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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 emanating from the center of the natal cleft, often extending to the buttocks. It is more common in males than females and usually occurs between the time of puberty and 40 years old. A common theory is that pilonidal disease is caused by an ingrown hair at the center of the cleft resulting in inflammation and infection extending to the buttocks. 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. Only in exceptionally rare cases is imaging required. 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 Bascom cleft lift procedure, karydakis flap, rhomboid, 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. Due to the extensive nature of the disease, a deep flap is required to mobilize tissues and close the eventual wound.

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