Modified Bascom’s Asymmetric Midgluteal Cleft Closure Technique for Recurrent Pilonidal Disease

Abstract

PURPOSE: Despite the variety of surgical techniques proposed for the treatment of pilonidal disease, recurrence after its operative management remains a common occurrence. Relatively few data exist that focus on an optimal surgical approach that should be followed in cases of recurrent pilonidal disease. The aim of this study was to describe the technical details, analyze the advantages, and present the early results of a modified Bascom asymmetric midgluteal cleft closure technique applied in patients with recurrent pilonidal disease in a military hospital setting. METHODS: Among the 72 male military service patients (median age, 21; range, 18–26 years) who underwent surgery for pilonidal disease in the Military Hospital of Samos Island, Greece, there were 24 who presented with recurrent pilonidal disease eight months to four years after one to four operations each, which were performed before their enrollment in the Army (total of 43 operations). One or two midline pits were evident in 41.6 percent of the patients, whereas the rest had more complex disease. Three patients presented with acute purulent disease and required initial incision and drainage. The modified Bascom technique was applied, which involved an asymmetric ellipse-like, gluteal fat–preserving excision of the affected skin, the pilonidal sinus, and lateral tracts, a thick skin and fat tongue of tissue mobilization, and finally, complete lateralization of wound closure and flattening of midgluteal groove. RESULTS: All patients tolerated the procedure well, with minimal to moderate postoperative discomfort. Full return to military duty was possible in three weeks after surgery. There was one case of limited primary healing failure. No recurrences have developed in a short median follow-up period of ten months. CONCLUSION: The suggested modified Bascom technique is an attractive, safe, easily performed operation with minimal morbidity and can be reliably used as a second-line surgical option for recurrent pilonidal disease.