Pilonidal disease is an acquired infectious disorder of the gluteal cleft skin. Pathogenesis is observed in traumatized dilated follicles along the midline crease [1],[2]. Surgical treatment is standard in chronic pilonidal disease including open excision with secondary wound healing or excision with primary closure with or without the use of a flap [3],[4]. Modified Bascom cleft lift technique is an option for primary closure with superior approach with regard to long-term recurrence rate [5]. Video 1 is to demonstrate the modified Bascom cleft lift technique in the treatment of recurrent pilonidal disease.

A 29-year-old male patient with a recurrent pilonidal disease after a previous submission to an open excision with secondary wound healing. Video 1 shows the modified cleft lift Bascom technique which consists of excision of the fistulous orifices, followed by primary closure outside the midline with advancement of a flap. The patient had three orifices including one near by the anal margin. Procedure had no intraoperative complications. After one week of postoperative period, the patient presented a wound dehiscence (1.0 cm) of the lower segment, involving only the epidermis and dermis requiring no treatment. There was complete wound healing after nine weeks from the procedure. No recurrence was observed within one year of follow-up period. The case report was previously approved by the hospital’s research ethics committee, and the participant gave his informed consent.

The principles for treatment of the primary and persistent disease are similar, requiring eradication of the sinus tract; complete healing of the overlying skin and prevention of new recurrence [3],[6]. Moreover, there is no consensus about the best surgical technique for the treatment of chronic pilonidal disease, as well as a primary or failed disease [3],[5],[6]. There are different types of procedures for pilonidal disease and according to the surgeon’s experience, characteristics of the patient and the recurrent pilonidal diseases; the most appropriate technique is chosen [3],[6]. Some techniques of flap reconstruction have been used in the treatment of failed/recurrent pilonidal disease with flap [1],[2],[5],[7],[8]. Studies have demonstrated excellent results (96.1% healed after one cleft lift) using the modified Bascom cleft lift procedure. The most common complication is a 2–3 mm separation of the lower portion of the wound, which involved the epidermis and dermis, and required no treatment other than having the patient keep it clean and dry [7],[8].

The modified Bascom technique with primary closure and advancement flap for the treatment of complex pilonidal disease showed effective for this case of recurrent pilonidal disease and the patient returned his activities in nine weeks.