Case Report August 2023
30 year old male presents with a Pilonidal cyst for 2 years. He complains of drainage, bleeding, pain with sitting and activities.
He previously was treated with antibiotics and underwent open excision at another provider 1 year earlier. He was well for a few months, but then had recurrent symptoms of bleeding and discomfort.
Upon presentation, the patient was noted to have an open wound at lower edge of previous incision with granulation tissue. There was no extension to the sides (sinus tracts). Surgery was scheduled to re-excise the non-healing wound and perform a cleft lift (HEAL) procedure. Prior to surgery, he developed increased pain, swelling and pus drainage. Upon re-evaluation, he was found to have undermining of the previous incision with a 6 cm tract extending upward (Figure 1).
(Figure 1)
The patient was marked for a cleft lift procedure. In the operating room, the sinus tract was demonstrated (Figure 2), with hair and extensive granulation tissue in the prior repair (Figure 3). This was opened and debrided.
(Figure 2) 
(Figure 3)
The skin flaps were elevated on both sides to prepare for the cleft elevation and closure.
A drain was placed in the wound (Figure 4), the excess skin was removed and the wound was closed without tension (Figure 5).
(Figure 4) 
(Figure 5)
The patient presents for his 1st postoperative visit one week after surgery (Figure 6). He is pain-free, with no need for pain medicine, recovering well, happy and comfortable. The wound is healing very nicely and there is minimal swelling. The drain is removed and the patient is instructed to return to normal day-to-day activities, however to limit strenuous activities and exercise for 3-4 weeks.
(Figure 6)
He will be seen one more time in 3-4 weeks as a final check.