excised elliptically and the wound closed lateral to the midline. To do this, a thick flap is created by undercutting the medial wound edge and advancing it across the midline. By doing this, the natal cleft is flattened and the entire suture line is positioned lateral to the midline. From Hull and Wu.¹⁵ With permission from Elsevier.