The Cleft Lift procedure for pilonidal disease renamed as a rotation and advancement flap procedure (RAF): Insights and technical tips for a successful outcome

Introduction

The Cleft Lift procedure originally named by Bascom is a derivative of the Karydakis flap procedure for pilonidal sinus disease. The terminology and variations of the name have long confused surgeons and have limited its wide adoption.

Technique

This technical paper deconstructs the confusing terminology, suggests simple steps for success, and proposes a more descriptive name for the asymmetric flap procedure which has the lowest reported recurrences for all surgical options for pilonidal disease.

Results

The author has successfully performed the Cleft Lift procedure for pilonidal disease since 2000. In the last consecutive 757 patients treated over 12 years, only 6 patients have required a second operation. This cohort included 287 patients referred with recurrent disease or open wounds from prior pilonidal surgery. A new naming scheme is proposed that more accurately describes the operation. The proposed name is the pilonidal RAF procedure for rotation (around the anus) and advancement (across the natal cleft midline) flap .

Conclusions

The pilonidal RAF procedure is highly successful in treating pilonidal sinus disease with a very low need for additional surgery even in complex recurrent disease.