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Dr. Immerman’s results on 700 cleft lift patients

Dr. Immerman has been keeping track of his cleft lift patients since 1993, and has just published his results in a peer reviewed scientific article. Although this was meant to be viewed by the surgical community, patients are certainly welcome to take a look at it.

The major findings described in the paper are:

  • Patients who had a cleft lift, but did not have any previous surgery and did not have wounds near the anus, had a 98.7% success rate with a single procedure.
  • Patients who had previous failed pilonidal surgery had a success rate of 94.7%.
  • Patients who had wounds actually on the edge of the anus were the most difficult group to treat and had a success rate of 84.4%, but a second revisional operation almost always solved the problem.
  • No patients in this series had a recurrence occur after 24 months from the cleft lift surgery.
  • There was no category of patient in whom this was not a highly successful approach.

If you would like to view the article, you may view and/or download it from THIS LINK.

It is important, when choosing a surgeon, to know their actual experience and results with this procedure, and Dr. Immerman is proud of his results, and is glad to share them. Taking care of pilonidal disease can be very humbling, and a 100% success rate is very elusive, but these results are coming close and have defined certain groups of patients who are at higher risk of recurrent problems or failures. Currently, there is not another operation that has a better success rate, and the cleft lift is indeed a good solution in all situations.

Flap Terminology Confusion

The difference between Bascom’s Operation and The Bascom Cleft-Lift

There are many different operations for pilonidal disease and the terminology can be confusing. At our clinic we perform the Bascom Cleft-Lift. However, there are other operations that are often confused with this. This post will, hopefully, end that confusion.

Bascom’s Operation (aka “Pit Picking)

This operation removes the midline pores with small incisions and makes an incision off to the side which is used to clean out the cyst. It is also called pit picking, or “Bascom’s Simple Surgery “, or the “Bascom I Procedure”, and is in the category of “minimally invasive” pilonidal operations.

The Bascom Cleft-Lift (aka “Cleft-Lift” or “Cleft Closure”)

Dr Bascom coined the term “cleft-lift” for his rotation flap operation. Originally, Dr Bascom called it a “cleft closure”, but he changed the name because he felt the “cleft-lift” terminology was better accepted by patients. Dr Bascom described this procedure in 1987. It has also been referred to ast the “Bascom II Procedure”, to differentiate it from the one described above.

The Karydakis Procedure

This was the early iteration of the cleft-lift as described by George Karydakis in 1973. This is similar to the cleft-lift in that it is an off-midline closure flap, but has some differences in how the subcutaneous tissue is handled. It is still considered a good procedure.

Other flaps

There are several other operations called flap procedures, such as the Limberg Flap, Rhomboid Flap, Z-Plasty, V-Y Plasty, and Dufourmentel Flap which are quite different from either the cleft-lift or Karydakis procedures. These flaps bring tissue into the midline to fill a defect. The cleft-lift and Karydakis Flaps remove tissue from the midline to flatten the cleft. These are not “Bascom” procedures and have no relationship to the cleft-lift.

Modified Cleft-Lift

A surgeon often might use this term if he or she feels that they are doing an off-midline closure flap operation, but not exactly like Dr. Bascom described. Overall, the differences may be unimportant within the grand scheme of things, because every patient presents a different challenge either by their body habitus, location of disease, or procedures that they have already been through. The main thing is that it bring the incision off the midline and flatten the cleft.

Letter from a grateful family

 

With permission, I thought I’d share a recent correspondence from a patient’s father, who is a physician who has retired from surgery and now works in a wound care clinic. He has been trying to get his daughter’s pilonidal wound to heal after three failed operations. He found that in spite of diligent wound care for over a year, that the wound kept partially healing, and then re-opening. Eventually, he brought her to see me for a cleft-lift. The communication below occurred four months after the cleft-lift procedure.

… Her surgical wound is completely healed and is beautiful. You did a masterful job of fitting those flaps together and the elevation of the edges near the anus healed and have flattened with anatomic contour. There have been none of the little pepper sized defects along the incision which for the last 2 years led to more openings, more disappointments and more misery.

She is reconnecting with activities she had been restricted from for 2 years. She is getting back many of the intangibles in her life which were taken from her by this unfortunate disease. She is losing weight and getting to be herself again and for that, I am eternally grateful to you. You did something for us that I nor the sum of my practice experience and contacts could have done. You educated me through your website about this affliction and gave us great hope. You were straightforward and encouraging in your contacts with us showing unsurpassed professionalism. I hope you and all of those important to you are doing well in these quite difficult times. Please accept our sincere gratitude, best regards and congratulations on such a fine outcome.

If I can in anyway help get the same educational message out about pilonidal disease, sign me up. What we never realized and I was never taught in Med school or in practice is that “pilonidal cyst” is a complete misnomer for this affliction. It really is a “disease” because it affects so much more than just that eccentric edge of the heightened gluteal cleft – especially when it just won’t go away!!! Please keep up your work. You have been blessed with a remarkable talent to really make a difference in patients and families lives particularly when most physicians don’t really understand pilonidal disease nor want to attend to those in need. I tell everyone who knows what we went through, the outcome we are now at, thanks to you!!

I read your paper with great interest and congratulate you on the content, presentation of honest data and the conclusions you draw. This is a paper that should be referenced in every general surgery text book because as you point out, the cleft lift procedure was not and is not taught in medical schools or in residencies – to include plastic surgery – as a more definitive solution to pilonidal disease based upon an anatomic etiology. Obviously, not every surgeon will have or develop the skills for this procedure that a master such as yourself has, but the anatomic knowledge of what causes the problem needs to be taught and the specialized, experienced approach that specialists such as you provide needs to be more widely recognized.

I think that this doctor is very articulate in expressing the relief that many patients and family feel after a cleft-lift successfully heals, often after many failed attempts with surgery and wound care. He is also pointing out the significant gaps in medical education about this difficult disease.

Even having your own surgeon and wound care expert in the house won’t make some wounds heal if the shape of the cleft is causing problems. Sometimes only a cleft-lift will help.

This is why I have limited my practice to pilonidal repair and cleft lift. It is results like these that make being a surgeon worthwhile.