Pilonidal disease (PD) is a chronic skin condition affecting the natal cleft, the crease between the buttocks, often resulting in painful abscesses and draining sinus tracts near the tailbone. This condition develops when loose hair penetrates the skin, causing a foreign body reaction and subsequent infection. For individuals suffering from chronic or recurring PD, the Cleft Lift procedure is a specialized surgical intervention designed to address the underlying anatomical cause of the disease. This technique represents a modern approach to treatment, focusing on altering the shape of the buttock crease to prevent future episodes.
Defining the Cleft Lift Procedure
The fundamental concept behind the Cleft Lift procedure is to permanently change the anatomy of the deep buttock crease. This deep midline fold is problematic because it creates a moist, warm environment, collects shed hair, and generates a suction effect that draws hair into the skin pores. The procedure’s primary goal is to flatten and shallow this deep cleft, not just remove the infected tissue.
By re-contouring the area, the Cleft Lift eliminates the anatomical conditions that cause pilonidal disease to develop and recur. The surgical closure is intentionally placed off the midline, moving the incision away from the area most susceptible to moisture and friction. This off-center placement ensures the wound is exposed to air and kept cleaner, leading to a more durable resolution.
The Surgical Steps
The Cleft Lift procedure begins with the excision of the diseased tissue, including all sinus tracts and pits, typically in an asymmetrical elliptical pattern. This removal is limited to the skin and subcutaneous tissue, avoiding deep tissue to prevent fluid accumulation. The operation is generally performed as an outpatient procedure, lasting between 90 minutes and two hours, under either general or spinal anesthesia.
Following the removal of the affected tissue, the surgeon creates a skin and fat flap, or “lift,” by mobilizing tissue from one side of the buttock. This flap is then rotated and advanced across the midline to cover the surgical defect. The deeper tissues of the buttock cheeks are sutured together to effectively shallow the crease before the skin flap is closed.
Key Advantages of This Technique
The primary benefit of the Cleft Lift technique stems directly from its anatomical correction, which significantly lowers the risk of the disease returning. By flattening the natal cleft and moving the incision away from the midline, the procedure prevents the conditions that lead to recurrence. This design allows the wound to heal by primary closure, where the edges of the incision are brought together and sutured shut.
This approach offers a superior success rate compared to traditional procedures that leave the wound open to heal, which can take many months. Studies show that when performed by experienced specialists, the Cleft Lift boasts a low recurrence rate, often cited in the range of 1% to 5% over the long term. The quick closure promotes faster recovery and reduces the probability of a chronic, non-healing wound.
Post-Operative Care and Recovery
Immediate post-operative care focuses on managing the closed surgical site and controlling discomfort. Pain is managed with a combination of injected long-acting local anesthetic and prescribed oral analgesics. A small drainage tube is placed under the skin flap during surgery to prevent fluid accumulation that could compromise healing.
The drain is connected to a small bulb that patients must empty several times a day and is generally removed about one week after the procedure. Patients are encouraged to walk and sit normally the day after surgery, as this activity promotes blood flow and helps the drain function effectively. Full healing is often achieved within three to six weeks, though most patients can return to work and light activities within one to two weeks.
For the first few weeks, patients are advised to avoid strenuous activities, heavy lifting, and contact sports to protect the incision from trauma. The surgical site should be kept clean, and showering is permitted 24 to 48 hours after the operation. Unlike older procedures, the Cleft Lift avoids the need for complex wound packing, making the post-operative experience more manageable.