Pilonidal Surgery Photo –  Pilonidal Cyst and Sinus Before Surgery

This pilonidal surgery photo shows what we typically see on the day of surgery.  The patient has been shaved.   The midline pits can be seen near the bottom of the picture, and a long sinus tract is invisible under the skin excepts it’s end near the top, almost 10 cm away from the lowest pit.


This patient took antibiotics prior to surgery and washed with hibiclens daily in order to minimize the infection coming out of the cyst and sinus tract.  In our practice we perform the cleft lift procedure on most of our patients.

Immediately Postop Cleft Lift, Pilonidal Surgery Photo

This photo shows the wound and drain immediately after cleft lift surgery, prior to putting on a bandage. The goal of surgery is to remove all of the disease, flatten out the natal cleft, and move the incision off the midline.  By moving tissues, in this case from right to left, we are able to create a flat surface that is easy to keep hair free and clean.  The advantage over traditional pilonidal surgery is that the risk of a wound complication is low.  Since the incision is closed away from the midline, if a wound complication does occur, it is much easier to take care of after surgery.  The rubber tube in the to right of the picture is the drain that we remove at the first visit.

2 Weeks Post Cleft Lift, Pilonidal Surgery Photo

This  pilonidal surgery photo shows what the incision and back look like 2 weeks after surgery.   The drain and suture have been removed and new hairs have been shaved in order to show a well healed incision.  At this point, most patients are home free as long as they avoid strenuous exercise or heavy lifting. Any activity that causes tension on the incision in the first few weeks, may cause the wound to separate and will require local wound care.


9 Months Post Cleft Lift, Pilonidal Surgery Photo

This cleft lift photo shows what the incision and back look like 9 months after surgery.   We clipped the hairs in the area to examine the wound closely.  The patient is starting to get normal sensation to the skin in the area of the surgery.  They have been back to normal activity for months without problems.  At this point we recommend patients continue washing with hibiclens till they are a full year out from surgery, but no hair removal is necessary.  In this last photo, we are not retracting the skin at all.  As can be seen, the incision is completly to the side, not at all going into the midline.  The key of the cleft lift surgery is to flatten out the gluteal cleft so that the incision can heal.  A lot of work in the operating room goes into moving the tissues from one side over to the other, in order to flatten out the anatomy.




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