What happens when there is an infection after cleft lift surgery?

Infections can happen after any operation. The incidence depends greatly on the surgeon and the particular situation. Infection rates as high as 13% have been reported with the cleft lift procedure. In our clinic the overall infection rate is about 3%. We wish it were zero percent, but there are no operations completely free of possible infection, and an infection rate below 2% with any operation is unusual. Considering the location of pilonidal disease, and the contamination of the area with bacteria within cysts, sinuses and wounds, 3% is a very acceptable infection rate. Below I will discuss the strategies we use to prevent and deal with wound infections.

  • All patients receive IV antibiotics at the beginning of the operation.
  • Patients receive one week of broad spectrum antibiotics after surgery.
  • The wound is washed out with antiseptic solution during surgery.
  • A drain is placed to remove any fluid that might accumulate after surgery.
  • If during the surgery we find active infection in cysts or sinus tracts, we take cultures which may help guide antibiotic choices.

However, in spite of these strategies, infections still do occur. How serious a problem this will ultimately be depends greatly on the construction of the cleft lift. One of the consistent problems that occurs with infection is that a portion of the incision separates, and it is usually in the lower third. If the cleft is flattened and the incision is nicely placed off the midline, this separation usually heals with time. However, if the incision is in the midline, and in a fold, it may become more of a long-term issue. This web page demonstrates the differences between a cleft lift where the incision is well placed, versus the opposite.

What are the signs of a developing infection?

  • Pain that is increasing in the days after surgery.
  • Increasing tenderness over the incision.
  • Redness of the skin.
  • Change in the appearance of the drainage in the bulb such that it appears creamy, rather than watery yellow or red.
  • Significant amounts of drainage through the incision.
  • Wound separation and drainage.
  • Fever.

What do we do if we think there is an infection?

  • Change to a different antibiotic. If we took cultures, we use that information to help guide antibiotic choice. We always worry about the possible presence of MRSA (resistant staph) in these situations.
  • Leave the drain in place, if it has not already been removed.
  • Frequently change the gauze next to any area of separation.
  • Be sure to continue to follow the nutritional recommendations.
  • Keep Dr. Immerman updated on your situation with photos.
  • If you are not too far away to come back to the clinic, there are times when we place a few sutures on the outside of the incision to help stabilize its position, and we may take cultures to help guide antibiotic treatment.

Then, what happens?

Then, we have to be patient and allow the infection to subside and the wound to heal. Once an infection is apparent, the wound may separate a bit more over the next week. Then, it stabilizes but doesn’t seem to be really making any progress for another 3-4 weeks, and then it seems to start closing steadily, and is usually healed between 8 and 12 weeks from the surgery.

Here is a series of photos showing the typical evolution of the separation from a wound infection:

Separation and drainage 8 days after surgery. Drain left in place.
A bit more separation on the 11th day after surgery
Three weeks after surgery - not much visible progress
Eight weeks after surgery - separation almost completely healed


If the cleft lift incision is off the midline these usually heal, but an infection slows down healing and can be frustrating. It is important to keep us posted on your situation, follow our instructions, and be patient. Complete healing will take longer than usual, but the infection usually will not sabotage the success of the cleft lift.