A modification of the Karydakis technique is the cleft-lift method introduced by Bascom in the 1980s, the aim of which is also to flatten or lift the bottom fold ("cleft" = column, "lift" = lift). The cleft-lift incision differs slightly from the Karydakis technique, but the main difference is that the tissue flap mobilized to cover the defect measures only 2 to 3 mm instead of 1 cm (for Karydakis).
Another difference to the Karydakis technique is that in the original Bascom technique the cyst and fistula system under the skin is not completely removed. Instead, the cavity is simply cleaned of inflammatory tissue. The idea behind this is to keep the tissue defect, which then has to be covered by a mobilized skin flap, relatively small.
In 2007 Bascom published the results of 69 cleft-lift operations. All patients had wounds healed at the end of the 30-month follow-up period and no patient had reoccurred with fistula. However, 12% of patients had to undergo two surgeries.
Other studies also confirmed low recurrence rates (0 to 5%) and a rapid return to daily activities after 2 to 3 weeks. However, the relatively high rates of wound healing disorders between 18 and 40% after cleft-lift surgery must be pointed out.
If the cleft-lift procedure is compared with minimally invasive surgical measures in pilonidal disease e.g. pit picking (Bascom I), fewer recurrences occur during the cleft-lift. Compared to the Limberg procedure, the recurrence rate (renewed fistula formation) and the frequency of wound healing disorders are approximately the same.
The cleft-lift procedure according to Bascom leads to approximately the same results as the Karydakis technique but tends to show a higher rate of wound healing disorders. The recurrence rate is comparable to that after Limberg plastic surgery. In practice, therefore, the cleft-lift technique for the treatment of pilonidal disease can be considered as one of the plastic procedures.
Literature sources:
Bascom JU (1987) Repeat pilonidal operations. Am J Surg 154:118–122
Bascom J (2008) Surgical treatment of pilonidal disease. BMJ 336:842–843
Bascom J, Bascom T (2007) Utility of the cleft lift procedure in refractory pilonidal disease. Am J Surg 193:606–609 (discussion 609)
Bascom J, Bascom T (2002) Failed pilonidal surgery: new paradigm and new operation leading to cures. Arch Surg 137:1146–1150 (discussion 1151)
Karydakis GE (1992) Easy and successful treatment of pilonidal sinus after explanation of its causative process. Aust N Z J Surg 62:385–389
Dudink R, Veldkamp J et al (2011) Secondary healing versus midline closure and modified Bascom natal cleft lift for pilonidal sinus disease. Scand J Surg 100:110–113
Gendy AS, Glick RD et al (2011) A comparison of the cleft lift procedure vs wide excision and packing for the treatment of pilonidal disease in adolescents. J Pediatr Surg 46:1256–1259
Guner A, Boz A et al (2013) Limberg flap versus bascom cleft lift techniques for sacrococcygeal pilonidal sinus: prospective, randomized trial. World J Surg 37:2074–2080
Morden P, Drongowski RA et al (2005) Comparison of Karydakis versus midline excision for treatment of pilonidal sinus disease. Pediatr Surg Int 21:793–796
