I Had a Cleft-Lift and It Failed!

Am I doomed?

The short answer is, “no”. But, what should you do now?

When a cleft lift fails – meaning that either the incision came apart and isn’t healing, or a new cyst, sinus, or wound has developed – it is usually because the cleft-lift failed to flatten the ENTIRE cleft, or that the incision from the cleft-lift ended up in the midline.

Fortunately, this can be repaired by revising the cleft-lift. The revision will flatten the lower portion of the cleft and bring the incision away from the midline. This is usually successful in salvaging the situation. Of course, nobody wants another operation – but it is better to just get this taken care of, then letting it linger. If six weeks or more has elapsed since your cleft lift, and you are still dealing with problems, then you should consider a re-operation.

Who should do this re-operation? You should make sure that it is a surgeon with a broad experience in re-operating on failed pilonidal surgery and failed flaps, since there is a unique skill-set needed for this. At the Evergreen Surgical Pilonidal Clinic, we have had extensive experience with this kind of re-operative surgery and are happy to see patients who have had failed surgery elsewhere. In our clinic we have had to re-operate on about 2% of our patients, but all of these had already had previous failed operations and/or wounds next to the anus, and were in the most difficult categories of pilonidal disease to treat.

THIS WEB PAGE will show you the difference between a successful and an unsuccessful cleft-lift. The takeaway being that although many surgeons call their procedure a “cleft-lift”, there are various degrees of quality and success based on the surgeons experience and expertise.

If you’ve had a cleft-lift and it has failed, don’t give up. Contact us for help!

Are Wound VAC’s Really That Great?

The pros and cons of wound V.A.C.’s

A suction device used to help heal a wound has several names: Wound V.A.C, VAC, “vacuum assisted wound closure” or “negative pressure wound therapy (NPWT)”. Sometimes they are referred to based on the specific brand of the machine, like a “Pico” or “VERAFLO”. VAC stands for” Vacuum Assisted Closure”. It consists of foam placed over an open wound, that is sealed with adhesive plastic, and connected to a machine that applies suction and removes fluid.

Note: this is not the same as a “closed suction drain”, also called a JP Drain, Jackson Pratt Drain, or Blake Drain. These are tubes that go INSIDE closed wounds to remove fluid.

Negative Pressure Wound Therapy is very helpful in getting wounds to heal faster and minimize daily dressing changes. The VAC has to be changed periodically, but less frequently than usual open wound care.

But, is it a good solution for pilonidal wounds?

I suppose it depends on how you look at the situation. There are quite a few negatives (no pun intended) attributed to the use of the wound VAC for pilonidal wounds:

  • It is an extremely awkward location to have a wound VAC, and it is hard to keep it well secured in place, especially with wounds next to the anus.
  • It has to be changed frequently, the materials are expensive, and it has to be changed by a wound care professional, either in their clinic, or by a home-care visit.
  • It is noisy, smelly, and embarrassing; and the VAC changes can be painful.
  • It may have to be in place for months at at time.
  • Even if it helps a wound to heal, it provided no guarantee that it will stay healed once the VAC is removed. The placement of a VAC is an extremely abnormal situation which does not replicate the environment and anatomy that will exist when it is removed. Frequently, when it is removed, the wounds open up again. Note: This is true for gluteal crease wounds, not wounds elsewhere on the body.

Although philosophically one could look at the use of a VAC in this situation as a difficult therapy that is trying to make the best of a bad situation, I don’t agree with that analysis. I think the smarter choice is to see a pilonidal expert and have surgery to close the wound. This short-cuts the whole situation, and usually turns this into a full recovery in about six weeks with a very low chance of recurrence. (I have not used a VAC on any of my patients in 27 years of pilonidal surgery.)

FURTHER SURGERY may seem like an illogical way of dealing with an open wound, that occurred BECAUSE of surgery, but if done properly it works. It is also appropriate with failed flap procedures, including previous failed cleft-lifts. If your current surgeon says that the wound can’t be closed – get another opinion. It may just mean that he or she does not know how to close it. There is almost always a faster and easier solution.

Contact us if you need help!