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Eric A. Weiss, MD
Orange Park, Fla

Arch Surg. 2002;137:1151.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

The authors report their experience of 31 patients with recalcitrant pilonidal disease. All patients had persistent open wounds and had at least 2 previous operations. The authors describe their operation of choice: the cleft lift. In this procedure, skin is excised from the left gluteus maximus and an advancement flap is created from the right gluteus maximus. The advancement flap redrapes across the cleft and closes the pilonidal wound and the left-sided skin defect. Twenty-eight patients received this operation, with most healing primarily and quickly, and all 31 patients healing eventually.

The authors point out that the nature of the pilonidal wounds predisposes to a failure to heal. They state that healing fails in "dirty ditches," ie, at the bottom of deep, moist, warm clefts despite carefully placed packing or stitches. Even normal skin breaks down in such sites. Thus, the primary source of surgical failure . . . [Full Text of this Article]

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