Flap Terminology Confusion

The difference between Bascom’s Operation and The Bascom Cleft-Lift

There are many different operations for pilonidal disease and the terminology can be confusing. At our clinic we perform the Bascom Cleft-Lift. However, there are other operations that are often confused with this. This post will, hopefully, end that confusion.

Bascom’s Operation (aka “Pit Picking)

This operation removes the midline pores with small incisions and makes an incision off to the side which is used to clean out the cyst. It is also called pit picking, or “Bascom’s Simple Surgery “, or the “Bascom I Procedure”, and is in the category of “minimally invasive” pilonidal operations.

The Bascom Cleft-Lift (aka “Cleft-Lift” or “Cleft Closure”)

Dr Bascom coined the term “cleft-lift” for his rotation flap operation. Originally, Dr Bascom called it a “cleft closure”, but he changed the name because he felt the “cleft-lift” terminology was better accepted by patients. Dr Bascom described this procedure in 1987. It has also been referred to ast the “Bascom II Procedure”, to differentiate it from the one described above.

The Karydakis Procedure

This was the early iteration of the cleft-lift as described by George Karydakis in 1973. This is similar to the cleft-lift in that it is an off-midline closure flap, but has some differences in how the subcutaneous tissue is handled. It is still considered a good procedure.

Other flaps

There are several other operations called flap procedures, such as the Limberg Flap, Rhomboid Flap, Z-Plasty, V-Y Plasty, and Dufourmentel Flap which are quite different from either the cleft-lift or Karydakis procedures. These flaps bring tissue into the midline to fill a defect. The cleft-lift and Karydakis Flaps remove tissue from the midline to flatten the cleft. These are not “Bascom” procedures and have no relationship to the cleft-lift.

Modified Cleft-Lift

A surgeon often might use this term if he or she feels that they are doing an off-midline closure flap operation, but not exactly like Dr. Bascom described. Overall, the differences may be unimportant within the grand scheme of things, because every patient presents a different challenge either by their body habitus, location of disease, or procedures that they have already been through. The main thing is that it bring the incision off the midline and flatten the cleft.