Welcome to “Bizarro World”

Getting the right advice at the right time

Those of you old enough to have read Superman Comics may remember the Bizarro World where everything was the opposite of the real world. Sometimes our patients feel like they have entered Bizarro World when they come to our clinic because of the vast difference between the instructions and information I give my patients, as opposed to what they have been told in the past. The instructions I give are what I have found works for my patients with the operation I perform. So, I can’t say that the advice patients have received elsewhere by other surgeons is wrong, but I can say that they don’t apply to my cleft-lift patients.

Here are some examples:

  • We encourage sitting immediately after surgery! I believe that this is actually beneficial for the incision, since it opens up the bottom of the cleft and allows air circulation. I have never seen a situation in one of my post op patients where sitting has caused a problem.
  • We do not recommend any type of hair removal. Once the cleft is flattened, hairs should not be an issue anymore.
  • We close the wound. No open wounds, no packing, no complicated dressing changes.
  • We use dissolving sutures. The large, external, sutures that many surgeons use do not guarantee that the wound will stay together; they leave permanent, unsightly stitch marks; and can be very uncomfortable.
  • We allow showering the day after surgery. I would rather have the area around the incision clean. Letting the shower run on the incision and drain has not caused any problems in my patients.
  • We recommend patients go back to fairly normal activity, as long as it is gentle on the incision. We do not recommend any period of immobility.
  • We allow lying directly on the incision when sleeping. It is OK to sleep in any position that is comfortable.
  • We never use silver nitrate on wounds. It is a caustic chemical that does more damage than good.

These instructions are often met with incredulous expressions, since they contradict all previous instructions – but this protocol works very well. I am trying to make recovery from the cleft-lift as simple as possible, and get my patients back to normal activity as soon as possible. There are certain instructions I give that are very important to follow, and this is all complicated enough without adding restrictions that aren’t necessary.

The success rate in our clinic of ~98% primary healing speaks for itself as far as the wisdom of this protocol, and our patient’s responses to our post op instructions have been positive, as you can see from the answers to our survey below.

This is what our patients feel about the activity restrictions after cleft-lift surgery.

I Had a Cleft-Lift and It Failed!

Am I doomed?

The short answer is, “no”. But, what should you do now?

When a cleft lift fails – meaning that either the incision came apart and isn’t healing, or a new cyst, sinus, or wound has developed – it is usually because the cleft-lift failed to flatten the ENTIRE cleft, or that the incision from the cleft-lift ended up in the midline.

Fortunately, this can be repaired by revising the cleft-lift. The revision will flatten the lower portion of the cleft and bring the incision away from the midline. This is usually successful in salvaging the situation. Of course, nobody wants another operation – but it is better to just get this taken care of, then letting it linger. If six weeks or more has elapsed since your cleft lift, and you are still dealing with problems, then you should consider a re-operation.

Who should do this re-operation? You should make sure that it is a surgeon with a broad experience in re-operating on failed pilonidal surgery and failed flaps, since there is a unique skill-set needed for this. At the Evergreen Surgical Pilonidal Clinic, we have had extensive experience with this kind of re-operative surgery and are happy to see patients who have had failed surgery elsewhere. In our clinic we have had to re-operate on about 2% of our patients, but all of these had already had previous failed operations and/or wounds next to the anus, and were in the most difficult categories of pilonidal disease to treat.

THIS WEB PAGE will show you the difference between a successful and an unsuccessful cleft-lift. The takeaway being that although many surgeons call their procedure a “cleft-lift”, there are various degrees of quality and success based on the surgeons experience and expertise.

If you’ve had a cleft-lift and it has failed, don’t give up. Contact us for help!