Pilonidal Disease: Before and After

Please be aware that the following before and after photos of patients may be considered graphic by some.  If you do not wish to view surgical photos of patients please go to another screen.

The following are a series before and after photos of patients who underwent The Cleft Lift procedure at The Sternberg Clinic of Pilonidal Surgery. Please note, that except where indicated, patients are photographed lying on their stomachs with their buttocks in view.  So the left side of the photo represents the left side of the patient.

This photo demonstrates the natal cleft and how it is hidden from view when one is standing.  This photo shows a pilonidal sufferer standing.  The verical black lines mark the line of skin contact of both buttock cheeks.  The horizontal line serves a reference to the horizon and is marked as the lowest part of the buttock exposed when a patient sits on a chair.

Please note how the natal cleft is completely hidden and there is not sign that the patient has a chronic pilonidal problem.

In this photo the patient’s buttock cheeks are spread apart to reveal a deep cleft or valley.  The shaded area is the natal cleft.  Multiple dilated midline pits and a sinus draining to the top right (better seen in other, non-shaded photos below) are revealed.

Here is a classic example of very symptomatic, primary pilonidal disease. This patient, a male in his early 20s, has developed several large dilated midline pits (previously infected hair follicles) and a draining sinus off to the upper portion of his natal cleft.

These photos show a patient who has suffered for 6 years with pilonidal disease. He has undergone 3 operations by other surgeons, all of which have broken down resulting in a much worse pilonidal problem.

Dr. Sternberg performed a cleft lift procedure and he rapidly recovered. The post-op photo was taken only 3 weeks after surgery. For the first time in years, he was able to return to athletics.

Here is an example of college student who has suffered from pilonidal disease since mid high school.

He had 3 previous operations from other surgeons, all of which failed. You can see that he developed a huge chronic open wound very close to the anus. His natal cleft is very scarred from the prior operations, which involved a wide excision and midline closure.

Dr. Sternberg performed a cleft lift procedure. He ends up with an excellent post-op result.

This photo demonstrates the island of skin that is typically removed during a the cleft lift procedure (outlined on the right).

Here is a photo of the debris and hair commonly removed from the chronic abscess of a chronic pilonidal sufferer at the time of cleft lift surgery.

This is an excellent demonstration a pilonidal sinus.  Here it’s demonstrated that the hole closest to the anus connects to the top draining sinus hole.  It is why operations that don’t address this lowest hole will result in failure and a recurrent abscess/sinus.

This is a 21 year old who has suffered from pilonidal disease for 6 years.  Another surgeon performed two wide excisional operations, both of which have failed.  He was left with a complex pilonidal wound with a number of midline openings, the largest of which was close to the anus.  Photo 3 demonstrates the outline of the island of skin on the left side, which will be eventually removed during the procedure.  Photo 4 shows that the lowest opening connects through a long abscess cavity to the top draining sinus.  In photo 5, the skin island has been removed and the abscess is revealed.  It is filled with hair.  That hair and debris has been removed in photo 6.  The white abscess cavity wall is preserved and used in the wound closure.  The last two photos show the immediate final result with the drain in place. I’m now using a different type of drain called a closed suction drain that is shown in some of the photos below.

Here’s an immediate post-op photo of a patient with steri-strips and drain in place. This is the drain configuration that I use now. The drain comes through the lower portion of the skin incision and passes through a skin opening that I create near the top of the flap. The drain is a loop and can be rotated. I’m now using a different type of drain called a closed suction drain that is shown in the photos to follow.

Here is a 19-year-old patient from Canada, who underwent a wide excisional operation 9 months ago. The wound never healed and has enlarged over time. He has been unable to sit much or participate in athletics and had to take a year off school for wound care. He had a successful cleft lift and is already back to participating in sports and school again.

Here is a patient who presented with a huge primary pilonidal wound (never has had surgery). You can see the extent of the mobilization required to repair this problem. The Cleft Lift result is shown.

This is a patient who underwent a wide excisional operation for his symptomatic pilonidal disease in Texas.  The incision was closed in the midline.  The wound opened up and the resulting 2wounds never healed.  The lower wound connects to the upper wound under the surface.  It’s a recurrent sinus.  He underwent a cleft lift procedure and 1 month later is back to all of his usual activities.

Immediately after surgery
One month post-op
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Meet Your Surgeon, Dr. Jeffrey Sternberg

After many years performing major abdominal operations including open and laparoscopic resections for colon cancer, rectal cancer, Crohn’s disease, and Ulcerative colitis, I have chosen to concentrate my efforts in a few highly specialized areas of surgery where I feel I can make the greatest positive impact on patients.

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To learn more about treating your Pilonidal Disease with surgery and the Cleft Lift procedure, contact our office staff for information or to schedule an appointment.

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Member of ASCRS, Crohn’s & Colitis Foundation,
American College of Surgeons, and Pilonidal Support Alliance