Wound Infection After Cleft Lift Operation for Pilonidal Disease

Objective This is an analysis of postoperative wound infections that developed in patients who had the cleft lift procedure for both primary pilonidal disease and for salvage after previous other failed operations. Infection after the cleft lift procedure can complicate or prolong healing and recovery by several weeks. The aim of this report is to help clinicians recognize and effectively manage these patients. Patients and methods All patients who had the cleft lift procedure by the author and developed postoperative infection during the period between January 2014 and May 2024 were included. This study evaluates the intraoperative measures to prevent infection, describes clinical presentations, and outlines specific treatment strategies for postoperative infections. Results During the approximate 10-year time period of this study, there were 1,200 patients who had the Bascom cleft lift procedure, and within that group, there were 39 patients who developed wound infections, for an overall infection rate of 3.3%. All patients with diagnosed postoperative infection were prescribed additional antibiotics, and if drains were present, they were left in place until the infection had clinically subsided, as was the case for 19 patients (49%). Two patients (5%) required return to the operating room (OR) for irrigation of the wound and replacement of drains, and three patients (8%) required placing additional supporting sutures in the outpatient clinic. 15 patients (38%) had their drain already removed when the infection became apparent, and they were successfully treated with antibiotics. Ultimately, 37 of the 39 patients went on to complete healing without the need for cleft lift revision, demonstrating the effectiveness of timely intervention. Two patients were lost to follow up. Conclusions Infections should be recognized and treated quickly with adjustment of the antibiotic regimen and assurance of adequate drainage. Maintaining the position of the lower incision is of paramount importance, and if these infections are properly treated, they do not jeopardize the ultimate success of the operation.