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Revision Bascom Cleft Lift Pilonidal Cystectomy

Michael Reinhorn, MD, MBA, FACS
Tufts University School of Medicine

Abstract

Pilonidal disease is a chronic skin and subcutaneous infection at the top of the crease in the buttocks. It is more common in males than females and usually occurs between the time of puberty and 40 years old. Pilonidal disease is believed to be caused by an ingrown hair at the top of the cleft in the buttocks resulting in inflammation and infection. If not treated, this infection can lead to the development of a cyst, abscess, or sinus. Presentation of pilonidal disease can range from asymptomatic with just a small dimple to pruritus, pain, and drainage of pus. It is diagnosed clinically by physical examination and does not require any other tests. Treatment depends on the disease pattern. An acute abscess is treated with drainage and antibiotics, while a complex or recurring infection is treated surgically with either excision of a cyst or unroofing of a sinus tract. Reconstructive flap techniques such as the cleft lift procedure or Z-plasty can be done to reduce the risk of recurrence by leaving less scar tissue and flattening the region between the buttocks. Here, we present the case of a male patient who had previously had surgery for pilonidal disease, but experienced recurrence and the development of a sinus tract.

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