THE CLEFT-LIFT PROCEDURE

Chronic or recurrent pilonidal disease requires surgical removal or pilonidal cystectomy. The cleft-lift procedure is a novel approach offered at PTCNJ.

When a patient has had multiple abscesses, or has developed a chronically draining sinus tract, surgical removal of the diseased tissue, or pilonidal cystectomy, is indicated.  Historically, the pilonidal cystectomy was wrought with wound breakdown, prolonged healing times, and high recurrence rates. Fortunately, a novel approach to the pilonidal cystectomy called the “cleft-lift procedure” has evolved.  When performed by a specialist, the cleft-lift brings superior healing and a low risk of recurrent disease.

The cleft-lift finds its origins in a precursor operation conceived by Greek surgeon G.E. Karydakis in the early 1970’s. In the “Karydakis flap”, an elliptical incision was created that incorporated the entirety of the diseased intergluteal cleft, but was strategically offset several centimeters from the midline. This approach brought the sutured surgical wound to the side of, rather than within, the inhospitable cleft, in a microenvironment far more conducive to healing

Karydakis Flap procedure

Cleft-Lift procedure

Building on the off-midline approach, American surgeon John Bascom further tailored the technique. He introduced the preoperative inscription of “safety lines”, the arcuate lines of gluteal skin contact seen when the patient is standing. These lines help define the incision and flap margins. Moreover, by modifying the tension in the closure, he added a shallowing or “lifting” of the cleft. This flatter cleft contour is the most important factor in recurrence risk reduction. .

At PTCNJ, the cleft-lift procedure is performed in our ambulatory care center under general anesthesia. The duration of surgery is approximately 90 minutes. The resulting wound is closed in four absorbable suture layers over a small drain. Patients are asked to rest at home for 48 hours after the procedure. The drain is removed either at home by a family member or friend, or in our center, at approximately one week following surgery. Stress to the operative site is avoided for 3 weeks. Full healing is seen between 3 and 6 weeks.

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