Cleft Lift Research Articles

Bascom's Simple Pilonidal Sinus Surgery: Simpler with Ultrasound Guidance

Although a range of procedures have been described for the treatment of pilonidal disease, two techniques form the mainstay of modern surgical management: Bascom's simple surgery and the Bascom cleft lift. We present a case report describing a novel refinement of Bascom's simple surgery using portable ultrasound to identify the extent and location of chronic pilonidal abscess cavities, which allows a more targeted and nuanced approach to this heterogeneous disease, thereby avoiding large and slow healing blind lateral incisions.

Cleft lift technique with tension-free primary closure for repair of pilonidal sinuses: Three years experiences

Objective: Cleft lift technique was performed in patients with chronic or recurrent pilonidal sinus (PS). It has been reported to provide better results than simple excision and closure in the midline. The aim of this retrospective study was to evaluate the results after introducing the tension-free flap as asymmetric cleft lift procedure in our hospital on a day care basis. Patients and methods: Between June 2008 and July 2011, 236 patients (199 males, 37 females: median age 30 years; range, 18-46 years) underwent excision ofthe pilonidal sinus with tension-free primary closure in cleft lift technique. Patients were observed and followed up (126 cases (53.3%) of these patients accepted a consultation in the outpatient clinic w hile 75 cases (31.7%) were interviewed by phone) for the healing rate and reporting the postoperative criteria over 2 years. Results: At follow up mean 24 (range 10--27) months after the operation, 169 (72.6%) of the wounds were healed while recurrences were present in 32 (13.5%) of the patients. Further results related to pre-, per- and postoperative conditions are discussed in this paper. Conclusion: Cleft lift procedure results in a similar looking wound of the midline and a shallow cleft. It is very successful in the treatment of difficult recurrent sinuses, where the early results are promising.

Pilonidal sinus treatment: A new simplified technique; filling natal cleft with fasciofatty flap.

Background: Karydakis and Bascom designed new lines of surgical treatment of pilonidal sinus. Both of them share the principles of off-midline scar and cleft lift. The objective of this randomized clinical trial was to evaluate prospectively the outcome of adding few modifications to both techniques ofKarydakis and Bascom. Method: Sixty eight patients with pilonidal sinus were included in this study. After eradication of pathological tissues; the skin flap was created, afasciofatty flap was everted to fill the natal cleft. On table removal of drain was done after sutureless collapse ofwound cavity. Results: The depth of the natal cleft showed a clear reduction. Four cases (5.9%) developed seroma which required simple needle aspiration. All patients attended the follow up period with no recurrences. Conclusion: This technique carries the simplicity with promising results. It helps in pathology eradication and reduction of natal cleft depth through a reliable filling with fasciofatty flap.

Síndrome de ectrodactilia, displasia ectodérmica y fisura de labio/paladar, informe de un caso con expresividad variable

The ectrodactyly-ectodermal dysplasia-cleft lip/palate syndrome is a rare entity associated with mutations in the genes that express the protein p63. We present a case of a patient with right foot ectrodactyly associated with cleft lip and palate, without other evident anomalies. The patient has a positive familiar history for cleft lift and palate and mortality during the perinatal period. The management of each case must be specific and multidisciplinary.

Aesthetic Sculpting for the Natal Cleft and Buttock Lift Using an Innovative Periosteal-Dermal Suture Suspension Technique

Natal cleft contouring poses a reconstructive challenge. Buttock aesthetics and the need for careful scar placement are part of the challenge faced by plastic surgeons. Various steps of the reconstructive ladder can be used with varying outcomes. We report a patient who underwent natal cleft reconstruction using a new suture technique and had a cosmetically pleasing outcome.

Interventional calendar and protocol for cleft lift and palate repair at the maxillofacial and plastic surgery department of the Armand Trousseau Children’s Hospital (AP-HP, Paris)

Parents want their children’s’ faces, the most visible part of their bodies, one that marks their identity throughout life, to be perfect. To satisfy this understandably urgent desire, a high quality of primary treatment for cleft lip and palate is essential and must satisfy a double objective: restore normal morphology and normal function. The functional, morphological, and esthetic prognoses depend on the character of the defect, whether it stands alone or is associated in a syndrome with other malformations. Important sequellae flow from the quality of the initial repair, as a consequence of the surgery and other therapies as well as from the deformity itself.

A comparison of the cleft lift procedure vs wide excision and packing for the treatment of pilonidal disease in adolescents

Background/Purpose The cleft lift for pilonidal disease is a flap procedure designed to counteract suspected causes of closed-technique failure. This study compares cleft lift with wide excision and packing in adolescents with respect to complications, healing, and recurrence. Methods Charts of all patients surgically treated for pilonidal disease at our institution from August 2000 to August 2009 were reviewed retrospectively. Wide excision was routinely performed until May 2007 when the cleft lift as described by Bascom was instituted here. Factors examined were postoperative complications, wound healing, and disease recurrence. Results Seventy patients (49 males, 21 females; mean age, 16 years; mean weight, 170.5 lb) with pilonidal disease underwent a total of 39 cleft lift procedures and 34 wide excision procedures. All but 1 cleft lift patient (97.4%) healed completely, whereas 25 (73.5%) of 34 patients in the excision group healed ( P < .001). The remaining 9 excision patients had chronic wounds, 3 of whom have undergone cleft lift with full healing. One cleft lift patient had recurrent disease (2.5%) compared with 7 (20.6%) of 34 excision patients ( P < .02). Conclusions The cleft lift procedure is a superior treatment method of pilonidal disease in adolescents, resulting in primary healing, lower likelihood of recurrent disease, and simplified wound care.

Secondary Healing versus Midline Closure and Modified Bascom Natal Cleft Lift for Pilonidal Sinus Disease

Pilonidal sinus disease is a common disease in young employed male adults. Ongoing discomfort usually indicates an operative intervention. The main drawback is however the complication of wound healing. Numerous techniques for surgical treatment have been proposed, which underlies the lack of a superior technique. A retrospective study was performed on the medical notes of 62 patients operated for a pilonidal sinus between May 2005 and December 2006. Used techniques were: 'modified Bascom procedure', 'excision and primary closure' and 'excision with secondary wound healing'. Patients' characteristics, operative parameters and data on outcome were included. The primary endpoint was wound healing. Twenty-five patients underwent the modified Bascom procedure, 19 underwent surgical excision with primary midline closure and 18 underwent surgical excision with secondary wound healing. There were no demographical differences between the groups of patients. The modified Bascom technique showed a significantly reduced wound healing time (29 days) compared to primary closure (52 days, p < 0.01) and secondary healing (62 days, p < 0.01). The duration of this modified procedure was significantly longer (49, 33 and 24 minutes respectively, p < 0.01). Wound healing remains an important problem in the surgical treatment of pilonidal disease. Significant faster convalescence can be achieved using the modified Bascom procedure. Wide local excision as primary therapy should not be advocated.

Un livre d’or de la chirurgie plastique française

Susruta, Tagliacozzi and Dieffenbach are considered to be the first plastic surgeons. Many French surgeons deserve to figure in the "Golden Book" of the specialty. From Pierre Franco to Paul Tessier, many famous or sometimes unknown surgeons introduced important innovations. In the XVIth century, Pierre Franco realized the first autoplasty of the face as well as the first suture of a cleft lift. This was modified by Mirault, three centuries later. Delpech created at Montpellier a real "school" dedicated to plastic surgery where there was an attempt to oppose a French technique to the success of surgeons from Berlin. Roux was the first (or the second according to Von Graefe) to succeed a cleft palate closure. The first Zplasty was performed by Denonvilliers and Morestin devoted many works to plastic surgery insisting on scar discretion. After World WarII, the main cosmetic procedures were described and performed by French surgeons: Bourguet, Passot, Dartigues… Suzanne Noel was the first female plastic surgeon and the first to perform outpatient operations. After the creation of the French Society of Plastic surgery, Paul Tessier conceived the craniofacial surgery. An important step in cosmetic surgery was liposuction described by Y.G.Illouz. More recently, French teams performed the first allotransplantation of the face and of the upper limbs.

Cleft Lift Procedure for Sacrococcygeal Pilonidal Disease

The surgical treatment of sacrococcygeal pilonidal disease varies widely. This study reports outcomes of cleft lift procedure combined with pit excision performed both in primary and recurrent pilonidal disease. A total of 76 consecutive patients with primary or recurrent pilonidal disease who received cleft lift procedure or combined (cleft lift with pit excision) procedure in our clinic between March 2005 and May 2007 were investigated prospectively. Rate of postoperative complications and disease recurrence were the primary outcomes. Mean follow-up was 16.4 months (SD 7.0, range 5-34). The most common early postoperative complications were minor wound dehiscence (11 patients, 14.5 percent), followed by infection (10 patients, 13.2 percent), and wound break (4 patients, 5.3 percent). One recurrence (1.3 percent) was observed during the follow-up. The results of the current study supported that cleft lift procedure fulfills the requirements of an ideal operation for pilonidal disease. The cleft list procedure was a relatively simple procedure that was easy to learn, to teach, and perform under either spinal or local anesthesia. The procedure can be performed as a "day-surgery" procedure with low postoperative morbidity, acceptable time to return to work, and low recurrence rate.

Short-Term and Long-Term Outcomes of the Cleft Lift Procedure in the Management of Nonacute Pilonidal Disorders

We report the results of the cleft lift procedure in the management of nonacute pilonidal sinus disorders. Seventy consecutive patients who underwent a cleft lift for nonacute pilonidal sinus were evaluated prospectively. Responses to a postal questionnaire were analyzed for long-term outcome. All patients who fulfilled the criteria for day-case were operated on as such. Sixty-six patients achieved complete wound healing within six weeks. Delayed wound healing occurred in three patients and nonhealing occurred in one. Fourteen patients had one or more complications: wound breakdown, superficial (n = 7) and deep (n = 1); wound infection (n = 5); wound seroma (n = 4); and early recurrence (n = 1). The median time off work and to return to normal activities was two and four weeks, respectively (range, 0.5-12). Forty-seven patients completed the questionnaire at a median follow-up of 24 months: five patients reported minimal tenderness in the sacral region; none reported recurrence of pilonidal symptoms; and all were satisfied. The cleft lift procedure is easy to perform as a day-case procedure. It is associated with high rates of primary healing, durable low recurrence rates, and early functional recovery. This technique may be the procedure of choice in the surgical management of nonacute pilonidal disorders.

Introducing an Asymmetric Cleft Lift Technique as a Uniform Procedure for Pilonidal Sinus Surgery

Asymmetric techniques for surgery in pilonidal sinus disease (PSD) have been reported to provide better results than simple excision and closure in the midline. The aim of this retrospective study was to evaluate the results after introducing the Bascom asymmetric cleft lift procedure in our hospital on a day care basis. From a total of 33 patients operated from April 2002 to September 2004 with the Bascom asymmetric cleft lift technique, we were able to contact 29 who were invited to a follow up study. Eighteen (62%) of these patients accepted a consultation in the outpatient clinic while 11 (38%) were interviewed by phone. At follow up mean 17 (range 10-27) months after the operation 24 (83%) of the wounds were healed while recurrences were present in 5 (17%) of the patients. In two of the patients with recurrences errors in the procedures were identified. Further results related to pre-, per- and postoperative conditions are discussed in this paper. Early results after surgery for PSD with the Bascom asymmetric cleft-lift technique are promising. The technique has now become our standard procedure for treating chronic, symptomatic PSD.

Utility of the cleft lift procedure in refractory pilonidal disease

Background Refractory pilonidal disease is a problem. We wished to show the utility of the cleft lift procedure in solving nonhealing. Methods We selected a subset of challenging cases for this study. The subset included all patients referred with persistent open wounds despite at least 2 prior pilonidal surgeries elsewhere. Results The 69 patients had undergone 223 surgeries (average, 3) and endured open wounds for a sum of 365 years (average, 5). All patients we contacted were healed after a single cleft lift surgery with 3 exceptions. Two patients required 2 lifts before healing and 1 patient required 3 lifts. Conclusions The cleft lift procedure gave excellent results in patients with refractory pilonidal disease.

Cleft lift procedure with excision of pits for extensive sacrococcygeal pilonidal disease

Cleft lift procedure with excision of pits for extensive sacrococcygeal pilonidal disease

Failed Pilonidal Surgery

Refractory pilonidal disease is due to damage of the epidermis in the deep gluteal cleft by moisture and bacteria, rather than to damage in deep tissues. A new paradigm suggests that a procedure to change the shape of the gluteal cleft will improve results. Before-and-after trial. Community private practice with extensive experience in pilonidal disease, providing ambulatory and hospital care. Thirty-one patients with severe refractory pilonidal disease, with a median follow-up of 20 months in 27 patients (87%). Patients had undergone a total of 141 operations with wounds still open for a combined total of 252 years. The deep gluteal cleft was reshaped with a skin flap. Deep tissue was left essentially intact. Number healed, time to healing, number of operations required. Wounds in all 31 patients healed, 28 after a single procedure. The time to healing was rapid, within 1 week in 22 patients. There were no recurrences. For refractory pilonidal disease, the cleft lift procedure produced rapid results by drawing intact skin over the cleft and bringing the suture line out to open air. The failures of old methods and success of this new one suggest a need for a paradigm shift in our understanding of pilonidal disease. The source of disease is not the deep tissue but rather the epidermis in the moist, hypoxic, and bacteria-laden gluteal cleft. This also has implications for initial treatment of pilonidal disease, where simple, nonoperative treatments are often effective.

Primary bone grafting in the treatment of cleft lift lip and palate with special reference to alveolar collapse

Primary bone grafting in the treatment of cleft lift lip and palate with special reference to alveolar collapse