The skin of the intergluteal cleft is the most inhospitable region to heal a surgical wound. Moisture, bacteria, and friction each contribute. Any pilonidal cystectomy technique that leaves an incision in the unforgiving cleft is potentially morbid. Moreover, the cleft anatomy is the driving force in the disease, and because it is not modified in…
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Emma S. came to PTCNJ with a typical failed pilonidal cystectomy story. She had struggled with pilonidal disease for 12 years, and had finally found a local surgeon to perform a pilonidal cystectomy. It was to be a full removal of the “cyst”, and a midline closure. When in her preoperative meeting, the well-informed Emma…
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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…
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In pilonidal disease, the term cyst is somewhat misleading. It suggests that an outer lining or “sac” exists, which it does not. In pilonidal pathology, we may see an impressive tuft of hair embedded under the skin, but no sac containing it. This contrasts with other true cysts that develop in the human body, such…
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The answer is a resounding yes. Traveling to a superspecialist for your pilonidal surgery is highly beneficial and likely critical to your outcome. PTCNJ is the only dedicated pilonidal center in the New York City metropolitan area and one of only 2 such Centers on the East Coast. As such, it offers the services of…
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Your prospective surgeon has made it onto an online list of cleft-lifters. He or she markets pilonidal excisions on their professional website. Unfortunately, these types of things do not guarantee that your surgeon is the pilonidal specialist that you need. Here are some red flags to look out for..1. The surgeon claims to have done…
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Patients are generally unclear about the forces that drive a physician to non-participation with major insurance plans. The most simple explanation is an economic one. For many solo and small group physician practices, the reimbursement rates offered for services and surgeries are prohibitively low. Surprisingly, an unfair playing field exists with this. As an example,…
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For decades, surgeons have struggled with the handling of the wound following pilonidal cyst removal. Early on, the most perfect-appearing midline closures would invariably fail. Some surgical schools theorized that tension was the problem, and devised elaborate skin rearrangements (flaps) to offset this. Others tried skin grafts from the thigh with minimal success. One wound…
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At PTCNJ, the drain used in the cleft-lift procedure is called a Blake drain. It is a closed-suction device used to evacuate clear fluid called serum, which tends to be produced under a closed surgical wound. The drain is made of soft flexible plastic-like material. It consists of a thin tube, part underneath the skin…
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At the most conservative end of the treatments spectrum, a nonsurgical depilatory technique, i.e. hair removal, may be used. This may be application of a topical agent (e.g. Nair), shaving, or waxing. Laser ablation is also an option but has limitations and setbacks. We add to this nonsurgical approach lifestyle modifications, the most important of…
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