Your NYC Pilonidal Cyst Doctor Weighs In On Emergency Cleft-lift Procedures
Patients with an acute pilonidal abscess need emergency drainage, this is standard. In the preoperative holding area, one of the common questions asked of the surgeon by the patient is “Can’t you just remove the whole cyst now, rather than just lancing it?” It might surprise many that the answer is sometimes yes!
A proper cleft-lift requires removal of a wide swath of soft tissue. When the reddened, swollen skin associated with an acute abscess falls within the prescribed cut lines of a cleft-lift, then the cleft-lift can be done in the place of a simple lancing. One can therefore be simultaneously relieved of the painful inflammatory symptoms of an acute abscess and definitively cured of pilonidal disease.
In our hands at PTCNJ, no increase in postoperative wound infection, healing time, or recurrence has been recorded when this strategy is selectively employed. It deserves important reiteration that this approach is really only successful when the surgeon performing the cleft-lift is truly a specialist, such as one found at PTCNJ. It will most certainly fail in the hands of a nonspecialist surgeon.
The images below exemplify the PTCNJ “emergency” cleft-lift described. The patient was an otherwise healthy 40 year old male who presented with an acutely inflamed and recurrent pilonidal abscess (upper image). Here, the swollen reddened natal cleft skin (circled in red) helps establish the acuity of the abscess. The necessary excision margin of a standard cleft-lift (green dashed line) is also superimposed. Note that the redness falls within this excision margin, and a definitive cleft-lift is achievable. The lower image shows full healing at 4 weeks.