Pilonidal Cyst Surgery Myth 2: All reconstructive flaps used in pilonidal excisions are created equal . No, no and no.
First, what is meant by the word “flap”? In a flap, a healthy equally-sized equally-shaped segment of adjacent skin and underlying fat is moved in to fill the defect (hole) left following removal or “excision” of pilonidal disease. In line with this definition, our gluteal cleft-lift is one such flap example, in which a flap of adjacent buttock skin from either side is transferred in to fill the defect following excision of tailbone-area pilonidal disease
(The Cleft-Lift Procedure – Pilonidal Treatment Center of New Jersey)
Another flap example in pilonidal disease is the Limberg flap in which a diamond-shaped replacement of adjacent skin is “transposed” in to fill a similar defect. Check it out here
(limberg flap closure – Google Search). It is also known as the “rhomboid flap”. The Limberg flap reconstruction is horribly flawed in that much of the incision falls in the midline, and the cleft is left far from lifted/flattened, but actually is left fairly mountainous! It generally fails at about the one year mark, coincidentally about 1 year after the plastic surgeon has declared success and signed off the case! We know this because we are often called in to address and correct these failures,which we gladly do using our revisional cleft-lift(see Revisional Cleft-lift 7 in Photo Gallery – Pilonidal Treatment Center of New Jersey). The Karydakis flap, seen and described in PTCNJ link above (https://ptcnj.com/our-treatments/cleft-lift-procedure/) is also far inferior to the cleft-lift in that the incision veers toward the midline as it progresses downward, leading to failures at the unforgiving perianal area. The specialist cleft-lift is far more evolved in how it handles this area, and so it is the perfect fix for such a failure! See Revisional Cleft-lift 1 in Photo Gallery – Pilonidal Treatment Center of New Jersey. The z-plasty flap reconstruction is quite disfiguring and actually a bit more difficult to correct when it fails. Avoid at all costs!
