The Data Mounts: 261 Cleft Lifts for Complex Pilonidal Disease and Excisional Failures.

INTRODUCTION:  The Bascom cleft-lift procedure is a superior approach for treating pilonidal disease. The purpose of this study was to establish healing time after cleft-lift, operative success, and any associated clinical or operative variables.

METHODS: The study group comprises all patients who underwent cleft-lift procedures at our center between December 2021 and February 2023. Many clinical and operative variables were collected before surgery. Postoperatively, patients were examined every two weeks until full epithelialization was achieved; thereafter, they were seen at 6, 16, and 30 months and as needed for recurrence surveillance. A successful cleft-lift was defined as one that fully healed by 120 days and showed no recurrence within 18 months of follow-up. Patients with failed cleft lifts were offered revision.

RESULTS: In total, 261 cleft -lifts were performed in 258 patients. Of these patients, 40.3% had at least one previous excisional surgery and 19.4% had a chronically open surgical wound. The median follow-up time was 19.8 (6.5 to 25.5) months. There were a total of 12 failed cleft-lifts, yielding an operative success rate of 95.4%. Recurrence was detected in two (0.08%) cases. The median healing time was 43 (15-387) days and did not differ by any covariate. Previous Limberg flap surgery and a shorter distance from the inferior extent of the wound/disease to the anal mucosa were associated with decreased operative success.

CONCLUSION:  Our data reinforce that the cleft-lift procedure is a highly successful cure for this disease and its surgical failures. Notably, the operation was a successful cure for many patients with extensive disease and previously failed excisional surgeries, including flap reconstructions.