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    • MARCH 26, 2023
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    International Collaboration on the Cleft Lift Technique

    International Collaboration on the Cleft Lift Technique

    This week, Dr. Norbert Zapotoczny joined me from Wroclaw, Poland to refine his cleft lift skills. Dr. Zapotoczny is already an experienced cleft lift surgeon, but wanted to collaborate on technique. We both learned by collaborating and sharing our experiences. It is important to expand the worldwide network of dedicated pilonidal surgeons, and it is wonderful to have another highly skilled cleft lift surgeon in Europe! 

    We welcome surgeons who want to learn the cleft lift technique to come and spend time with us in Wisconsin!

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    • MARCH 25, 2023
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    Over 25,000 Article Views

    Over 25,000 Article Views

    The research is making a difference

    Dr. Immerman published the article “The Bascom Cleft Lift for All Presentations of Pilonidal Disease” in February of 2021.

    Since then, it has had over 25,000 views from 133 different countries. Clearly, this research is of interest to doctors and patients all over the world, and the concept of online publishing is an important way to spread information. Of the over 10,000 articles on the Cureus platform, this article is 198th in the number of reads!

    You can read the article yourself by following this link: “The Bascom Cleft Lift for All Presentations of Pilonidal Disease”Although there are many published papers describing the benefits of the cleft lift operation, Dr. Immerman feels it is important that more papers are published to convince the surgeons of the world to learn this procedure.

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    • MARCH 25, 2023
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    What are pilonidal “flare-ups” and how do I prevent them?

    What are pilonidal “flare-ups” and how do I prevent them?

    Why do “flare-ups” occur?

    Pilonidal disease had a tendency to intermittantly become symptomatic and then settle down. We often refer to these symptomatic episodes as “flare-ups”. Patients often question why these flare-ups happen, and hopefully this blog post will help explain the situation.

    In many situations pilonidal patients have a tiny midline pore in the gluteal crease, which connects to a pocket under the skin we call a “pilonidal cyst”. If this cyst tunnels to another area of skin and emerges as another opening, we now call it a “sinus”. There are bacteria and hair shafts in these cysts and sinuses, and the bacteria are able to move in and out of the pore or the secondary opening. When this is happening we say that the cyst or sinus is “contaminated” with bacteria, but not infected. (For something to be considered infected bacteria must be trapped within the tissues, and start invading normal areas.) A person can have this happening for a long time with minimal symptoms, or not even notice it.

    However, if something causes the openings to swell shut – that can create a situation where bacteria are trapped under the skin and cause an actual infection. The most common situations that cause the midline pores to swell shut are trauma to the area (falling on the gluteal crease) or prolonged sitting. There are other situations that can cause this as well, but those are the most common. Some women notice a relationship between flare-ups and their menstrual cycle and pregnancies.

    Once this happens it can become progressively more painful each day, and may require surgical drainage or antibiotics (in that case we would call it an “abscess”), or it may drain by itself and seem to resolve spontaneously. The drainage may be very minimal, and not really noticed, but occurs if the pore opens up and allows bacteria to exit.

    How do I prevent pilonidal “flare-ups”?

    Of course, avoiding prolonged sitting and trauma to the area is a good idea. Topical antiseptics may play a role in minimizing the number of bacteria in the pores and cyst, and therefore might help. Allowing air circulation in the cleft by placing a piece of gauze tucked into the crease may decrease pressure in the cleft and make the environment less hospitable to bacterial growth. Wearing clothes that are not compressing the buttocks together is very important as well. This is discussed in more detail on this web page about home remedies.

    What if these episodes keep occurring?

    In that case, having surgical treatment for the pilonidal disease is probably a reasonable next step. My recommendation is a cleft lift operation, and you can read about that here.

    Conclusion

    So, even thought these episodes of pain seem to be occurring randomly, there is some explanation for why these happen when they do. It especially explains why they seem to occur when traveling. I hope this discussion has been helpful!

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    • AUGUST 27, 2022
    • 0
    The Cosmetic Appearance of A Pilonidal Cleft Lift

    The Cosmetic Appearance of A Pilonidal Cleft Lift

    What does the contour of the gluteal area look like after a cleft lift?

    When I am performing a cleft lift we are dealing with patients of various body shape, amount of body hair, and location of their pilonidal cysts, sinuses and wounds- so the final appearance is different from person to person, and the subjective opinion regarding the change is quite personal. My feeling is that although we are making a significant change in the contour, we are turning it into a shape that is very natural.

    Here are some examples:

    These are photos of post op cleft lift patients with the actual scar Photoshopped out so it doesn’t distract from the evaluation of the contour.

    I recently published an article regarding patient satisfaction with the cleft lift procedure performed at our clinic. One of the questions asked how the patient felt about the appearance of the buttocks and scar (see graph below). Of 490 respondents, 98.8% felt it was acceptable. Only six were “very unhappy with the appearance” (1.22%). (Keep in mind that some of these patients had endured multiple previous operations, and started out with severe scarring and distortion even before they had their cleft lift.)

    Update: We now have data on 1000 patient surveys. You can read more about that here.

    Conclusion

    When surgeons first learn to perform the cleft lift procedure for removal of pilonidal cysts, sinuses, and wounds, their main goal is to remove the pilonidal disease and prevent recurrence. However, as we learn the procedure the goals expand to making the procedure less painful, make recovery smoother, and make the cosmetic appearance more natural.

    If you have your surgery done by someone who performs these frequently, you may end up with a better cosmetic result.

    In general, I feel that the cleft lift operation is the best procedure to cure pilonidal disease. But, it is not for everybody, and I understand if the cosmetic change is not something that a patient can accept.

    If you feel that you can not tolerate the change in shape of the cleft or the presence of the scar – then the cleft lift is not the best option for you as your first operation for pilonidal disease. If other operations fail, it can always be considered as a secondary procedure.

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