This article aims to reinforce this shift by reporting on successful treatment of complicated pilonidal disease.Ī paradigm shift had been building in pilonidal disease for 60 years or more. The author has given us this opportunity by not only challenging convention but also providing us with a lucid alternative thesis and compelling arguments for changing current surgical practice. There comes a time in the treatment of surgical disease when conventional methods are no longer improving the outlook for the patients and a paradigm shift in our concepts of aetiology and hence surgical treatment is required. IN AN INVITED editorial response to an earlier article on pilonidal disease by one of us (J.B.), an English surgeon wrote, This also has implications for initial treatment of pilonidal disease, where simple, nonoperative treatments are often effective. The source of disease is not the deep tissue but rather the epidermis in the moist, hypoxic, and bacteria-laden gluteal cleft. The failures of old methods and success of this new one suggest a need for a paradigm shift in our understanding of pilonidal disease.
Bascom flap skin#
There were no recurrences.Ĭonclusions 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 time to healing was rapid, within 1 week in 22 patients. Results Wounds in all 31 patients healed, 28 after a single procedure. Main Outcome Measures Number healed, time to healing, number of operations required. Intervention The deep gluteal cleft was reshaped with a skin flap. Patients had undergone a total of 141 operations with wounds still open for a combined total of 252 years. Patients Thirty-one patients with severe refractory pilonidal disease, with a median follow-up of 20 months in 27 patients (87%). Setting Community private practice with extensive experience in pilonidal disease, providing ambulatory and hospital care. A new paradigm suggests that a procedure to change the shape of the gluteal cleft will improve results. Hypothesis 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.
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![bascom flap bascom flap](http://3.bp.blogspot.com/_9CP9HNKaQM4/Sc1oXNaH-VI/AAAAAAAAAJQ/8G0XzfsghDg/s320/Pilonidal+8.jpg)