Revision Bascom Cleft Lift Pilonidal Cystectomy
Michael Reinhorn, MD, MBA, FACS¹; C. Haddon Mullins, IV, MD²
¹Tufts University School of Medicine
²University of Alabama at Birmingham
Pilonidal disease is a chronic skin and subcutaneous infection emanating from the center of the natal cleft, often extending to the buttocks. 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, Dr. Reinhorn at Tufts University School of Medicine presents the case of a male patient who had previously had flap 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 was required to mobilize tissues and close the eventual wound. A deep flap like this is often only required in re-do surgery, rather than for primary disease, for which only a 1-cm subcutaneous flap is required.